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Metrics Lessons Learned Managing Risks

Metrics Lessons Learned Managing Risks. Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn Johnson, RPh, CAC. Today’s Presentation. Metrics: Productivity Patient Care / GPRA Collections Lessons Learned / Managing Risks. Productivity Metrics. Provider Productivity.

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Metrics Lessons Learned Managing Risks

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  1. MetricsLessons Learned Managing Risks Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn Johnson, RPh, CAC

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

  3. Productivity Metrics

  4. 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

  5. Provider Productivity (Site A) EHR

  6. Site C Productivity

  7. Patient Care Metrics

  8. Medication Errors (Site A) EHR

  9. Pharmacy Waiting (Site D)

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

  11. GPRA Indicator – Pneumovax over 65 y/o

  12. EHR GPRA Indicator – DV Screen Age 15-40 (Site A)

  13. EHR GPRA Indicator – Tobacco Assessment (Site A)

  14. EHR GPRA Indicator – Medication Education (Site A)

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

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

  17. Collections Metrics

  18. 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

  19. Automatic Notifications

  20. RPMS Billing Package Superbill link to Billing

  21. Coding Tools in EHR • Links to coding sites, reference guides, E&M Coder

  22. Medicare/Medicaid/PI Collections 10% increase

  23. Itemized Billing Collections Partial EHR Year 22% increase

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

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

  26. Podiatry Billing (Site D)

  27. Optometry Billing (Site D)

  28. Identifying and Managing Risks The Bad The Ugly TheGood

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

  30. Lessons Learned / Managing Risks • HIPAA/Privacy: • Use of CHAT instead of BROADCAST • GPRA/CRS: • Be consistent: • Who enters each data element • Where/How data is entered • Incorporate Cheat Sheets in Your EHR • Medication Order Errors/Frustration at startup • Use Pharmacy Quick Orders

  31. Lessons Learned / Managing Risks • Lengthy PCC Error Report (everyone wants to start the visit) • Keep a pulse on the error reports • Fixed by patches (soon!) • 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

  32. EHR-The Wave of Change Think of EHR as a tidal wave of change…. How do YOU react to change? • Do nothing….. • Run….. • Ride the Wave!!

  33. Evaluations • http://porwsp-b/wspintranet/EHR/EHR.htm

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