1 Revised 02/6/13

ReDoc Implementation Guide

CHS Facilities

2 Revised 02/6/13

Table of Contents

Introduction ………………………………………………………………………………………………………… 3

Stages of Implementations ….………………………………………………………………………………. 4

Workflow Analysis ……………………………………………………………………………………………… 7

Interface Testing ………………………………………………………………………………………………. 7

User Training ……………………………………………………………………………………………………… 7

ReDoc University …………………………………………………………………………………….. 7

Signatures / Banners ……………………………………………………………………………….. 9

Scheduler ………………………………………………………………………………………………….. 9

ReDoc 360 ………………………………………………………………………………………………………….. 10

Appendix A: ReDoc Glossary ………………………………………………………………………………... 11

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INTRODUCTION

This guide provides helpful information to implement and successfully use ReDoc software. ReDoc will assist with efficient clinic management, compliance goals, documentation legibility, and time management. Software implementation is a team effort. The ReDoc team consists of a Project Manager, Interface Specialist, and Clinical Advisor. Together, they will work with the hospital and clinic team to ensure a successful and timely implementation. The information and checklists provided in this guide will help the implementation stay on track which will save time and effort. These key components are essential for a successful implementation:

Dedication of the Rehab Director in leading the rehabilitation staff in the adoption of ReDoc and support of the natural workflow changes that occur when integrating a new documentation system.

Appointment of an effective project manager at the facility with the leadership skills to manage details and communications, both internal and external, and to be the primary point of contact for the ReDoc implementation project. This could be the Rehabilitation Director or designated Power User

Support of the executive management and clinic directors by providing therapists time away from patient treatment responsibilities to participate in training sessions and to practice with ReDoc prior to go-live, and to acclimate to the new workflow and electronic documentation after go-live.

Consistent communication and teamwork between the ReDoc and clinic implementation teams, including immediate report to ReDoc of any issues post go-live.

A dedicated clinic IT resource to handle the technical details of software implementation. Hours required should be explored in initial discussions as this is dependent on current network, equipment, number of users, and number of sites.

Customization of the ReDoc application by each discipline according to the clinic’s best practices.

Selection of enthusiastic therapists as ReDoc Power Users. Power Users represent each discipline and assist with system set up.

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STAGES OF IMPLEMENTATION (overview of full project plan)

Pre-Installation

Project Kick Off Welcome Call (Rehab Director, IT Director, Network Specialist, Interface Specialist, HIM and Business office staff, if applicable) 1. Meeting with rehab leaders and IT/ IS leaders

Server (CHS server group, CHS PM, and local IT) 1. Review architecture with local IT and ReDoc 2. Configure connectivity for network and server access 3. Order and deploy workstations

Network (CHS Network Group and local IT) 1. Network connectivity check 2. Establish VPN or other method that allows ReDoc remote access 3. Validate performance of wireless infrastructure

Utilize Current CHS CDM (Rehab Director and hospital Business Office Director) 1. Verify hospital has current approved CDM for therapy

In order for ReDoc to work properly, the hardware must meet specific minimum technical requirements including the server, network, and workstations. This information is available at Minimum Hardware Requirements.

Install ReDoc, Modules, and Interface

Installation 1. ReDoc Integration Specialist remotely installs ReDoc applications on server. 2. Local IT deploys software to workstations. 3. Local IT and rehab staff test latency with a stopwatch comparing speeds with times on this document: Loading Times

Administrator Set Up 1. Administrator class (Sysadmin) with Rehab Director and ReDoc Clinical Advisor 2. Complete initial set up 3. Deactivate non-applicable items in Interventions tables in ReDoc 4. Select power users

Power User and Staff Remote Training/ Practice 1. Facility training of users on laptop or tablet functionality 2. All staff attend remote web training (refer to page 11 for ReDoc University) 3. All staff practice using ReDoc as schedule and leadership verifies 4. Feedback given to power users for table maintenance customization 5. Set up training scheduler and practice scheduling appointments 6. Training Tracking Tool to be completed, signed, and returned to CHS. CHS

Requirement

Build (Facility rehab staff) 1. Create electronic signature files 2. Create facility and generic banners 3. Power users customize table maintenance

