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