IN THIS ISSUE
Winter 2013  
ICD-10
By Rob Culbert
As the year comes to a close, it is clear that ICD-10 will and has already begun to affect all aspects of the healthcare industry. No longer will coding be an isolated task within your billing office, but rather will become a group effort between providers, support staff, and coders to accurately account for the patient visit and level of care provided. In relation to healthcare reform, ICD-10 has become the largest, most cost consuming, and resource intensive government mandate to date. With the high stakes of reimbursement and compensation on the line, organizations are working vigorously to prepare for the October 1, 2014 deadline.
As your organization gets ready for this transition, take into consideration that ICD-10 also presents a great opportunity to evaluate and enhance workflows, policies, procedures, and even governance structures. We commonly see clients leveraging this large project to improve a variety of ICD-10 related business and clinical functions including patient access enhancement, clinical documentation and workflow, physician productivity and adoption, and business intelligence.
Time and resource constraints certainly play a role in terms of how broad or focused an organization’s ICD-10 program can be. At a minimum, healthcare organizations should identify opportunities for improving productivity and performance in all the operational areas impacted by ICD-10. If optimization activities cannot be included in the initial ICD-10 conversion plan, these initiatives can be prioritized and addressed post October 1, 2014.
The Importance of Patient Access in the Age of Healthcare Reform
By Johanna Epstein
Spotlight Article
Improving your organizations’ access to physicians and other healthcare extenders, i.e. physician assistants, nurse practitioners, healthcare coaches, and healthcare navigators has never been so important. Healthcare reform has created an environment where the patient is in control. More and more patients, as consumers of healthcare, can select and purchase their health plan of choice. If the patient is not satisfied, the patient, as a consumer, can simply “return” the plan for another one, like purchasing a pair of shoes. Further, healthcare organizations will be penalized for providing poor quality care and for achieving poor patient satisfaction scores. Physician reimbursement will be moving from a Fee for Service methodology to a Fee for Value based system. In this new era of Healthcare Reform, physicians will not earn more money for providing more ancillary tests. They will not earn more money for readmitting patients into the hospital. The key to financial viability will be the providers’ ability to focus on wellness, not illness and the overall patient experience from the time the patient schedules an appointment, to the ability for the patient to find a parking space, to the time the patient spends in the waiting room, to the time their bill for services is fully adjudicated.
While a patients’ clinical care is critical in the era of Healthcare Reform, it is just one component of the patients’ overall experience. More and more healthcare organizations are recognizing that a highly functional patient access process forms the basis for a high performing revenue cycle. Obtaining proper patient demographics and financial information and the subsequent verifying of insurance coverage and benefits has become an integral part of any effective patient access workflow. Obtaining proper authorizations from the insurance company for scheduled ancillary tests or procedures and the collection of any deductibles, co-insurances and co-payments either prior to the date of service or on the day of the visit are commonplace in today’s healthcare organizations. These pre-visit functions allow the billing office to quickly submit insurance claims correctly to the payer, reducing, if not eliminating rework by way of denied or delayed claims. It cannot be stressed enough: “the days of let’s just let the billing office correct the errors” is OVER.
Healthcare reform is patient-centric. All clinical and business related functions must be functioning at the highest level of efficiency and effectiveness in order for a system to be financially successful. Technology plays a very important role in ensuring that your healthcare organization will be competitive during these very challenging times. Robust, patient registration and scheduling systems with interactive patient portals, and direct interfaces to health insurers for benefits and eligibility information can remove the labor intensive manual effort that historically was required to perform these pre-visit functions. Using technology to send automated patient appointment reminders via phone, text and/or email is critical and eliminates the need for staff to make confirmation calls; often times being unable to reach patients during normal business hours. Patient portals that allow patients to pay for services rendered using encrypted payment processing technology will make paying for services easy and convenient for the patient and can eliminate the expense of sending out patient statements and manually posting payments upon receipt of payment. Website links to downloadable patient-friendly documentation for way-finding and accessing resources in the facility to online patient education regarding disease management, can create an environment where the patient feels in control of their care and will increase the likelihood of the patient returning to your facility and referring your facility to family and friends.
