Health eRecordsMaintaining Document Quality
and Clarity with a Certified EHR
Dale Kivi, MBA
• EHR Adoption Rates – what is the current national profile?
• EHR Adoption Realities – the good, the bad & the ugly.
• EHR Quality –what works, what doesn’t & why?
• The Blended EHR Approach – what is it & how does it work?
• Improving EHR Quality – practical steps for every platform.
Presentation Overview
ONC Data Brief No 9: March 2013
National EHR Adoption Rates
Basic EHR: Includes functions such as clinician notes.Certified EHR: Platform is certified for Meaningful Use.
ONC Data Brief No 9: March 2013
Certified EHR Adoption Rates
National Average: 44% Wisconsin: 63%Illinois: 49%Michigan: 56%Minnesota: 59%
South Dakota: 71%Rhode Island: 69%Colorado: 68%
New Hampshire: 21% New Mexico: 26%Kansas: 26%
Eligibility for Meaningful Use Incentives
ONC Data Brief No 9: March 2013
44.4%Basic w/o clinical notesBasic with clinical notesComprehensive
16.9%
EHR Adoption Realities:
The Good
The Bad
The Ugly
62 Federal regional centers assist with EHR adoption Hospital adoption rates have tripled since 2009December 2012 MU incentive payments hit $1.25B
17% of organizations already want to switch their EHR’s Documentation time increases mean fewer patient seenData capture increases lead to higher bills/rejects/auditsAuto alerts average 63/day and 30% of them are missed
Mounting pressure in congress to eliminate incentivesPatient count loss costing physicians up to $100K/yearStage 2 MU and ICD-10 are both scheduled for 20141,300 Vendors certified for Stage 1, only 100 for Stage 2
• Liability management through improved report consistency
• Improved charge trace-ability through automation & CAC
• Ease of analytics/quality reviews through if/then queries
• Greater control/efficiency for e-prescriptions, labs & CPOE
• Better inter-office messaging, data access & interoperability
• Easy to generate CIO & CFO spreadsheet Shangri-La
EHR Quality: What Works
• Increased physician documentation time leads to shortcuts
• Highly templated output can be viewed as cloned reports
• More content/less specificity impacts clarity & patient care
• Copy forward functions result in condition & billing errors
• In room documentation negatively effects patient experience
EHR Quality: What Doesn’t Work
Clinical Documentation Process Average Error Frequency Error OccurrenceTraditional Dictation/Transcription Technology 0.33 Per ReportBack-end Speech Recognition Technology 1.48 Per ReportEHR Procedure/Diagnosis Code Selection System 7.8 Per Chart
Document & Process Quality Depend On Communication Efficiency
Communications Method Words Per Minute WPM SpeedAverage mobile device “thumbing” speed 18 - 24 WPMAverage hand writing (copying) speed 23 WPMAverage hand writing (memorized text) speed 31 WPMAverage typing/keyboarding speed 40 WPMAverage speaking speed 105 WPMComprehensible listening speed 150-160 WPMAverage reading speed 250-300 WPMAverage speed-reading speed 600-800 WPMExpert speed-reading speed 2,000 WPM
Physicians dictate more than 2.5 times faster than they can type.
DiscreteData
StructuredData
MeaningfulUse
Narrative Reports
EHR Input
NLP• Diagnoses• Procedures• Heart Rate• Temperature• Height• Weight• Prescriptions + + + +
Data Imports• EHR Reports • Med lists• Problem lists• Allergies• Immunizations• Vital signs• Output to CAC + + + +
• Clinical decision support• Quality measures• Educate material triggers• Data exchange reporting + + + + +
• Lab results• Diagnostics• Medications + + + +
Blended EHR Workflow Approach
HIM Physicians Patients Coding & RCM Collections
Traditional Dictation /
Transcription
Familiar & stable process
Overwhelming preference
Personal & understandable
Labor intense with TAT risks
DNFB concerns
Pure EHR Point & Click
Accuracy & quality issues
Extremely time consuming
Very difficult to understand
Highly automated
Increased rejections
Blended Solution
(EHR + D/T)
Proactive risk management
Acceptable compromise
Reasonably understandable
Automated with QA checks
Minimized DNFB/rejects
EHR Impact on User Satisfaction
• Physician productivity is not hampered by EHR data entry
• Patient satisfaction improves with no in-room documentation
• Fewer claims rejected due to EHR copy/paste abuse
• Document clarity is ensured with traditional narrative
• Certified EHR data advantages & funding goals remain intact
• Addresses satisfaction issues for all process participants
Blended EHR Quality Advantages
• Monitor patient volumes & billed amounts to address change
• Minimize point & click time with blended approach if possible
• Incorporate supplemental dictation if NLP not available
• Turn off copy forward function to prevent billing errors
• Utilize documentation specialists for pre-signature QA
• Cost justify satisfaction issues for all process participants
Improving EHR Quality – Practical Actions
Health eRecordsMaintaining Document Quality
and Clarity with a Certified EHR
Dale Kivi, MBAFutureNet