Post on 02-Jan-2016
transcript
EMR: electronic medical recordAn electronic medical record for a patient at a
particular site, providing such functionalities as e-prescribing, order/results management, work-flow tasking, communication and messaging
An EMR is NOT a paper record made electronic
EHR: electronic health recordThe sum of a patient’s EMRs and other health-
related information from multiple sites CCR: Continuity of Care Record
Electronic core data set about a patient’s health-care status and treatment, current and historical
Patient safety Quality improvement Rising healthcare costs Competitiveness Evolution not only toward electronic
medical record but also to computer-guided and -supported healthcare
Consumer-driven care (participatory health) Internet resources Personal health records
More timely, accurate, complete patient information No longer practicing
blindly Point of care access to,
capture of, transmission of patient information
Real-time, remote access Improved patient
care Improved patient
safety Improved
outcomes
Reduced costs of healthcare Reduced wasteful
duplication Improved efficiency Financial squeeze on
physicians Reduced hassles Improved quality
of life For yourselves For patients
Office workflow: Who does what, how, when, where, why?
Current practice management system? Information capture preferences? Staffing: Adequate? Ready? Colleagues: Supportive? Ready? Financial planning and expectations Realistic timeline What do you want/need from an EMR? What features do you want? What barriers do you face?
Increased revenues Improved reimbursement Increased patient volume Increased charge capture Decreased accounts
receivable days Increased net collection
rate Decreased denied claims Improved E&M compliance New business opportunities,
clinical trials, data Improved competitiveness
Improved quality of careImproved patient
satisfaction
Decreased costs Reduced chart filing
costs Reduced transcription
costs Decreased telephone
calls, faxes from pharmacy
Increased efficiencies, decreased hassles
Improved quality of life
Improved provider satisfaction
Improved staff satisfaction
Less time after hours
Clinical documentationOptionsManagementScanningCCR
Clinical and administrative workflow tasking
ePrescribingDrug interactionFormulary mgmtRefills
Referrals Order entry Results management
AbnormalsTrends/graphs
Summary listsProblemsAllergiesMedications
Health maintenance reminders
Charge capture & codingMedical necessityAutomated codingE&M coding &
compliance Decision support Clinical practice
guidelines
Practice messaging InternalExternal
Population/disease management
Patient portals Patient data entry mHealth Participatory
health
Expense Selection difficulties Staff resistance Time & effort
required Incompatibility of
hardware/software Ease of use Security Lack of technical
expertise
Obsolescence Ease of integration Concerns about ROI Solutions not right for
you Lack of
demonstration site Data/chart
conversion Increase
documentation Other?
Templates with guideline prompts Flow sheets, tables, summaries, etc. as
decision aids Internal messaging and flags for
coordination, self-reminders, goal prompts
Personalized results letters or handouts for patient education
Lab interface for results reporting Advance scheduling for follow-up
Develop effective team communication Measure for improvement and
accountability Incorporate performance and outcome data Coordinate care and services across
settings Queries to identify patients needing specific
care leading to flags or outreach
Educate yourself and others on EMRsConferences, web, colleagues, experts, etc.
Prioritize goals and problems to solveNarrow potential vendors: Determine
Cost Features and functions Usability
Set-up vendor demosInclude physicians, staffDevelop scenariosSite visits to similar practices
Practice size designed for, installed in? IHN/hospital linked? ASP-based? Is system designed for and installed in
endocrinology practices? Costs? Functionalities? Usability?
What does pricing include?Hardware
Data center only Peripherals
SoftwareTemplatesCPT codesE-prescribingCCR integrationPHR integration
What recurring costs?Software/hardware
maintenanceUpfront or annual
license fees
What else? Interfaces and conversion
costs including mapping data fields
License fees One-time or annual
ImplementationTraining
Travel costsSupport and upgradesBackup: where and whenOther?
What isn’t included?
What modes of information capture does it offer?TranscriptionSpeech recognition: front-end, back-endKeyboard entryDigital pen and paperHandwriting recognitionPoint and clickPull-down menusTemplates, custom or standardHome monitoring devicesData entry by patientDirect from mobile devices (mDevices)HYBRIDS
Is system interoperable with Local hospital systems?Personal health records?Patient portals?Patient data entry systems? Other?