Your patients are becoming more and more educated regarding healthcare consumerism and choice. The marketplace is becoming more and more competitive. Organizations must invest in the people, the processes and the technology to assist them in developing the patient access solutions that will be best suited for their marketplace. Culbert Healthcare Solutions has a highly experienced team of healthcare professionals that can help you develop an approach to Patient Access that will stand the test of time.
Epic Meaningful Use Stage 2
By Tom Gantzer
CMS recently released the Meaningful Use Stage 2 criteria. Stage 2 will go into place for early demonstrators who have qualified as meaningful users for three consecutive years will begin Stage 2 in the fiscal year 2014. These are the ones who first qualified in 2011. They will have three years of Stage 1 prior to moving to Stage 2. For all others 2012 and forward the qualifications are two years on Stage 1 prior to moving to Stage 2. Stage 2 brings with it some new measures as well as some changes to existing measures. Stage 2 maintains the core and menu objectives framework from Stage 1. One new change for 2014 regardless of stage is all providers are required to report on a three month period however Medicare providers are required to report on a quarter rather than any three month period. Medicaid only providers can still report on any three month period.
A certified Electronic Health Record (EHR) must be used to qualify for any stage of Meaningful Use. EpicCare is a certified EMR that has been used successfully around the country to qualify for Stage 1 Meaningful Use. Epic has many tools that can help a provider qualify for Meaningful Use, both on the data entry side and the reporting side. The foundation system comes with a robust array of tools that allows a site to implement the meaningful user measures more relatively quickly compared to other alternatives. To report on Stage 1 Meaningful Use a site must be live on Epic’s 2008 code level or newer. To report on Stage 2 a site must be live on Epic’s 2010 code level or newer. This may mean more some an upgrade is needed to report on Stage 2. Epic has measures built into the software that require some small configuration to begin capturing Meaningful Use criteria. Epic also comes with reports to assist with reporting on the measures. The reports require a bit more configuration than the measures however they also allow for a lot of extra reporting for dashboards and other tools to allow status to be tracked on those reporting. This offers management the opportunity to follow up with a provider who might be falling behind. Epic also has guides published on their user web to offer assistance to all level of project staff. There are guides for measure configuration, project management, reporting, testing, and measure explanation. All of these assist with easing the implementation of Meaningful Use with Epic software.
Gap Analysis
Reviewing Stage 1 is an important step in preparing for Stage 2. Analyzing how successful reporting on Stage 1 went and what the organization’s lessons learned from Stage 1 will help prepare for Stage 2. Implementing Stage 2 Meaningful Use on Epic first requires a site be on Epic 2010 code level although with the changing measures and frequent levels the most recent code level is always best. By being on the most recent code level it limits the number of SU packages that will have to be installed back to your level of code from the most recent level. In some cases it may also require a work around of functionality is not able to be brought back to the older code level. Once on at least the 2010 code level one can begin to look at Stage 2 Reporting. The first step is to conduct a gap analysis between Stage 1 and Stage 2.
Stage 2 retains most of the measures from Stage 1 however some have been combined and a few have been eliminated. Most of the Stage 1 objectives are now Core objectives for Stage 2. The thresholds to meet these objectives have also been raised. MyChart also plays a much bigger role in Stage 2. Many of the changes to existing measure as well as requirements for new measures require MyChart. For sites minimally using MyChart this would be a good opportunity to do a comprehensive overview of MY Chart and it features to ensure you are maximizing what MyChart can do for your organization. To start with implementing Stage 2 the first part of the gap analysis is to look at your level of Epic code and make sure you have all the required SUs installed to support Stage 2. These SUs are key to ensuring you have the correct pieces in place to allow for data collection and reporting. After you verify the correct code is in place you need to begin to start looking at the measures changes between Stage 1 and Stage 2. Several configuration changes will need to be made on both the application side and the reporting side. All of these changes need to be identified and analyzed to understand the impact to your organization. Some of the changes may require workflow change to ensure the data is being input appropriately and some will just require some measure set up change. All the changes will require some reporting changes to some degree. New measures are also a part of Stage 2. To implement the new objectives they must first be analyzed to understand where the organization is in the workflow for the measure. Any gaps in workflow need to be outlined and addressed to ensure all data is being captured.
