Centricity Physician Office

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Tracy Williams
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1 Centricity Physician Office 2005 User Summit EMR Orders Implementation in an Enterprise Don Sepulveda, Clinical Consultant GE Healthcare Clay Williams, Clinical Consultant GE Healthcare Peggy Romfh, Project Manager Baylor College of Medicine Baylor College of Medicine Academic medical center located in the Texas Medical Center in Houston Three year plan to implement electronic medical record (EMR) in all clinical specialties including 600 providers Technology integration GE Centricity Physician Office EMR Clinical Content Consultant (CCC) forms and voice-to-text technology IDX practice management software Interfaces from multiple hospital, lab, and radiology systems Secure patient portal 1

year plan to implement electronic medical record (EMR) in all clinical specialties including 600 providers Technology integration GE Centricity Physician Office EMR Clinical

2 Presentation Objectives Describe the set-up and basic orders functionality in the EMR with a focus on service and test orders Describe alternatives in the orders processes that optimize provider and staff efficiency Show how service orders can be integrated with the practice management system Share implementation methodology that includes use of Six Sigma and Lean Service Orders Capture of charges associated with a visit or procedure CPT codes ICD-9 codes Modifiers 2

service orders can be integrated with the practice management system Share implementation methodology that includes

3 Service Orders: Project Plan Project CTQ s All Users: no paper Provider: easy process; seamless Coder: immediate chart access; easy communication for corrections Billing Staff: legible; correct; continuous flow of work Manager: less work for Front Desk before and after visit Compliance: audit of documentation, coding and corrections Service Orders: Project Plan Team Charter Goals: Eliminate all paper Super Bills Streamline coding/coder review function Integrate charge capture with charge entry Team Operations, IT, GE partnership Scope: Pilot in Family Medicine Implement in all clinics during EMR rollout 3

documentation, coding and corrections Service Orders: Project Plan Team Charter Goals: Eliminate all paper Super Bills Streamline coding/coder review

4 Service Orders: Current Process PROCESS MAP: Cycle Time 4 to 10 Days Front Desk Print Front Desk Sort MA Transport Provider Charge Capture Front Desk Sort, Batch Med Records Pull Charts Coder Review Transporter to Billing Billing Sort, Reconcile Billing Enter Charges Billing Edit Charges Archive, File, Scan Forms Service Orders: Current State Measurement System Analysis Waste in Current Process $ 92K Super Bill forms cost $ 75K Labor forms printing, sorting, printing $ 36K Labor transporting forms to billing $ 75K Labor Medical Records, Coder follow-up $ 30K Labor Billing sorting, batching $ 76K Scanning/filing costs of Super Bills $384K Total Annual Waste in Process 4

Current State Measurement System Analysis Waste in Current Process $ 92K Super Bill forms cost $ 75K Labor forms printing, sorting, printing $ 36K Labor transporting

5 Service Orders Analysis of Gaps CONTINUOUS FLOW REWORK Service Orders New Process 5

6 Service Orders Provider Charge Capture with Orders Module Service Orders Provider Charge Capture with Orders Module Cont. 6

7 Service Orders Missing Charges Report Service Orders Coder Work List 7

8 Service Orders Coder Work List Service Orders Billing Report Billing Report Data Elements Location Of Care ICD-9 Provider Name Modifier Visit ID Date of Service Patient Name Signed By IDX Acct # Complete Date and Time CPT-4 Organized by IDX charge entry screen and grouped by provider 8

Visit ID Date of Service Patient Name Signed By IDX Acct # Complete

9 Service Orders - Training Provider and Assistants Orders functionality Selection of Visit ID Selection of all Service orders Coder Orders functionality Missed Charges Report Create Coder Work List Biller Billing Report by Location of Care and Complete Date Service Orders Process Control Mistake Proofing EMR set-up optimized Re-training coder, biller Validation of reports Process Control Plan # Missing charges # Missed/wrong codes # Work in process coder Process Capability and Control Improvement Goals Met Eliminated paper Decreased coder review/cycle time Used single document from EMR for charge entry Lag Days to charge entry 9

optimized Re-training coder, biller Validation of reports Process Control Plan # Missing charges # Missed/wrong codes # Work in process coder Process

10 Test Orders Provider orders for diagnostic tests, procedures, and therapies in EMR Selection of service providers for each Printing of order forms for each service provider selected Test Orders Project Plan Project CTQ s All Users: minimum clicks Provider: custom order form; easy search for additional tests RN/MA (Assistive Staff): minimum effort to choose service providers; no duplication onto service provider order forms Service Providers: same test order information and codes found on service provider form Manager: less work for Assistive Staff to process orders Patient: legible order form; location on testing identified; patient instructions clear 10

Staff): minimum effort to choose service providers; no duplication onto service provider order forms Service Providers: same test order information and codes found