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4. Set up production scheduler

Interface Set Up (ReDoc, local IT, and CHS Interface Group) 1. Determine and agree upon required interface configurations(ADT/ DFT ports and IP

addresses) 2. Determine facility codes 3. Schedule ReDoc Installation (inbound and outbound) 4. Configure interface filters and message types 5. Complete interface installation 6. Connect interfaces

Interface and Workflow Testing

Initial testing of ADT (patient demographic) registration and update messages

Make needed ADT interface adjustments as needed

Re-test ADT interface adjustments as needed

Approval of ADT interface

Initial testing of DFT (billing) messages

Make needed DFT interface adjustments as needed

Re-test DFT interface adjustments as needed

Approval of DFT interface

Interface testing sign off (CHS Requirement)

ReDoc receives completed Interface Testing Acceptance Form from customer

Go Live Process

Workstations and Confirmations 1. Confirm that all users workstations have been set up with ReDoc and have access to

appropriate printers 2. Testing workstations access to both training and production ReDoc icons on desktop 3. Testing workstations access to ReDoc share on server 4. Technical readiness checklist completed 5. Create shortcut to ReDoc export folder on the designated workstations

Software Confirmations 1. Confirm all therapists signatures and banners have been collected and saved in the

images folder in the ReDoc shared folder and appear on reports 2. Confirm all therapists have access to ReDoc and Scheduler with the appropriate

rights to ReDoc folders 3. ReDoc installs Links and Attachments Folders 4. Each therapist confirms that their signature is appearing on signed document

previews 5. Verify correct facility banners on reports 6. Sign and Return the Go Live Sign Off form

Transition To Production 1. Confirm that table maintenance has been completed in the training database as

future changes made in training will not show up in the production database

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2. Copy ReDoc interface and run transfer scripts to move facilities, tables, and users from training to production database. Practice patients will not be transferred. Scheduler training database will not be copied to production database.

3. Switch charges from real-time to batch. Charges were tested in real time, but in Production charges will be processed at 9 PM daily.

4. Confirm all signatures/ banners are in production images folder 5. Confirm all user log ins are active in ReDoc production and Scheduler production

Interface Connection in Production Database 1. Start ReDoc Interfaces in the production system and confirm connection

Using ReDoc for Actual Patients 1. Establish “partial go live” several days prior to everyone using the system. At the

partial go live, the interface will be activated, transfer scripts will be run from Training to Production database, and power users will start using ReDoc for their new patients.

2. ReDoc clinical advisor available onsite for support on “Go Live” day 3. Go live sign off 4. Go live documentation, scheduling, and charging in ReDoc 5. Install and deploy ReDoc Business Intelligence Suite for leaders

Post Go Live Process

Implementation team will remain engaged and be available for assistance

30 days after go live, facility will graduate from ReDoc implementation team to ReDoc support staff as the primary contact for assistance (technical and clinical)

ReDoc support contact information: 888-401-4400 Option 2 support@rehabdocumentation.com

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WORKFLOW ANALYSIS Understanding workflow is useful when transitioning from paper to an electronic environment. The questionnaire below will be used in the workflow analysis so that all will have a good understanding of current workflow. Projected future state will be completed after the Workflow visit by your Clinical Advisor. The Excel spreadsheet for you to fill in and return to your Clinical Advisor can be accessed here: Workflow Questionnaire

SOFTWARE INTERFACE TESTING CHECKLIST While therapists are learning how to use ReDoc, the technical team will work with the hospital IT staff to configure the ReDoc interface to the hospital’s information system. When complete, both teams will test registration (ADT), billing (DFT) transactions and Results (document flow to medical records storage system). These forms will be signed by the facility when the testing is complete. The editable forms can be accessed here: Test Scripts

ReDoc UNIVERSITY USER TRAINING A series of training courses are available via ReDoc University for all staff. ReDoc University consists of live web trainings and recorded training sessions. As a secondary resource, video tutorials and user guides are available within the ReDoc application Help menu. A training checklist is also available to ensure everyone attends the correct classes and practices what they learn.

Certain training elements won’t apply to CHS facilities. These are listed below. Please make sure all staff members are aware of these variances before and after training:

Diagnosis code numbers will not print on reports.