Reporting
A reporting strategy is important to successful Meaningful Use reporting. Epic delivers reporting tools and a guide to reporting with its software. It is good for each site to develop their own strategy on how they are going to use the reports once generated. It is good to have some monitoring tools in place as well. This will allow management the opportunity to address those who might not be doing what they should ahead of time or during a test run period. It is a good idea for sites to run reports for a period prior to their submission period to get a baseline on how they are doing. Reports can often be set to run for different dates and or providers or practices and measures. Most of the time these can be done with little additional work for the report writers.
Build
The build phase starts after decisions have been made on which measures tom implement. First you need to make sure that a build tracker is put in place to capture the progress of the measures and any key decision or issues that come up during the build process. Epic typically has these trackers on their website that serve as a starting point and typically are modified to meet each organization’s needs. Build typically starts by rolling out any pieces of build that serves as input points for capturing the data or any pieces that have workflow implications. It is good to get those moving first so that data is there when the measure build is put in place. The next step is to start configuring the measures and the groupers. In Stage 2 this requires changing build to various Stage 1 measures as well as turning on and configuring new measures. For some sites large amounts of build related to MyChart may be required. MyChart build plays a big role in Stage 2 as MyChart plays a much bigger role in Stage 2 than it did in Stage 1. For organizations with advanced build already rolled out for MyChart some modifications will still be required to allow for adequate reporting.
After the application build is complete some basic unit testing can be done to ensure the data is being captured and groupers populated. Then the reporting piece can be configured. Much of the reporting piece will need to be changed due to the change in measures for Stage 2. Additionally new reports will need to be written for the new measures, dashboards updated etc. New clarity tables may also need to be added. This will require some time from the report writers to organize test and
Testing
Testing is an important part of the process. Basic unit testing can be done to ensure a grouper is populated or a report is pulling in stage environment. A good strategy once unit testing is done is to either run reports out of your shadow environment or a recent copy of your production environment. This will give you an idea what if anything is not working or is completely broken and build needs to be adjusted either on the application side or the reporting side. One successful strategy is also to run reports out of production to finally verify everything for a period of time prior to your reporting period. This give you a chance to review and make any necessary build or wok flow changes as well as address any staff issues prior to your reporting period.
How Can Culbert Help?
Culbert can help in all phases of Stage 2 Meaningful Use implementation. Our experienced consultants have experience with every phase. Our approach is to first assess the situation through a comprehensive review of the Stage 1 process to understand how successful that was for an organization or to outline any gaps. We also take a look at the measure build and do a gap analysis between Stage 1 build and Stage 2 build. We have a deep understanding of MyChart and the changes that need to be made for Stage 2. We will conduct a complete review of MyChart build to analyze any gaps that need to be filled for Stage 2. We can provide a roadmap on where an organization is and what needs done to achieve successful Stage 2 reporting. We can develop detailed project plans to outline what needs to be built and tested to meet timelines. We also have the expertise to help with the build process as well. We partner with the sites staff to share our knowledge and help complete the build and testing process. Our staff has in depth knowledge of the Epic system and the Meaningful Use process. We have built measures and developed report for many organizations which allows us to come on site and quickly develop and execute a plan. After the build is in place we remain a partner with our clients to ensure that thing are going well and help with any changes that an organization wishes to make after the initial build phase. All of these lead to a successful partnership and successful Stage 2 Meaningful Use reporting.
