EHM-520: Electronic Health Records (Week 6) PDF

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 6 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 6 Topic Reading Ambulatory Care EHR Applications MARGRET’S CH 16 Due in Class 2 Learning Objectives • Recognize differences and similarities between elemen...

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 6 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 6 Topic Reading Ambulatory Care EHR Applications MARGRET’S CH 16 Due in Class 2 Learning Objectives • Recognize differences and similarities between elements of EHRs for acute versus ambulatory settings • Discuss ambulatory interoperability strategies, especially between providers and hospitals • Identify EHR functionality for ambulatory care facilities, considering the key clinical processes performed and data needed in such a facility • Describe how scheduling, registration/check-in, patientprovided documentation, in-basket, and checkout functions may be impacted by an EHR • Discuss the purposes of the patient clinical summary • Distinguish between care plans, clinical guidelines, protocols, pathways, and evidence-based medicine and how such are aided by an EHR Learning Objectives • Formulate a proposal for adoption of e-visits • Identify the functions provided by clinical decision support and how they can be carried out in an EHR • Discuss non-visit functions of EHRs for ambulatory facilities • Plot a migration path for an ambulatory facility given their readiness and tolerance for change, budget, and technical infrastructure • Distinguish electronic prescribing (e-prescribing) from computerized provider order entry (CPOE) • Explain how e-prescribing works • Distinguish between clinical messaging and portals Focus on Ambulatory Care • Although there has been little data on ambulatory EHR adoption, there has been a tremendous surge in acquiring EHR since government incentives have focused on ambulatory care. • Barriers have been largely cost, change, and quality of product. • Many physicians, however, are coming to appreciate there are better products, real benefits, and want the incentives – especially when the incentives become sanctions to be avoided! Ambulatory vs. Acute Care • Existing infrastructure – Legacy systems fewer in ambulatory care – A registry may be a bridge technology for ambulatory care – IT staffing often non-existent in small offices • Engagement of physicians may be easier • Nature of data and workflows – Change – Trust – Understanding Interoperability • Within ambulatory care practice – Many fewer interfaces (PMS, maybe Lab) • Outside of practice – Commercial and reference labs are very willing to support interfaces – Imaging centers (PACS) somewhat tricky • With hospitals – Largely portal strategy to enable practice to have access to hospital data, and in some cases applications 80/20 Rule • Hospital systems have traditionally not supported ambulatory data and workflow needs well (and likewise, ambulatory systems have not supported acute care) – Community offering from vendors with integrated product suites is changing this, and supporting data exchange through single Active Directory • Many practices want seamless exchange of data (interoperability), but not when it requires them to use products from a vendor that does not have the robust functionality of other products • “If I only need 20 percent of data from the hospital and need 80 percent of the functions of an ambulatory EHR, why give up the 80 percent for the 20 percent?” EHR Functionality • EHR is much more a single product with tightly integrated applications • “Paperless” state easier to get to quickly in ambulatory care • Different data needs to exist between primary care and specialists, however Ambulatory Processes • Visit-Specific – Pre-visit registration, scheduling, insurance verification – Check-in – Patient intake – Chart review – Medical history review – Physical exam – Assessment – Diagnosis – Care planning – Health maintenance – Staff tasking/back office orders – Procedure – Prescribing/samples – Lab/radiology order – Coding, including E&M – Charge capture and billing – Referral management – Patient instructions – Visit summary – Check out Ambulatory Processes • Non-Visit-Specific Functions – – – – – – – – – – – – – – Results review and management No show management Prescription refill/renewal requests Other phone calls/email Patient follow up/recall Release of information Forms completion Patient document management Chronic disease management Quality improvement Required reporting Pay for performance Patient self-management/PHR Clinical trials EHR Functions • • • • • • • • • Patient data capture Patient data management Prescription/ordering Clinical decision support