Metrics Lessons Learned Managing Risks Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn Johnson, RPh, CAC

Today’s Presentation  Metrics: Productivity Productivity Patient Care / GPRA Patient Care / GPRA Collections Collections  Lessons Learned / Managing Risks

Productivity Metrics

Provider Productivity  All sites see a transient decrease in provider productivity (pts/day) at first  Typically takes 1-3 months to recover to pre-EHR levels  Mitigate by staggering implementation, either by provider or by function, or both  Efficiencies in other areas (phone calls, chart reviews) can improve productivity

Provider Productivity (Site A) EHR

Site C Productivity

Patient Care Metrics

Medication Errors (Site A) EHR

Pharmacy Waiting (Site D)

GPRA Indicator - Flu Vaccine 65+ (Site A) EHR

GPRA Indicator – Pneumovax over 65 y/o

GPRA Indicator – DV Screen Age (Site A) EHR

GPRA Indicator – Tobacco Assessment (Site A) EHR

GPRA Indicator – Medication Education (Site A) EHR

GPRA Indicator – BMI 2-74 y/o (Site A) EHR

GPRA Indicators – 1 st Qtr ‘05 (Site C)

Collections Metrics

EHR Creates the Potential to Increase Collections Due to:  More Complete documentation with templates  Provider notifications – received automatically if they forget to enter POVs or codes  Superbills, ICD/CPT Pick Lists – make it easier to find correct codes  Coding Tools and Training with EHR

Automatic Notifications

Superbill link to Billing RPMS Billing Package

Coding Tools in EHR  Links to coding sites, reference guides, E&M Coder

Medicare/Medicaid/PI Collections 10% increase

Itemized Billing Collections Partial EHR Year 22% increase

Medicaid Collections (Site B) 16% Increase from FY03 to FY04

PI collections (Site B) 29.9 % Increase from FY03 to FY04

Podiatry Billing (Site D)

Optometry Billing (Site D)

Identifying and Managing Risks The Good The Bad The Ugly

Lessons Learned / Managing Risks  Unsigned notes/orders are invisible Med Rec Supervisor should run “unsigned notes/orders report” daily Med Rec Supervisor should run “unsigned notes/orders report” daily  Server room environment is critical Backup generator Backup generator Backup cooling system Backup cooling system  Decreased provider productivity at first Planned / staggered implementation Planned / staggered implementation Monitor and adjust Monitor and adjust Tweak templates to facilitate rapid documentation Tweak templates to facilitate rapid documentation Future – dictation / voice recognition for some notes Future – dictation / voice recognition for some notes  Management plan for staffing changes Proactive business process plan Proactive business process plan Medical Records role changes Medical Records role changes

Lessons Learned / Managing Risks  HIPAA/Privacy: Use of CHAT instead of BROADCAST Use of CHAT instead of BROADCAST  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 EHRIncorporate Cheat Sheets in Your EHR  Medication Order Errors/Frustration at startup Use Pharmacy Quick Orders Use Pharmacy Quick Orders

Lessons Learned / Managing Risks  Lengthy PCC Error Report (everyone wants to start the visit) Keep a pulse on the error reports Keep a pulse on the error reports Fixed by patches (soon!) Fixed by patches (soon!) Train providers on visit creation Train providers on visit creation  Ongoing Cost of Ergonomics, Computers  Go-live is just the beginning – continue to meet and train regularly afterward  Template approval process in place  Cutting & Pasting can transfer patient A’s data into patient B’s chart

EHR-The Wave of Change Think of EHR as a tidal wave of change…. How do YOU react to change? 1. D o nothing….. 2. R un….. 3. R ide the Wave!!

Evaluations 