Allscripts and ICD-10
By Mike Ochlan
As many healthcare organizations move to the ICD-10 compliant version of Allscripts V11.4.1, the main focus is getting through the problem mapping tool (PMT) which typically takes 6 - 10 weeks to complete. Clients are responsible for this portion of the upgrade as the vendor takes a limited role. Clients will need to complete 80% of the patient problem mapping and 90% of all charge diagnosis mapping before they are scheduled for the actual upgrade. The mapping of the ICD-10 is not solely an IT project but an organizational issue since this affects all aspects of your organization, clinical, reporting, billing, research and compliance. Therefore, all parties need to take an active role in the mapping; IT should only provide the tools for the conversion and work with those that will be tasked with the actual mapping. Some ICD-9 codes can be easily mapped to one ICD-10 code; however other codes will require additional information for mapping to the appropriate ICD-10 code. ICD-10 codes are based on 7 characters, which are broken down in the following manner:
  • Characters 1-3 represents the disease category
  • Character 4 represents disease etiology
  • Character 5 represents the body part affected
  • Character 6 represent the severity of illness
  • Character 7 represents placeholder for extension of code to increase specificity.
Once the recommended mapping thresholds have been met, Allscripts will schedule the upgrade to v11.4.1. The tool does not map Quicksets or Keywords (problems) these require manual mappings. Once the mapping has been completed and v11.4.1 is live, you are ready for the transition to ICD-10. Wait! Not so fast!
CMS recommends 18 months to prepare for ICD-10, systems maybe ICD-10 compliant however is your staff preparing for the looming deadline? Education at your organization should have already begun or should be scheduled to begin in the near future, attempting to train staff right before the deadline is not best practice and will likely lead to anxiety and confusion . Training within your organization should have begun or will be within the next month, especially for clinical staff. The training sessions should begin with a high level overview, sessions should be well organized and to the point. The sessions should be relevant to your audience if you presenting to a specialty group make sure the codes are specific for that group, so the staff can envision the changes coming down the road. Provide staff with online resources or mobile apps so they can have the information readily accessible to them.
Coders should begin attending ICD-10 classes sponsored by organizations like AHMIA with the goal to become ICD-10 certified. The new coding system is complex and without proper training will affect organizations bottom line more so than organizations that have already started this process.
In addition to ICD-10 Training, your documentation within Allscripts will need to be reviewed to support the inherit specificity within the new codes. This process should be in place or should be in the planning stages to begin the review of your structured notes to include the documentation required supporting the new specificity. This should not translate into mountains of work since these items should be already included in your notes for quality measures. Providers do not need to understand the details of the new coding structure they just need to understand why it’s important for complete and proper documentation along with the use of problem lists within Allscripts.
An example is: 822.00 - Patella Facture Closed the ICD-10 is S82.025A – Non displaced longitudinal fracture of left patella, initial encounter for closed fracture.
You will need to make sure the documentation will provide the location, body part affected, type of fracture and the type of visit.
Incomplete documentation due to not updating your notes will cripple a provider or organization’s ability to assign ICD-10 codes. As a result this could see an impact to your revenue cycle with potential delays in reimbursement to complete the charge processes from Allscripts. Improper documentation can also delay ordered services, delay scheduling and registration processes, overall coding processes, and increased volume of queries to the ordering physicians.
Interfaces between labs, radiology, HIE’s, and billing systems (Charge) will need to be thoroughly tested to ensure that internal and external systems can accept ICD-10 codes from Allscripts and that it can file codes from external systems. Additional reporting that’s diagnosed based will need to be updated to reflect the new coding standards.
The problem mapping tool is just one of many steps, albeit a large one towards your transition to ICD-10, and it’s vital that the mapping is done correctly. It’s imperative that all parties are involved in this step, Providers, Coders (billing) and Compliance in order to ensure that the mapping is accurate. Take your time in this process.
What’s New with ETM Workflows?
By Jan Bargman
Enterprise Task Manager (ETM) began its life as an application to assist clients with accounts receivable follow up efforts within the BAR functions. As ETM evolved, it became an application that could address the front-end edits through integration with TES. The continuing evolution integrates ETM with other billing and collection processes and has become a solution that can address the entire revenue cycle – not just the post claims processing stage.
