health erecords maintaining document quality and clarity with a certified ehr dale kivi, mba
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Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA. Presentation Overview. 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? - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA](https://reader036.vdocuments.mx/reader036/viewer/2022070406/5681405f550346895dabd4af/html5/thumbnails/1.jpg)
Health eRecordsMaintaining Document Quality
and Clarity with a Certified EHR
Dale Kivi, MBA
![Page 2: Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA](https://reader036.vdocuments.mx/reader036/viewer/2022070406/5681405f550346895dabd4af/html5/thumbnails/2.jpg)
• 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
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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.
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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%
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Eligibility for Meaningful Use Incentives
ONC Data Brief No 9: March 2013
44.4%Basic w/o clinical notesBasic with clinical notesComprehensive
16.9%
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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
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• 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
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• 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
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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.
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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
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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
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• 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
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• 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
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Health eRecordsMaintaining Document Quality
and Clarity with a Certified EHR
Dale Kivi, MBAFutureNet