EJttilb Health. The University of Texas Medical Branch Audit Services. Audit Report. Epic In-Basket Management Audit. Engagement Number

Transcription

1 ', : t'f" ' EJttilb Health The University f Texas Medical Branch Audit Reprt Audit Engagement Number July 2015 nie University f Texas Medical Branch 301 University Bulevard, Suite Galvestn, Texas

2 Backgrund The University f Texas Medical Branch's (UTMB Health) "The Rad Ahead: Institutinal Visin " utlines fur strategic gals essential fr achieving its visin and advancing its missin "t imprve health fr the peple f Texas and arund the wrld". Fr Institutinal Gal #2, "Value", UfMB Health seeks t deliver "tp-tier" service t its patients and streamline perating systems t imprve/ ptimize utcmes and verall efficiency. In 2008, UTMB Health cmpleted implementatin f the Epic Electrnic Medical Recrd (EMR) system t imprve quality f patient care, patient safety, and peratinal efficiency. The Epic "In-Basket" functin is a secure, clsed messaging system allwing users t send and receive messages abut patient care and billing needs. While similar t , it permits messages t be directly linked t patient accunts, charts, lab results, rders etc. Open messages/ encunters are ruted t ne f 54 available flders t help rganize user wrklads and ensure timely respnses. In-Basket users cmplete message related tasks by clicking cntext-specific buttns n the In Basket tlbar. The In-Basket functin is custmizable and allws the ruting f messages by type t certain users r grups f users, such as a pl f nurses. Ambulatzy Operatins' leadership indicated effectively managing the Epic In-Basket prcess has presented n-ging challenges due t numerus factrs including the cmplexity f the design and lack f initial, detailed guidance and training t fster standardized practices amng users. In an effrt t facilitate standardizatin and ptimizatin f Epic In-Basket prcesses, Ambulatzy Operatins created a six-member In-Basket supprt team which meets regularly t priritize prjects and discuss prcess imprvements with a gal f ensuring imprved patient care, safety and satisfactin. Audit Objective The primary bjective f this audit is t assess the prcesses in place t manage Epic In-Baskets in an effrt t identify additinal pprtunities fr standardizatin and ptimizatin. Scpe f Wrk and Methdlgy The audit scpe included current prcesses used within selected areas f Ambulatry Operatins. Our methdlgy included gaining an understanding f the In-Basket wrkflws thrugh interviews and bservatin f key persnnel within the Access Center, League City Family Health Clinic, Mainland Cardilgy Clinic, and Wmen's Healthcare Clinic- Galvestn. Additinally, we interviewed members f the In-Basket supprt team and reviewed applicable plicies, prcedures, and ther related dcumentatin. The audit was cnducted in accrdance with the Internatinal Standards fr the Prfessinal Practice f Internal Auditing as prmulgated by the Institute f Internal Auditrs. July 201."i Page 1f."i

3 .Health Audit Results interviews with members f the In-Basket Supprt Team indicated the team has identified several pprtunities and prpsed changes t streamline and ptimize In-Basket prcesses. These initiatives fall int fur key areas: In-Basket Design/Functinality; Data/Reprting; Training; and Prtcls and Prcesses During ur interviews and bservatins at select clinics and the Access Center, identified additinal pprtunities t imprve current In-Basket tls and prcesses. Identified pprtunities by area include: In-Basket Design/Functinality Items Identified by In-Basket Supprt Team Add "Orders" as reasn fr call encunter type t allw ruting directly t nurses - Request apprved; hwever, still awaiting implementatin. Create "hard stp" t require dcumentatin f reasn fr phne calls. Create field t allw fr secndary reasn fr phne call, if needed. Create ability t search by patient fr multiple encunters pen within different flders. Cnslidate all messages/encunters related t medicatins int ne flder (currently ins different flders). Disable MyChart standard aut respnse - It is a nn-patient satisfier and des nt facilitate addressing message. Items Identified by Cnslidate messages/encunters related t test results int ne flder. Identify ther pprtunities t reduce the number f flders used. Data/Reprting Items Identified by In-Basket Supprt Team Validate data in current reprts fr accuracy and cmpleteness. Create a reprt t track respnse time fr ther call types nt currently captured in existing reprts. Create a reprt shwing message backlgs by user and message type. Items Identified by Current reprts available are fr respnse time fr the 7 reasn fr call types, respnse time fr clsing patient calls and reprt t view Open Encunters fr Telephne, Letters, and MyChart flders nly. Create similar reprts fr the ther flder types. Create a reprt t shw ttal Open Encunters within all ther flder types t help facilitate mnitring f the ther flders. Julv201,1; Page 2 f.11