What’s new with ETM? In early versions of ETM, the starting workflow package included: BAR workflows for Insurance Followup, Rejections Followup, Self-Pay Followup and Claim Edits. Underpayments were offered, but without Payer Contract Module, were not very useful. The next workflow that GE came out with was TES edit workflows.
The Transaction Editing System (TES) Workflow was introduced with v5.0 and creates tasks from the edits you choose to work in ETM. Transaction-level tasks show all edits for the transaction listed in the Preview and Instruction panes. Transaction edit tasks show each edit as an individual task unless you use the roll up functionality for identical dictionary field edits or all registration/insurance edits for the same patient into a single task. The rollup functionality can streamline the working of TES edits and reduce system overhead when the old TES workfiles required nightly compiles.
The newest additions are workflow enhancements that support EDI functions. Eligibility workflows help identify response types and route them to ETM views to work. ETM status is used to tell whether the request is sent or the response received. EDI claim status is now part of the BAR insurance followup flows and provide claim acknowledgements and status updates. Additional BAR workflows include Prepayment Allocations, Credit Card/Recurring Payments for patients on budget plans, and Self-Pay Statement Edits. The Underpayments module is integrated with the Payer Contract Module (PCM) to make it a more effective tool.
Prepayment Allocations is useful in organizations or areas that have prepaid services like OB, elective surgery or patients who have high-deductible insurance plans that require prepayments. Prepayments are matched with the charges that are entered to insure patient satisfaction by not billing them for services that were prepaid.
If you use the Credit Card/Payment Authorization module with BAR, an organization can set up recurring payments on a credit card or an automated clearing house (ACH) account with the permission of a patient on a budget plan.
You can direct all or a subset of BAR statement edits detected during a statement run to ETM as tasks. Views are set up to work the edits rather than work from a statement edit report. Custom or standard GE edits can be routed to ETM tasks and worked from the task list.
As more customers implemented visit management (VM), GE developed VM workflows for placing holds on claims that were missing key billing information such as diagnosis or medical record attachments. For customers with HPA/CBO, hold bills/alerts prevent a claim from being queued for printing. For customers with VM, but not HPA/CBO, hold bills/alerts serve as alerts only. They do not hold the bill in the billing system, but instead alert staff that information is needed to properly bill the visit.
The workflows for bundled care, Bundled Care Manager (BCM) offer customers the ability to manage an episode of care which is defined by payer agreements as the package of services needed for treatment of a condition or illness.
ETM has also expanded into workflows for EDM, MCA and Financial Assistance. EDM workflows support processing of payment posting from explanation of benefits (EOB) batches and insurance verification from scanned insurance cards through the building of tasks as documents are scanned. Features of the EDM workflow can also be used for claim edit processing. The ability to lookup the scanned insurance card through the EDM preview can speed up the time for resolving claim edits.
MCA workflows are available for use with case management in the Managed Care Application. The benefits are reduction in time spent trying to identify patients who require case management due to certain clinical categories or high dollar or high volume visits. ETM Watchpoints allow management of changes that occur in terms of vendor contracts, enrollment contracts and coverage plans that may result in claims that need to be reprocessed. This is done through the Retroactive Claims Adjustment workflow. Claims departments can manage claims via the Managed Care Application (MCA) Claims workflow for ETM. This workflow mirrors the functionality available via the Claims Queue Manager (CQM) in MCA Function 27.
Financial Assistance workflows allow tracking and working applications for financial assistance or charity. Agents in ETM can be employed to close financial applications through updating the status if certain conditions are found.
ETM continues to grow and develop innovative ways to streamline billing and collections. Eligibility workflows open the door to front-end processes that can be used in a centralized scheduling/registration department or at patient check-in. Through the routing of tasks to the proper place at the appropriate time, combined with providing the tools needed to work the task, ETM could expand into other areas of the healthcare continuum.
Epic’s Dashboard Utility
By Joe Borzilleri
One of the great things about Epic’s reporting capabilities, be it through Clarity or through Reporting Workbench, is that there are so many different reports available for a user to choose from. For the most part, if a report does not already exis , it is possible to completely create it from scratch.