Billing modifiers will not be available. The billing office will add modifiers so there is no need to use a modifier. However, therapists will need to pay attention to the documentation reminders in a typical coding alert.

Social security numbers will not be available.

Administrators are not allowed to un-sign or delete notes after the charges have been transmitted to the financial system. The CHS Manual outlines the process to correct notes by using the Internal Communication Note in ReDoc

CHS has chosen to require these fields: Certification To/ From, Duration, Frequency/ Current Plan, Pain In/ Out, and Time In/ Out, and Functional Characteristics and Analysis (PT, ST)/ Skilled Analysis of Safety Deficits (OT). Abuse and Neglect Concerns will be charted in Rehab Info History/Status/Clinically Complex Situations (All Disciplines). The facility may choose additional fields that must be completed before a note is signed.

Refer to the CHS Processes Manual for more details. Access the ReDoc University website to view the class schedules and to register for a class, please visit: ReDoc University. Enter the course name in the Search bar to find available options.

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Note: All class times are scheduled in Central Time Zone. You can set your Preferences for your time zone the first time you register for a class. Each user will need to register with a unique email account in order to join the online training individually. A group may also look at the same computer during the training. The registration confirmation email sent after registering for the class allows that specific email account to join the meeting on the day of the class. Training Tracking Tool will need to be completed for each user. Once completed, send this spreadsheet to your ReDoc Clinical Advisor. The following courses are available:

SysAdmin: System set up intended for rehab director and conducted one on one with a Clinical Advisor. Please do not register for these classes in ReDoc University.

Power User (40 minutes): Intended for staff assigned as a power user. Power users will be responsible for managing and customizing table maintenance, adding physicians, and creating exercise protocols.

Clinical 1-Navigating Pt. Files/Starting a Treatment Cycle (30 minutes): Intended for ALL clinicians to demonstrate how to navigate the different screens, tabs, and toolbars of ReDoc as well as how to search for patients and access the patient files. Information in General Information will be included. This is part of a Clinical series and should be taken before Clinical I.

Clinical 2- Creating an IE - PT (45 minutes): Intended for physical therapists to introduce creating the initial evaluation.

Clinical 2 – Creating an IE - OT (45 minutes): Intended for occupational therapists to introduce creating the initial evaluation.

Clinical 2 - Creating an IE- SLP (45 minutes): Intended for speech therapists to introduce creating the initial evaluation.

Clinical 3 - Completing a Treatment Cycle (30 minutes): Designed for ALL clinicians to demonstrate how to complete a treatment cycle in ReDoc. Will discuss: progress notes, re-evaluation, missed visit report, worker comp report, supervisory report, internal communications, physicians communications, and the discharge summary.

Clinical 4 - Main Menu/ Exercise Protocols for PT/ OT (30 minutes): Intended to introduce the functionality and basics of the main menu, checking unsigned notes, and understanding protocols. *SLPs are encouraged to attend; however the exercise protocol section will not pertain to your discipline, and will be covered towards the end of the session.

Links & Attachments (L&A) (30 minutes): Intended for customers who will be utilizing L&A. Please talk to you your clinical advisor before registering for this class to determine if this will fit into your clinic’s workflow.

Scheduler SysAdmin (45 minutes): Intended for staff that will be setting up and customizing scheduler.

Scheduler Clinical (45 minutes): Intended for staff that will be scheduling patients and viewing schedules.

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ReDoc Best Practices (45 minutes): Intended to be taken after go live ReDoc. Recommended for directors and managers for helpful solutions for creating compliant and efficient documentation.

Front Desk/ Support Staff Class (45 minutes): Intended for all clerical staff to learn how to access ReDoc, navigate patient records, edit patient demographics, manage insurance information, and understand Reporting Options.

Recorded classes are available here. Click on the word Topic in the red header bar to sort classes alphabetically.

To watch a recorded class click View and enter the recording password: ReDocU (case

sensitive and no spaces).

*Once a class is completed, it is MANDATORY for users to practice and apply knowledge learned in the ReDoc Training Database*

Links For E-Sigs and Banners Report headers (banners) in ReDoc are customizable. The report banners and electronic signatures should be collected and customized prior to installation of ReDoc. To watch a video for instructions to install signatures please view: Esig Setup A form to help with formatting of signature images is here: ReSig Worksheet To watch a video for instruction to set up your report banner please view: Report Branding To create a ReDoc banner, use this form to communicate your preferences: Banner Request Form ReDoc Scheduler ReDoc Scheduler is an electronic scheduling application integrated with ReDoc Suite. Integration allows the sharing of patient demographic information. The Scheduler will be a replacement to the appointment book or application currently in use. Guides for the Scheduler: Scheduler SysAdmin and Clinical Use Guides.

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REDOC 360 Enterprise 360 Solutions is a package of consulting services and software. The 360 Business Intelligence Suite is a robust reporting tool for transparency into key performance indicators. Post go live the Clinical Advisor will help set definitions for Key Performance Indicators (KPIs). The 360 module will also assist with best practices for clinical workflow, productivity, and documentation. Four monthly calls will be established after the post-go live visit.

Phases of 360 Implementation 1. First Onsite Workflow Visit

Your Clinical Advisor (CA) will analyze clinical workflow as it relates to efficiency and how

well various departments are integrated and collaborating. This information will be used

during planning for the Implementation of ReDoc as it becomes a part and driving force for

new workflow. Any pre-go live metrics or Key Performance Indicators will be shared with

ReDoc and CHS Corporate at this time. Use ReDoc 360 Questionnaire. Chart audits may be

included as indicated.

2. Go-live Visit

Your CA will show you some of the reports in BIS that will be immediately useful. Best

practices for use of ReDoc documentation software will be incorporated into feedback

provided to clinicians as they use the program.

3. Post Go-live

Initial Chart Audits will be performed by the Clinical Advisory team, usually 2-6 weeks post

go-live with feedback provided via email or phone. Consultation with directors and power

users if desired will focus on how to perform chart audits with ReDoc and making a plan for

regular audits by leaders and peers. Chart Audit Form

4. ReDoc 360 Visit

Your Clinical Advisor will help you set definitions for initial success with Key Performance

Indicators (KPIs) and compare to KPIs used your Sales Return on Investment, if available.

This may include the director’s supervisor to explore additional areas of accountability.

Best practices for clinical workflow and documentation will be addressed with staff and

leaders.

5. Monthly Follow up calls

On monthly calls, your CA will remotely help you analyze your progress toward KPI targets

and identify additional areas for improvement in documentation quality and compliance,

arming you to manage the ongoing and continuous process to define and refine best

practices.

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Appendix A: ReDoc Glossary Administrator - Assigned role in ReDoc that allows full access to system maintenance, table maintenance, and patients’ personal information. This allows read only access to patients clinical date. ADT – Terminology used during interface testing. ADT is an acronym for admission, discharge, transfer which equates to demographics testing. Assistant – Assigned role in ReDoc for Assistant Therapists. This role restricts the therapist role for a given user. Makes evaluations and supervisory reports read only. This is not a standalone role; one must be assigned as a therapist as well. Authorizing Therapist – When a co-signature is needed, a therapist can select a second, or Authorizing Therapist to co-sign the note. In a separate, unrelated field, a therapist can be selected as “Authorizing Therapist” from within the General Information/Treatment Cycle/General screen. This links the patient to this Authorizing Therapist, to populate their “My Patients” list. Auto Correct Macro – A documentation shortcut for information you frequently use in your clinical documentation. A macro utilizes a shortcut, nonsense word that automatically expands to a full word, phrase, sentence, or paragraph. This feature utilizes the Auto Correct function. Banner – A banner is a header (Report Branding) in ReDoc that can display your clinic logo, name, address, phone and fax numbers, and web address. It allows report branding and displays as a header on the first page of all notes/reports. BIS – Business Intelligence Suite. This includes Current Status, Management Reports, BI Dashboard, and 360 consulting services. The Current Status provides real-time metrics of your business performance. With Management Reports, you can set filtering criteria and run reports and create mailing labels. The BI Dashboard module has 12 key performance indicators to choose from. Can Unsign – Therapists who are given this role are able to unsign their own notes for editing. Clerical – An assigned role in ReDoc that allows full access to patients’ personal information. This role allows read-only access to clinical data, but does not allow access to system maintenance or table maintenance. Diagnostic Episode – This refers to a patient’s primary diagnosis, and can be shared by PT, OT, and SLP. A Treatment Cycle is attached to a Diagnostic Episode.

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DFT - Terminology used during interface testing. DFT is an acronym for detailed financial transaction which equates to billing charges testing. Electronic Signature – comes with purchase of ReSig – allows the therapist to electronically sign documents within ReDoc. Excluded Benefits – Interventions that are never covered by a given payer. Export –Sends a completed document to the export folder, and this document becomes your legal medical record. Once you select Export it will give the destination that the document is being exported to so that you can easily locate it. Facility – A physical clinical location with the ability to have its own host code for billing. It is not an installed database or a cost center. You can use facilities to segregate your data, even if not distinct separate cost centers. Filter Parameters – Allows one to search for a user or therapist using certain search parameters, such as first/ last name, facility, DOB, account numbers, etc. Medical Necessity –When a payor determines that an intervention is medically necessary or appropriate when paired with a given diagnosis. Medicare defines it as, “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.” My Patients – A list that populates the Patient Filter Screen, if the therapist is selected as either the Treating or Authorizing Therapist from within General Information. Patient File Menu – This is the electronic “chart”, from where the various clinical note forms can be created or existing notes accessed. Patient demographics are also accessed from here in General Information. Power User – This is a user role in ReDoc, often referred to as a Super User, normally assigned to a lead therapist(s) of each discipline. It allows the setting up of tables for drop down lists and creation of exercise protocols. Protocols – groupings of therapeutic exercises that can be created by a System Administrator or Power User to pull into a treatment note; available for PT and OT disciplines. ReClaim Module – a set of filters that alert the treating therapist concerning NCCI Edits, Medical Necessity, and Excluded Benefits. Some coding alerts are determined by each specific insurance carrier’s exclusion policy for specific therapy interventions (CPT codes). There are three distinct alert filters: Insurance carrier excluded benefits, insurance carrier medical

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necessity requirements, and the national correct coding initiative (NCCI). Color-coded prompts assist with correct entry of minutes and units. Messages alert therapist to use of modifiers and additional documentation requirements. RePrint – Automates printing and export of documents after signing. The default setting is to just export all necessary documents. Report Branding – Allows the customization of ReDoc report headers with the clinic’s own brand that may include the clinic logo, clinic name, address, phone and fax number, and any other important information. Branding is also referred to as a Banner. Required Fields – These are fields in ReDoc that can be configured to make them mandatory. Therapists must complete these fields, now shaded in blue, before being allowed to sign or complete reports. Schedulee – Identifies which users can be scheduled in Scheduler Schedulee ReadAll – Identifies which users can only see schedules in Scheduler Scheduler – Identifies which users can create schedules in Scheduler Scheduler Sysadmin – Allows Sysadmin functionality for allowed facilities in Scheduler SysAdmin - The System Administrator or Administrator is a user role allowing the setup of facilities, users, and templates, along with other “behind the scenes” functions and tables in ReDoc and Scheduler. There is a ReDoc Sysadmin role and a separate Scheduler Sysadmin role. System Maintenance – This menu includes areas of ReDoc that can be accessed by a System Administrator, with some areas accessible to a Power User. Table Maintenance – the area in ReDoc Suite where the tables and droplists are customized. The droplists are available to all registered users in ReDoc, but can only be customized in Table Maintenance by users with a designated role of System Administrator or Power User. Tabs – In a clinical note, tabs are options that when selected, open up a screen. In ReDoc, selected tabs can be configured so that they do not display, if they are not needed. Therapist – An assigned role in ReDoc that allows full access to patient’s personal information and clinical data. This role does not include access to system maintenance or table maintenance.

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Treating Therapist - A therapist can be selected as “Treating Therapist” from within the General Information/Treatment Cycle/General screen. This links the patient to this Treating Therapist, to populate their “My Patients” list. Treatment Cycle – This refers to a course of treatment by a single discipline, and corresponds to a Patient File Menu. Each Treatment Cycle has one Patient File Menu.

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