navigating the gray areas: inpatient/outpatient hybrids
TRANSCRIPT
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NAVIGATING THE GRAY AREAS: INPATIENT/OUTPATIENT HYBRIDS
Session 250, March 8th, 2018
Andrea Hall, RN MHA and Christina Hiatt, BSN
Shawnee Mission Health
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Conflict of Interest
Andrea Hall RN, MHA
Christina Hiatt RN, BSN
Has no real or apparent conflicts of interest to report.
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Agenda
About Shawnee
Mission Health
Overview of our existing
solutions
Case studies
CHF clinic
Hand clinic
Pain ClinicFuture state
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Learning Objectives• Recognize there are clinics that do not fit in inpatient or outpatient
documentation platforms
• Formulate a process on which EHR is appropriate for identified hybrid clinics
• Describe how reimbursement drives EHR decision making
• Discuss the journey from paper documentation to electronic documentation for an offsite procedural area
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About Shawnee Mission Health
• Three facility locations including a 504-bed facility
• 20,000 inpatient admissions annually
• 200,000 outpatient admissions annually
• 2,900 associates and 700 physicians
• HIMSS Level 7
• More births than any facility in Metropolitan KC, 2nd in the state of Kansas
– Over 5,000 births in 2017
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AHS Headquarters
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2005 Cerner go-live
SurgiNet
Pathnet
RadNet
Pharmnet
2007 iConnect EMR
2009 Case Management
2011 CPOE
PowerNote
PowerChart Maternity with FetalLink
2012 HIE
mPPID
CareAware
PowerChart ECG
2013
CPA and Vitals Link
Capacity Management
Behavioral Health and ED Redesign
Surginet Anesthesia
ePrescribe
2014Clairvia
Tele-ICU
eQuality
2015ICD-10
Discharge mPage
tPPID
Rehab Optimization
Cerner Oncology
2016Biometric hand scanning
Physician Playbooks with mPage
bPPID and sPPID
iSynergy
2017mModal
Dynamic documentation
Physician Documentation Improvement
Logistics Center
Athena
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What is a hybrid clinic?
"We are moving from a hospital centric model to a patient centric model to a remote centric model. If we can intervene with patients on a continual basis, we will deliver a lot better care at a lower price.” Chris Van Gorder, Scripps Health
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Hospital Centric
• High acuity
• Frequent intervention
• Inpatient billing
Outpatient Centric
• Lower acuity
• Low intervention
• Outpatient Billing
Hybrid
Clinics
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Case Study #1: CHF Clinic
• New clinic created specifically to reduce readmissions and fill in gaps in care
• Incorporating quality measures including post discharge phone call, appointment within 7 days of discharge
• Located within the hospital- 4 rooms
• Clinic stats:
– Staffed by an employed nurse practitioner, nurse and an office coordinator
– Average 7-10 patients per day
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Gap Analysis
What is the patient flow?
Who needs to see the information?
How will billing and charging occur?
Frequency of procedures/infusions?
Role definition
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Solutions implemented• Utilized inpatient solution
• Two forms created- initial visit and follow up
• Provider alerting
• Report to see who presented to ED
• Consult made available for inpatients in order sets
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Current state
• 12 patients per day
• Preregistration done centrally with check in at clinic
• Referrals from cardiology offices as well as hospital
• Future: ED will be able to schedule urgent patients for next day
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CHF Readmissions
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0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Readmission Rate, % # of Readmissions Linear (Readmission Rate, %)
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Case Study #2: Hand Clinic
• Opened in 2012
• One board certified hand surgeon
• 5-10 patients a day predicted
• Specialize in carpal tunnel syndrome, lacerations, fractures, cut tendons, amputations, crush injuries and nerve compression syndromes
• Mix of recurring patients and single encounters
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Gap Analysis
What is the patient flow?
Who needs to see the information?
How will billing and charging occur?
Frequency of procedures/infusions?
Role definition
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Solutions Implemented
2012
Inpatient scheduling and charting
Determined what documentation would drop a facility charge
Provider billing done out of their office
2014
Therapy solution implemented for outpatient therapies
Inpatient scheduling remained
User access to inpatient EMR remained for record query
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Outcome/Current State
• Provider Clinic (15-20 patients in morning)
– One time visit patient’s have eval documented on paper
– Billing entered after visit in ReDoc
– Eval form scanned in real time
– MD charges from office
• Occupational therapy Clinic
– ReDoc documentation
– Charges auto drop in ReDoc
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Case Study #3: Pain Clinic
• Two existing locations looking to migrate from paper to an EHR
• Hospital managed with contracted anesthesia providers
• Facility charges and provider fees
• Desire for electronic from leadership- staff resistant
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Gap Analysis
What is the patient flow?
Who needs to see the information?
How will billing and charging occur?
Frequency of procedures/infusions?
Role definition
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Solutions implemented
• Decided to use inpatient EMR and began customization work
• Cross walked documentation of each paper form
• Created resource guide/classroom training
• Additions to existing electronic forms
• Prescription process- how are refills handled?
• Access to an HIE to see information from ambulatory
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Outcome/current state• Utilizing inpatient EMR
• Anticipate further transition of paper records
• Unable to find a good solution for visit summary form and follow up
• Ongoing project
• Will begin positive patient identification to match hospital initiatives
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Questions1. What should initially drive decision making when choosing an EHR for a hybrid clinic?
a. Reimbursement
b. Nurse choice
c. The newest system
d. Providers
2. Hybrid clinics do not answer to regulatory requirements on documentation. True or
false?
3. What is a hybrid clinic?
a. A hospital based clinic that does not operate the same as a true primary care
office
b. The doctors are hospital doctors and primary care doctor
c. A clinic with two different billing methods
d. No one knows
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Contact Us
Andrea Hall
Director of Clinical Informatics
Christina Hiatt
Clinical Informatics Education Specialist