HIM 660 Module 2 Environmental Analysis Short Paper Example

What Surrounds the Record Room: An Environmental Analysis of Health Information Management at Kanawha Ridge Health

[Student Name]

Southern New Hampshire University

HIM 660: HIM Strategic Planning and Financial Management

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

What Surrounds the Record Room: An Environmental Analysis of Health Information Management at Kanawha Ridge Health

A strategy that ignores its environment is a wish list. Before Kanawha Ridge Health's health information department sets goals, it needs a clear view of the forces outside it, in payment, labor, technology and the population it serves, and of its own strengths and weaknesses. The department supports a composite system of one 260-bed regional hospital and one 70-bed community hospital in the Kanawha Valley, with 61 staff, most of them coders and release-of-information specialists working remotely. This paper examines the external and internal environment and sorts what it finds into strengths, weaknesses, opportunities and threats. It closes with the strategic questions the department's plan must answer.

External Forces: Payment

The way the system is paid is changing slowly but in one direction. Federal officials set targets in 2015 to tie most Medicare fee-for-service payments to quality or value and to move a growing share into alternative payment models such as accountable care organizations and bundled payments (Burwell, 2015). For HIM, this means that documentation and coding now affect more than the claim. Diagnosis codes feed risk adjustment, quality measures and shared savings calculations, so an incomplete record can cost the system both on the claim and in a later reconciliation. Kanawha Ridge's regional hospital joined a Medicare accountable care organization two years ago, which makes complete capture of chronic conditions a financial matter as well as a clinical one.

Payer mix adds pressure. Medicaid covers roughly a quarter of the system's discharges, a higher share than in most states, and Medicaid generally pays less than the cost of care. Thin margins leave little room for revenue lost to denials or delays, which raises the value of every day the department removes from the billing cycle.

External Forces: Labor and Technology

The coding labor market is tight. Federal labor projections expect continued demand for medical records specialists across the decade (U.S. Bureau of Labor Statistics, 2025), and remote work has turned local hiring into a national competition. Kanawha Ridge now competes for experienced inpatient coders with large systems and vendors in other states that can pay more. When positions sit vacant, the department fills the gap with contract coders at a much higher hourly cost.

Technology offers part of an answer. Campbell and Giadresco (2020) reviewed 38 studies of computer-assisted coding and found that it can improve accuracy and quality by catching details that manual coding misses, while warning that the shift requires deliberate change management because it reshapes coders' roles toward editing and analysis. The system's current encoder vendor offers such a module, but the department has not evaluated it, and the change would require training and workflow redesign before any savings appear.

External Forces: Regulation and Community

Two federal rules touch the department directly. Federal information blocking rules, written under the Cures Act of 2016, expect electronic health information to reach patients and other requesters without unreasonable delay, so release of information is judged on speed as well as accuracy. Hospital price transparency rules require public files of standard charges, which draws attention to how services are coded and grouped. Neither rule is new, but both raise the cost of sloppy or slow work.

The community matters as well. The Kanawha Valley's population is older than the national average and carries a heavy burden of chronic disease, which means more complex inpatient stays, more conditions to document and more patients whose care is paid by public programs. Complex patients are exactly where incomplete documentation costs the most, both in payment and in the accuracy of quality data the system reports.

Internal Environment

Inside the department, the measures are mixed. Accounts wait an average of 6.8 days after discharge for final coding against a target of four, and about 12% of claims are denied on first submission. Coders report that many denials follow from documentation that does not support the diagnoses coded, a problem a clinical documentation improvement program would address, but the system has none. Vacancies in five coding positions have pushed contract spending well past budget.

There are real strengths as well. The remote coding team is experienced and loyal, with an average tenure of eleven years, and its accuracy on internal audits is high. Release of information was outsourced successfully three years ago. The department also has a good relationship with the revenue cycle director, who shares denial data monthly. These strengths matter because any strategy will depend on the people already in place.

SWOT Summary

Table 1 sorts the findings. The aim is not to list everything but to keep the items that should change what the department does.

Table 1. SWOT Analysis of the Health Information Department

Note. Compiled by the author from department reports, revenue cycle data and the sources cited.

Strategic Questions

The analysis points to three questions for the department's plan. First, how can the department shorten the wait for coding without depending permanently on expensive contract labor, whether by hiring remotely, retaining current staff or adopting computer-assisted coding? Second, should the department lead the creation of a documentation improvement program, given that denials and accountable care results both depend on documentation? Third, how should the department prepare for retirements among its most experienced coders? Each question links a weakness or threat to an opportunity, which is where a strategy is most likely to pay off.

Conclusion

Kanawha Ridge's health information department sits where payment, labor and technology meet. Its environment rewards complete documentation and fast, accurate coding at the same time that skilled coders are harder to keep. The SWOT shows that its strengths lie in its people and its weaknesses in process and staffing, and the plan that follows should be built around that contrast.

References

Burwell, S. M. (2015). Setting value-based payment goals: HHS efforts to improve U.S. health care. New England Journal of Medicine, 372(10), 897-899. https://doi.org/10.1056/NEJMp1500445

Campbell, S., & Giadresco, K. (2020). Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals. Health Information Management Journal, 49(1), 5-18. https://doi.org/10.1177/1833358319851305

U.S. Bureau of Labor Statistics. (2025). Medical records specialists. Occupational outlook handbook. https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm