Metrics Lessons Learned Managing Risks Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn...
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Transcript of Metrics Lessons Learned Managing Risks Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn...
MetricsMetricsLessons Learned Lessons Learned Managing RisksManaging Risks
Howard Hays, MD, MSPHHoward Hays, MD, MSPHMedical Informatics ConsultantMedical Informatics Consultant
Carolyn Johnson, RPh, CACCarolyn Johnson, RPh, CAC
Today’s PresentationToday’s Presentation
Metrics:Metrics: ProductivityProductivity Patient Care / GPRAPatient Care / GPRA CollectionsCollections
Lessons Learned / Managing RisksLessons Learned / Managing Risks
Provider ProductivityProvider Productivity
All sites see a transient decrease in All sites see a transient decrease in provider productivity (pts/day) at firstprovider productivity (pts/day) at first
Typically takes 1-3 months to recover to Typically takes 1-3 months to recover to pre-EHR levelspre-EHR levels
Mitigate by staggering implementation, Mitigate by staggering implementation, either by provider or by function, or botheither by provider or by function, or both
Efficiencies in other areas (phone calls, Efficiencies in other areas (phone calls, chart reviews) can improve productivitychart reviews) can improve productivity
Provider Productivity (Site Provider Productivity (Site A)A)
0
5000
10000
15000
20000
25000
Feb-
A pr
'04
May-
J ul
A ug-
O ct
Nov-
J an
Feb-
A pr
May-
J ul
Visits Patients
EHR
Site C ProductivitySite C ProductivityAverage General Clinic Patients Per Day Per Provider : June-December 2004
0
2
4
6
8
10
12
14
16
18
20
Jun Jul Aug Sep Oct Nov Dec
Medication Errors (Site A)Medication Errors (Site A)
0
5
10
15
Sep '03
Mar '04
Sep '04
Mar '05
Sept ̀ 05
E nd of Q tr Med E rrors
EHR
Pharmacy Waiting (Site D)Pharmacy Waiting (Site D)
0
50
100
150
Pre-E H R Post-E H R
Pharmacy Waiting T ime (minutes)
GPRA Indicator - GPRA Indicator - Flu Vaccine 65+ (Site A)Flu Vaccine 65+ (Site A)
0
10
20
30
40
50
60
70
80
2000 2001 2002 2003 2004 2005
Percent w/ Flu vax-over65 y/o (GPRA year)
EHR
GPRA Indicator – Pneumovax GPRA Indicator – Pneumovax over 65 y/oover 65 y/o
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005(so
far)
Percent w/ Pneumovax>65 y/o (GPRA year)
GPRA Indicator – GPRA Indicator – DV Screen Age 15-40 (Site A)DV Screen Age 15-40 (Site A)
0
5
10
15
20
25
30
2000 2003 2004 2005
Percent w/ DV/IPVScreening (GPRA year)
EHR
GPRA Indicator – GPRA Indicator – Tobacco Assessment (Site A)Tobacco Assessment (Site A)
0
10
20
30
40
50
60
70
2000 2003 2004 2005
Percent w/ Tobacco UseAssessed (GPRA year)
EHR
GPRA Indicator – GPRA Indicator – Medication Education (Site A)Medication Education (Site A)
0
10
20
30
40
50
60
70
80
2001 2003 2004 2005
Med E ducation(calendar year)
EHR
GPRA Indicator – GPRA Indicator – BMI 2-74 y/o (Site A)BMI 2-74 y/o (Site A)
0
10
20
30
40
50
60
70
80
2000 2003 2004 2005
Percent w/ BMICalculated (GPRA year)
EHR
GPRA Indicators –GPRA Indicators –11stst Qtr ‘05 (Site C) Qtr ‘05 (Site C)
0102030405060708090
TobaccoScreening
TobaccoCounseling
AlcoholScreening
BMICalculated
Pneumovax
EHR Clinic Non-EHR Clinic
EHR Creates the Potential to EHR Creates the Potential to Increase Collections Due to:Increase Collections Due to:
More Complete documentation with More Complete documentation with templatestemplates
Provider notifications – received Provider notifications – received automatically if they forget to enter POVs automatically if they forget to enter POVs or codesor codes
Superbills, ICD/CPT Pick Lists – make it Superbills, ICD/CPT Pick Lists – make it easier to find correct codeseasier to find correct codes
Coding Tools and Training with EHRCoding Tools and Training with EHR