Different implementation paths for different practice sizes and specialties
Realistic timeframes Staff involvement Workflow changes Data conversion: scanning, CCR Support and maintenance Backups and recovery
Plan and test, plan and test Policies & procedures
Privacy, confidentiality, securityMedicolegal requirementsBackups and disaster recovery
Support and maintenance Modular or “Big Bang”
Have flexible timetables Appoint a project manager Assign responsibilities Modify schedules Start immediately following training Implementation never ends
Incorporates much greater specificity and clinical information, which results in:•Improved ability to measure health care services•Increased sensitivity when refining grouping and reimbursement methodologies•Enhanced ability to conduct public health surveillance•Decreased need to include supporting documentation with claims
Key issues include training courses, but equally ramping up to productivity standards and confidence Training programs will yield competence but not speed Need approach to building coding skills in live environment, not just
training courses Training courses abound (albeit they are getting full faster
today than in the past) Future needs to meet:
Coders will need to train in real environments with real notes/encounters and see where skill gaps exist
Multiple passes –at first getting comfortable with coding, then testing productivity. See where the gaps exist and retrain specifically.
Computer-assisted coding will greatly assist the transition Dual coding environment –specific notes, engine suggested codes,
coders code, after-the-fact analyses of generic versus specific codes Organization will want to be sure they understand revenue risk from
non-specific coding prior to 10-13.
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The Problem Physicians have learned how to
document at the detailed level over the last 20 years
More detailed information required to get to the most specific codes (e.g. laterality, body part, etc.)
Organizations have meaningful revenue risk with ICD-10 if documentation is not up to the new standard
No physicians want to worry about this now, but every physician will need to adapt
The Problem Physicians have learned how to
document at the detailed level over the last 20 years
More detailed information required to get to the most specific codes (e.g. laterality, body part, etc.)
Organizations have meaningful revenue risk with ICD-10 if documentation is not up to the new standard
No physicians want to worry about this now, but every physician will need to adapt
Needed approach Note-by-note and ICD-by-ICD
analysis of the specific changes each physician needs to make
Data-driven training with physicians – their documentation, their deficiencies, needed changes
“Small footprint” discussions over time—topic-by-topic rather than all-at-once. Aggregated plan between now and 2014
Follow-up data analysis to determine effect of training and to structure additional interactions
Value of training: Average doctor revenue X 20% risk = $120,000 – 200,000 per doctor.. How much spending to avoid the risk?
Needed approach Note-by-note and ICD-by-ICD
analysis of the specific changes each physician needs to make
Data-driven training with physicians – their documentation, their deficiencies, needed changes
“Small footprint” discussions over time—topic-by-topic rather than all-at-once. Aggregated plan between now and 2014
Follow-up data analysis to determine effect of training and to structure additional interactions
Value of training: Average doctor revenue X 20% risk = $120,000 – 200,000 per doctor.. How much spending to avoid the risk?
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Diagnosis Codes (ICD-9 to ICD-10-CM)Goes from 5 positions (first one
alphanumeric, others numeric) to 7 positions, all alphanumeric
From 13,000 existing codes to 68,000 existing codes
Much greater specificity
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Laterality (left, right)
Body part (e.g. bone in the hand)
Stage of disease (e.g. severity of pressure ulcer)
Injury (e.g. hit by baseball)
Episode of care (e.g. initial visit or followup)
Present evidence of what physicians do or do not document today
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Documentation of diagnoses and procedures
▫ Codes must be supported by medical documentation
▫ ICD-10-CM codes are more specific▫ Requires more documentation to support codes▫ Expect a 15% increase in documentation time
(per AAPC)▫ Revenue Impacts of specificity
▫ Denials▫ Additional Documentation
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Coverage and payment
New coding system will mean new coverage policies, new medical review edits, new reimbursement schedules
Changes will be made to accommodate increase specificity
May need to discuss changes with patients
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Contracts with plans
Coding more specific and includes severity Renegotiations will be based on new coding,
coverage, and reimbursement Difficult to measure what the changes will mean
to overall reimbursement
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Billing and eligibility transactions Updated transactions include support
for ICD-10 New codes mean more specificity How smooth the transition? Expect increased reject, denials, and
pends as both plans and providers get used to new codes
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