4 .Health Training Items Identified by In-Basket Supprt Team Enhance basic In-Basket training fr nursing staff and prviders t include definitins f all flders and hw messages are ruted t each flder. Implement side-by-side shadwing with best practice In-Basket users. Items Identified by Develp and implement advanced training fr each f the flder message types within the In-Basket fr Patient Service Specialists (PSS) and clinical staff t better understand what is in the flders and hw t manage their In-Basket activity. Develp and implement specialized training fr PSS supervisrs, clinic managers and clinic medical directrs n hw t mnitr their area's In-Baskets and hw t read and understand the reprts available t mnitr In-Basket activity. Prtcls and Prcesses Items Identified by In-Basket Supprt Team Develp additinal standard prtcls fr nursing and medical assistants t handle certain calls withut sending t physician and awaiting a respnse. Implement standard methdlgy fr wrking In-Basket messages - Need wrkflws fr nurses t knw when t dne a message. Further define nursing pl rles t identify wh can/ shuld be wrking different types f messages. Establish standard prcessing time fr prviders t respnd t messages if n actins taken. Standardize prcess fr ruting and "dneing" messages. Implement expected respnse time fr all ther call reasns. Establish expectatin fr prviders t cmplete prescriptin messages (erx) instead f ruting t nurses. Items Identified by Establish guidelines fr handling messages/ encunters f users ut n leave r when terminating their emplyment. Develp and implement guidelines fr all flders/message types available within the In-Basket. Establish guidelines fr prviders t send results straight t MyChart t ntify patients f nrmal test results instead f ruting t nurses t cmplete. Additinally, identified the fllwing pprtunities in the areas f Oversight and Mnitring: Establish escalatin prcess t address lack f timely respnse t messages and backlgs. Cnsider establishing a guideline fr results that have nt been clsed timely t autmatically rute t the clinic manager's and medical directr's In-Basket fr fllw up. Use available tls within Epic such as the In-Basket Dashbard t mnitr activity. July 201."i P e f:;

5 The recent rapid grwth in and mvement f UTMB Health's ambulatry clinics, cupled with increased fcus n ensuring a cnsistent, high-quality patient experience acrss the enterprise, has put added pressure n existing rganizatinal resurces previusly dedicated t peratinal ptimizatin. Althugh the supprt team cntinues meeting weekly t discuss implementatin status f prpsed changes and enhancements, the extensive nature f its list utweighs currently available team resurces, including thse prvided by Infrmatin Services, resulting in a lack f sufficient mmentum t address items in a timely manner. nted sme change requests dated back t September The imprtance f patient access t timely, respnsive supprt fr their health care needs and questins ccurring utside f scheduled appintments with their prviders is paramunt t the verall success f UTMB Health's institutinal visin related t patient care and satisfactin. Recmmendatin R: The Vice President, Ambulatry Operatins, the Vice President, Chief Physician Executive and the Vice President, Chief Infrmatin Officer shuld develp a frmal actin plan with apprpriate milestnes, timelines, and resurces t priritize and implement Epic In-Basket prcess and design changes t ensure current and recmmended Epic In-Basket initiatives are addressed in a timely manner. Management's Respnse: The VP, Ambulatry Operatins, VP & Chief Physician Executive, and Chief Infrmatin Officer will develp a frmal Epic In-Basket prcess and design change actin plan with apprpriate milestnes, timelines, and resurce estimates by December 23, The prcess imprvements and design changes will be implemented by March 31, Implementatin Date: Actin plan - December 23, Implementatin - March 31, Cnclusin cmpleted an assessment f the Prcesses within Ambulatry Clinics t identify additinal pprtunities fr standardizatin and ptimizatin. In additin t pprtunities previusly identified by the In-Basket Supprt Team, nted pprtunities exist t further streamline and standardize current prcesses, prvide additinal user guidelines and advanced training, and perfrm versight and mnitring. With the recent rapid grwth in and mvement f UTMB Health's ambulatry clinics, resurces previusly dedicated t peratinal ptimizatin have been refcused. Withut sufficient resurces and mmentum t ensure efficient and effective use f the Epic In-Basket functin, the institutin has an increased risk f nt achieving its gals related t patient care, safety, and satisfactin. July 201/i Page4 f!i

6 llj!!health Epicln-Basketl\lanagelllent We greatly appreciate the assistance prvided by Clinics Administratin and Supprt, and individual clinic/ area persnnel, and hpe that the infrmatin presented in ur reprt is beneficial. Kimberly K. Hagara, CPA, CIA, CISA, CRMA Assciate Vice President, Barbara L. Winburn, CIA, CRMA, RHIA Senir Manager Julv2015 Page fi f fi