Conversely, one of the worst things about Epic’s reporting capabilities is that there are so many different reports available for a user to choose from. Were you to take a look at the reporting library for any organization that has been up on Epic for a good length of time, you’ll quickly see that there are hundreds, and maybe in some cases thousands, of reports sitting in the library. It can quickly become overwhelming.
Fortunately, Epic offers a dashboard utility that allows users to see, process, and use only those reports that are important to their immediate workflows and needs. This utility is extremely flexible and can be refreshed quickly and painlessly to see the most up-to-date data available.
The core functionality of the dashboard utility is the dashboard component. These components appear as individual boxes on the user’s dashboard page and are generally used to group together reports and activities that are similar in nature. For example, an OR Manager might have one component on the dashboard called Case Statistics that looks at all the reports relating to OR Case Statistics, one component called Case Volume that looks at all the volume reports, and yet another called Utilization that looks at all the room and block utilization reports.
This is advantageous because it is possible to configure the dashboard so that it is the first thing a user sees when they log into Epic. Additionally, while dashboards allow for links to Clarity reports, you can link directly to summary data from Reporting Workbench within the dashboard so that you have real-time data at your fingertips.
Finally, dashboards allow you to link directly to activities you might need in your daily workflow. For example, one component on an OR Manager’s dashboard might link out to the Master Daily Schedule, ORs At a Glance, and the Case Depot.
Because the dashboard offers so much functionality and flexibility, it’s truly one of the best tools available for management. It allows them to get at the data they need without having to sift through all of the extraneous information available in the library. Whatever information they need is truly at their fingertips. The activities functionality also makes it a great tool for many other end users to use, such as lab techs and OR Schedulers. Links to Specimen Receiving, ORs At a Glance, and other essential activities can be built into their dashboard so that they can access it during the course of their normal workflow without having the disconnect of maneuvering around through the system.
Utilizing Epic’s Overdue Results Routing Functionality as a Quality Assurance Tool
Culbert’s Epic Practice
Electronic Medical Records
Electronic health records or EHRs, have all but become the standard for clinical documentation and record keeping in hospitals and physician offices throughout the United States and abroad.1 EMRs or EHRs (electronic health records) have been developed to assist administrators and clinicians in healthcare to meet specific goals, objectives and regulatory requirements. EMRs certified by The Certification Commission for Health Information Technology (CCHIT®)2 are recommended for use by healthcare organizations.
Quality Assurance
Quality assurance is an importance aspect in healthcare3. For example, hospital systems which may include physician offices, have been expected to put policies and procedures in place to make sure patient lab orders were followed by results in a timely manner. Data, collected and integrated via EMRs, now make adherence less difficult.
While using paper charts, providers have adopted workflows to ensure patients are notified when results have been returned to the office. The results were called or faxed in and initialed by a nurse or medical secretary. The patient was called and the document was eventually placed in the patient’s chart. Electronic medical records have assisted with workflows by defining when the result arrives, who the result belongs to and where the result should go.
Epic Systems
Epic Systems5 is a fully integrated EMR used by over two hundred4 hospital and health systems. Epic contains several modules, ranging from Inpatient (ClinDoc/Orders) and Ambulatory (EpicCare) to Revenue Cycle (Hospital and Professional Billing), with everything in between!
Overdue Results in Epic
As mentioned earlier, quality assurance in healthcare can be enhanced by the use of EMRs. The Epic Ambulatory module, also known as EpicCare, is equipped with tools that enable results to appear in an “In Basket” after a period of time.
The Scenario
The provider places the order for a patient in EpicCare. Dr. Jones orders a Hemoglobin A1C lab test for a patient with diabetes mellitus. He wants the patient to get the test completed within the next 14 days. The order is sent through an HL7 interface to the receiving lab system. The patient is now responsible for visiting the lab and having his blood drawn and analyzed within the next two weeks.