11 Test Orders Project Plan Goals Team Charter Implement EMR Orders and/or CCC test management forms Optimize set-up of tests, prompts, and service providers Eliminate service provider order forms Team Operations, IT, GE partnership Test Orders Project Plan Team Charter Scope Pilot in Family Medicine Implement in all clinics during EMR rollout Outside Scope Approved service providers linked to patient insurance Interfaces to service providers 11

partnership Test Orders Project Plan Team Charter Scope Pilot in Family Medicine Implement in all clinics

12 Test Orders Current Process Provider orders tests on custom form, verbal order, or in chart note 0 0 RN or MA manually completes all order forms needed. RN or MA finds service provider order forms 0 0 RN or MA prints patient instructions, maps, or other required clinical data. RN or MA provides copy of order to patient and may fax order to service provider. Test Orders: Current State Measurement System Analysis Waste in Current Process $ 81K Manual completion of forms $ 13K Ordering and stocking forms $ 94K Total Annual Waste in Process different forms typically stored on each workstation 12

RN or MA provides copy of order to patient and may fax order to service provider.

13 Test Orders Analysis of Gaps Organizational person Gap: Test Order knowledge that resides among staff must be translated to a knowledge bank in the EMR. Gap: Service providers need to accept test orders printed in standard formats from the EMR to eliminate manual completion of forms. Test Orders Set-up Strategy CLEAN UP existing tests and service providers entries MAINTAIN test and service provider tables on an ongoing basis ADD new tests and service providers following standards 13

Gap: Service providers need to accept test orders printed in standard formats from the EMR to eliminate manual completion

14 Test Orders System Set-up Test Orders System Set-up Order Forms General order form Custom order form for Lab with Service Provider order codes designated Custom order form for high volume service providers (e.g. partner hospital) or BCM service provider Tests Standardized format for instructions and additional required information To or from service provider To patient Test instructions researched for all high volume tests and maintained accurately Handouts and letters created for adjunct instructions or requested clinical information 14

15 Test Orders Process Test Orders Process Provider only: 1. Enters order in Orders Module, CCC Test Management Form, Custom Encounter Form or CCC CPOE 2. Reviews orders in Orders Module and adds information as needed (Instructions, date, Service Provider, etc.) 3. Signs Order 4. Give printed order to patient 15

16 Test Orders Process CCC Test Management Form Test Orders Process Orders Module 16

17 Test Orders Process Provider with Assistant: 1. Provider Enters order in Orders Module, CCC Test Management Form, Custom Encounter Form or CCC CPOE 2. Assistant reviews orders in Orders Module and adds information as needed (Instructions, date, Service Provider, Authorized Provider, etc) 3. Assistant Signs Order 4. Give printed order to patient Test Orders Process 17

18 Test Orders Process Optimization EMR needs additional functionality Separate instructions from vs. to a service provider Automatic pop-up of handouts and letters/questionnaires without additional clicks Additional information about service provider search terms related to diseases or tests to aid in use of search functionality Ability to obsolete Service Providers Test Orders Process Optimization Issues: MEL_ADD_ORDER Currently lacks the ability to send Service Provider to orders module from form components Service provider acceptance of EMR order form Service provider wants their own form also filled out 18

search terms related to diseases or tests to aid in use of search functionality Ability to obsolete Service Providers Test Orders Process Optimization

19 Test Orders Training General orders functionality training Workflow and process training Test Orders Process Control Mistake Proofing EMR set-up optimized Validation of Test Codes Validation of Service Providers Process Control Plan Reconciliation Reports Maintenance Role Process Capability and Control Improvement Goals Met Decrease paper Decreased Provider and Assistant time to complete orders Legible order forms for patient and service provider 19

Control Plan Reconciliation Reports Maintenance Role Process Capability and Control Improvement Goals Met

20 Referral Orders - Summary Set-up Use Categories for Specialty and set service provider preferences Use Codes for generic description Process Order from orders module, use instructions field for service provider instructions Set disposition to Admin Hold for Referral Coordination Limitations Cannot push from form component Other Orders - Challenges Not all orders can be handled within the Orders Module Nursing Orders-Assisted Living Vendors needing complex information-durable Medical Equipment Patient care-chemotherapy Orders The Orders module may be supplemented by using Centricity Form Components CCC functionality Letters 20

component Other Orders - Challenges Not all orders can be handled within the Orders Module Nursing Orders-Assisted Living Vendors needing complex

21 Other Orders - Centricity Form Component Form components can be used within an Encounter type to create a chart note. The chart note will document Home Health Care, Nursing Home, and Assisted living orders that can then be directly faxed to the facility. Other Orders CCC Functionality 21

22 Other Orders - Centricity Generated Letter for DME Summary Service Orders Opportunity to streamline charge capture process Easy entry to the use of orders Test Orders Set-up and maintenance must be well defined and governed Can be very complex Must understand all roles involved in process Next Steps Continue implementation in rollout of EMR to all BCM clinics 22

Shellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc.

Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. My connection to coding and documentation My connection to clinical processes My connection to ICD-10 My connection to YOU Coding