Coding Tools in EHRCoding Tools in EHR Links to coding sites, reference guides, E&M Links to coding sites, reference guides, E&M
CoderCoder
Medicare/Medicaid/PI Medicare/Medicaid/PI CollectionsCollections
Revenue Site A
$2,754,676
$3,028,828
$2,000,000
$2,200,000
$2,400,000$2,600,000
$2,800,000
$3,000,000
$3,200,000
FY 03 FY 0410% increase
Itemized Billing Collections Itemized Billing Collections Partial EHR YearPartial EHR Year
PI and Medicare
$470,836$575,416
$-$100,000$200,000$300,000$400,000$500,000$600,000$700,000
FY03 FY0422% increase
Medicaid Collections (Site B)Medicaid Collections (Site B)
$2,817,798
$3,268,280
$2,000,000
$2,300,000
$2,600,000
$2,900,000
$3,200,000
$3,500,000
FY2003 FY2004
16% Increase from FY03 to FY04
PI collections (Site B)PI collections (Site B)
29.9 % Increase from FY03 to FY04
$545,798
$709,042
$0
$300,000
$600,000
$900,000
FY2003 FY2004
Podiatry Billing (Site D)Podiatry Billing (Site D)
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
Billed Collected Adjustment
1st Qtr 2004 (1081 pts) 1st Qtr 2005 (1107 pts)
Optometry Billing (Site D)Optometry Billing (Site D)
$0
$50,000
$100,000
$150,000
$200,000
$250,000
Billed Collected Adjustment
1st Qtr 2004 (2080 pts) 1st Qtr 2005 (1824 pts)
Lessons Learned / Managing Lessons Learned / Managing RisksRisks
Unsigned notes/orders are invisibleUnsigned notes/orders are invisible Med Rec Supervisor should run “unsigned notes/orders report” Med Rec Supervisor should run “unsigned notes/orders report”
dailydaily Server room environment is critical Server room environment is critical
Backup generatorBackup generator Backup cooling systemBackup cooling system
Decreased provider productivity at firstDecreased provider productivity at first Planned / staggered implementationPlanned / staggered implementation Monitor and adjustMonitor and adjust Tweak templates to facilitate rapid documentationTweak templates to facilitate rapid documentation Future – dictation / voice recognition for some notesFuture – dictation / voice recognition for some notes
Management plan for staffing changesManagement plan for staffing changes Proactive business process planProactive business process plan Medical Records role changesMedical Records role changes
Lessons Learned / Managing Lessons Learned / Managing RisksRisks
HIPAA/Privacy:HIPAA/Privacy: Use of CHAT instead of BROADCAST Use of CHAT instead of BROADCAST
GPRA/CRS:GPRA/CRS: Be consistent:Be consistent:
• Who enters each data elementWho enters each data element• Where/How data is enteredWhere/How data is entered• Incorporate Cheat Sheets in Your EHR Incorporate Cheat Sheets in Your EHR
Medication Order Errors/Frustration at startupMedication Order Errors/Frustration at startup Use Pharmacy Quick OrdersUse Pharmacy Quick Orders
Lessons Learned / Managing Lessons Learned / Managing RisksRisks
Lengthy PCC Error Report (everyone wants to Lengthy PCC Error Report (everyone wants to start the visit)start the visit) Keep a pulse on the error reportsKeep a pulse on the error reports Fixed by patches (soon!)Fixed by patches (soon!) Train providers on visit creationTrain providers on visit creation
Ongoing Cost of Ergonomics, ComputersOngoing Cost of Ergonomics, Computers Go-live is just the beginning – continue to meet Go-live is just the beginning – continue to meet
and train regularly afterwardand train regularly afterward Template approval process in placeTemplate approval process in place Cutting & Pasting can transfer patient A’s data Cutting & Pasting can transfer patient A’s data
into patient B’s chartinto patient B’s chart
EHR-The EHR-The WaveWave of Change of Change
Think of EHR as a tidal wave of change….Think of EHR as a tidal wave of change….How do YOU react to change?How do YOU react to change?
1.1. Do nothing…..Do nothing…..
2.2. Run…..Run…..
3.3.Ride the Wave!!Ride the Wave!!