The Workflow
How will the results return? If the patient visits the lab within the 14 days, Dr. Jones will receive the results in his In Basket. The results will also appear under the “Labs” tab in Chart Review. However, if the patient fails to have the order fulfilled at the lab and NO results are returned within a designated period of time, Epic will send an In Basket message. All of this can be configured in Epic based on various settings.
The Build
The foundation for Epic’s build is hierarchical. The Overdue Results build is at the System Definitions level. The settings at the “System” level guide end-user workflows. Prior to beginning the build for the Overdue Results workflow, it is recommended to meet with the lab administrators, providers and clinicians governing the ambulatory clinics for decisions regarding the accepted best practices for lab results.
Build Part 1
Enter the System Definitions by accessing Clinical Administration and do the following: (ClinAdm)1-Management Options4-Edit System Definitions12-Lab, Result. Page down fourteen times to get to the Overdue Results screen (see below):
An explanation of the fields are as follows:
  • The order type will be matched with the order class and days entered by tabbing across the columns. The three prompts work together to define the number of days that can elapse before overdue results messages are sent for certain orders in certain classes. Overdue results messages are sent to the authorizing provider.
  • An overdue results routing scheme allows the organization to set up rules that describe who should receive the overdue results message under various conditions. The scheme is usually set at the provider (SER) or department (DEP) level.
  • Create overdue results messages for open orders is used to either enable or disable messages for overdue results. If the organization is not ready to utilize the overdue results functionality, adding “Never” will prevent all schemes from working. Conversely, placing “Always” will create overdue messages for all open orders. Future will create overdue messages for standing orders only.
  • Send future orders based on expiration date will send overdue results messages for future orders based on the expiration date instead of the order's expected date.
Build Part 2
The next step in the build is to specify a “scheme” or instructions so the system knows where to send the overdue results message after the number of days entered in Build Part 1. The workflow would indicate the nurse would most likely be the clinician following up with the patient about whether they had blood drawn or not. So, the overdue results scheme will be sent to a pool that is accessible to all of the nurses in the office.
Build Part 3
After the scheme has been created, it can be added at the following levels: procedure category level, procedure level, provider, department or system definitions level. Each level, starting with the procedure category level, becomes less specific as it moves to the system definitions level.
For example, if the scheme is placed at the “System Definition Level”, all overdue messages for every patient across the organization will follow that scheme; the scheme placed there will take precedent. The Model Overdue Results created for Build Part 3, however, has been placed at the department level. Therefore, all Dr. Jones’ patients will be covered by this scheme.
The Build and the Scenario
The goal of the build for the overdue results message functionality is to make sure someone at the provider’s office knows the patient hasn’t followed through with the physician’s order (a lab draw) since their last visit.
Up to this point, the build has been put in place, in Epic, to do just that – let the nurse know that the patient has not been to the lab to have the hemoglobin A1c drawn. How does she know? According to our set-up:
  • Time has elapsed - For a Lab with an Order Class of Normal, if the order is Open, send an overdue message to the pool attached to the Overdue Routing Scheme
    • For the HbA1c that is Open (because it has not been drawn/reconciled by the Lab), send a message to Nurse Pool in Dr. Jones’ Department
The nurse will see the message from the In Basket and begin the process to contact the patient to follow up as to his/her needs regarding making sure the lab test is done. The clinical downside of not doing so for a diabetic patient can be devastating physically. The call and follow up are critical.
The nurse will document her communication with the patient in Epic using other tools available and be able to aptly share it all with the physician.
The patient was successfully reminded to get lab work done; adjustments to medication or diet could be put in place by his/her providers and well-being overall has been improved.
EMRs are only tools to assist what clinicians do every day to care for one patient at a time. The build and workflow outlined are merely a very small part of a much larger piece of an integrated system used by many across the country. Using it to help keep patients well should always be the ultimate goal. Remember, there can never be a substitute for using clinical judgment.
References
1. www.healthcareitnews.com
2. www.cchit.org
3. www.ahrq.gov
4. www.bloomberg.com
5. www.epic.com
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