Patient support Clinical work flow Administrative and reimbursement Electronic communication and connectivity Quality measurement, reporting, and improvement Scheduling, Registration, In-basket • EHR aids insurance verification • Some clinics promote self-administered history assessment to reduce data entry burden for providers and engage patient • Starting process for routine labs reduces after visit patient anxiety and phone calls (see next slide) • Registration and check-in supports wait time monitoring • Patient-provided documentation/PHR • In-basket workflow • Checkout – often a new function that enables bill collection, education, and provision of patient summary Patient Visit Benefits Schedule appointment Insurance Co-pay? Check-in Y Patient Told Amount N Need Lab Work? Collect co-pay Patient arrival to RN in-basket RN takes V/S Y Get lab work done “Patient ready” to MD in-basket N Patient Self-Administered HPI & PHR MD sees patient with all necessary information available Copyright © 2012, Margret\A Consulting, LLC. Reprinted with Visit Summary RN Educates Documentation • Templates aid structured data collection and CDS • Generally built around: – – – – Care plans Guidelines Protocols Pathways or care maps • Care management – Patient-centered medical home – Accountable care organization • Evidence-based medicine • E-visits CPOE and E-Rx • Orders are documentation for and clinical messaging for: – Lab tests or diagnostic studies – Referrals – Other, non-medication orders and tasks • E-prescribing is a special kind of order when a prescription is given for filling at a retain pharmacy (including mail order) E-Rx • Computer supported selection, generation, transmission, and filling/refilling of prescriptions (“orders” for drugs sent to retail pharmacies, and not paid for as part of the care delivery visit) Pharmacy Benefits New Prescriptions Renewal Requests Prescriber Claim: 99203 G8443 $ Incentive Drug Knowledge Fill Status Notification E-Prescribing Gateway Changes - Cancels Prior Authorizations Copyright © 2012, Margret\A Consulting, LLC. Reprinted with permission. Dispenser Clinical Messaging Versus Portals • Clinical messaging is the secure transmission of clinical information from one entity to another, including providers to providers, patients to providers, payers to providers, and among members of a healthcare community, such as within a regional health information organization (RHIO) – Data may be in structured or unstructured (most common) form • Portal is access to information (view only) and/or the applications (interact only) in another system – Data are often not exchanged, but viewed, interacted with, and possibly retrieve or download a print file, scanned image, or digital document Coding Support • Professional service documentation and coding drives physician reimbursement • Evaluation and Management (E&M) codes must be assigned accurately in order to obtain optimal reimbursement – – – – – Authorship integrity Auditing integrity Documentation integrity Patient identification and documentation accuracy Policies and procedures for responding to prompts Functions of CDS Systems • Presentation of CDS may be: – Passive – Context-sensitive ─ Mandatory ─ Reference Data Analysis & Report Generation • It is important to work with data being collected, analyze them, and develop reports from them. • This is the essence of many external reporting programs, disease management functions promoted by health plans, and pay-for-performance incentive programs – which today rely largely on data that can be recorded on claims (which is a growing amount of data). • However, EHRs are largely focused on care delivery, not data analysis and reporting, so there is difficulty today. • As incentive programs grow and start to require more data than what can be recorded on a claim, EHRs will need to respond. Ambulatory EHR Migration Path Clinical messaging E-Visits Hospital portal Others Registry EDMS e-Rx Update PMS EHR Update LIS Copyright © 2012, Margret\A Consulting, LLC. Reprinted with permission. • But, some areas where physician offices err and often end up with a failure are: – Buying hardware before selecting an EHR – Buying standalone systems that are not standards compliant or certified – Starting down the EHR path without engaging all stakeholders, including the board, nurses, and administrative staff – Engaging in self-development or alpha testing, thinking this will save money Conclusion • Adoption of EHR in ambulatory care is accelerating – More than in acute care • Still, implementation ≠ adoption; challenges of cost, change, and product maturity remain, although improving For Next Session # WEEK 7 Topic Reading Specialty-specific EHRs MARGRET’S CH 17 Due in Class 24 9/29/2022 25