EMR Designed For Physicians By Physicians

Transcription

1 EMR Designed For Physicians By Physicians Focused on the Practice PegasusEMR has a unique heritage in the medical software industry. It was designed by a team of Physicians who, along with a team of process Engineers, produced an Electronic Medical Record (EMR) software application that has superior performance characteristics and an easy to use interface. PegasusEMR is not an appendage of a large hospital-based system. Those systems focus most of their efforts on managing the supply chain of the hospital. Our solution was built from the ground up to help the Physician improve patient care, patient safety and increase productivity. How it works PegasusEMR utilizes several software modules to improve the manual processes in a repetitive, clinical work environment. It is an integrated solution that provides more information and improvements faster and more accurately than competitive products. Benefits of PegasusEMR Reduces duration and effort between functions Eliminates manual and high risk steps Reduces errors associated with patient encounters Increases employee efficiency, moral and retention Increase in productivity and decrease in claims denials associated with documentation and charge entry errors Decrease costs associated with handling of paper records. Allows for documentation of clinical services (evaluation, daily treatment notes, patient progress reports, and discharge summaries) and charge entry PegasusEMR is an open architecture system built on state of the art technology We are HL7 compliant Fully integrated with Microsoft office products At the heart of the system There are 6 critical modules that power PegasusEMR. On the following 6 pages, we have presented a fairly in-depth summary of the modules as well as their features and benefits. Please review them and call us if you have any questions.

2 PegasusEMR Chemotherapy Module Chemotherapy Management: All treatments are plotted out in the schedule up to 180 days and/or thru completion of the next cycle Rescheduling/Moving of treatment days are managed by the system when a nurse moves or holds a single day Chemotherapy Calendar provides a consolidated 4 week schedule for patients with nursing notes and oral medication schedules Automated notifications for calculations dependent on Weight and/or specific lab values Internal documentation for Administration and Reaction procedures. No more searching through manuals Dynamic generation of Chemo Administration codes Scheduled Labs / Studies: Chemotherapy manager allows Nurses to focus on Nursing tasks and not Billing and/or Inventory functions. Required Labs prompt nursing for values prior to administration Billing approval by Insurance Class captures potential loss due to insurance denials Maximum Dose warnings for specified medications Automated tasks for treatment ensure future compliance to NCCN guidelines Automated prompting for missing waiver forms and patient acknowledgement forms for specified medications Advantages: Automated scheduling enables a nursing resource to plot and schedule a patients treatment plan and provide a single page appointment schedule to the patient Elimination of billing errors through dynamic coding generation Instant access to medication requirements by day for the next 45 days Managing nurse can view instant status of all patients currently receiving treatment Nursing Evaluations captures standard values for Nausea, Pain and other practice defined variables.

3 PegasusEMR Protocol Module Protocol Management: Manage Protocols by disease state Define required medical test by protocol Define required pre medications by protocol Lists treatment references and internal administration notes Define standard dosing procedures by medication Specify unique Tasks for specified treatment View Protocol utilization by Date / Indication / Treatment Status (Complete/Held/Successful/Active) Drill down into listed treatments Protocol Compliance: Filter Treatment progress by a wide variety of variables, such as, Date of Death, Date of Dx, Last office visit, First office visit, Last chemo treatment to name only a few options Instantly view any patients treatment summary or flowsheet from the protcol management window Advantages: Protocol Modules provides a practice with the control and insight into protocol utilization and compliance never before seen. Standard Labs and Diagnostics are difficult to miss. System will continually notifiy user that a specific test is required for the current treatment being used Standard NCCN references ensure documenation and knowledge is passed through the system to all users Reporting and Filtering functions provide a unique insight to providers for successful treatments Ease of treatment location ensures provider acceptance and utilization of system.

4 PegasusEMR Inventory Module Inventory Management: Manages Inventory by Station Inventory included Medication / Procedures / Tasks Electronic tracking of Administration Notes, Premedication notes, Reaction procedures, Billing notes, Lifetime maximum dosages and many other control points Document dependencies allow automated capture of day when a drug is Administered, Ordered, Held etc. Medication Utilization by Site provides instant access to required volumes by location Define required/assign codes by inventory item (medication/procedure) by insurance class Unit of Measure conversions perform all calculations for medication Dosing calculation are automated through patient treatments Location rules for Administration, Ordering and Scheduling Point of Sale: Inventory manages any inventory items required by the practice. Rules processing allows a practice to controls medication dosing, billing, administration and reaction procedures. Inventory Items can be setup as Point of Sale (POS). This allows a practice to sell specific items if required Automated billing of POS ensures proper tracking through Practice Billing system Advantages: Internal procedures for Administration/Reaction and patient acknowledgements are available at the click of a button during administration Reduced medication volume on hand due to accurate plotting of treatments. No more multiple hours of nursing time to calculate medication volumes required Automated Billing Approval tracking by Insurance Class Locate all affected patients for medication shortages and move and notify patients from a single point Tracking of required lab values by medication ensure medication is not administered with outdated lab values No manual calculations of medication doses Location rules for specific medication ensure locations where medications can be administered

5 PegasusEMR Billing Manager Billing Manager : Billing manager utilizes state of the art concepts and procedures to reduce data entry requirements for billers by 70-80%. This reduction allows billers to focus on payer issues, verification and collections. Unique procedures reduce data entry by an estimated 70-80%. Chemotherapy billing calculation are completed by the system allowing a typical 8 hour billing cycle to be completed in 2-3 hours. Single Claim window provides access to all data required to generate a claim Patient Claim status window provides instant access to status of patient claims Auto-posting sends claims to alternate payer and/or set to patient responsibility Automated line posting eliminate data entry required for manual posting of line items Procedure Payment analysis at the point of posting, enables the users to address underwater claims immediately Manage procedure referrals and authorizations Eligibility tracking and prioritization Payer / Patient Credit management and reconciliation Dynamic patient statement management Advantages: Elimination of manual calculation of chemotherapy appointments Elimination of paper fee tickets means no lost billings System manages referral and authorizations remaining Multiple statement schedules allows balancing of incoming payments Claim Statuses displayed by Last User, Status and Balances allows user to prioritize focus based on dollar amount User can produce a detailed underwater claim list by payer in order to facilitate reimbursement by individual payers.

6 PegasusEMR Oncology Case Studies Oncology Case Study Overview PegasusEMR was requested by Oncology Physicians Resource (OPR) to provide costs effective simple solutions to provide Chemotherapy functions and Inventory management for oncology offices. The WANTS The anticipated need was to provide new inventory software in order to reduce the expense of existing equipment. In addition, to provide a basic documentation tool for chemotherapy tracking. The NEEDS PegasusEMR engineers quickly determined that the primary requirement (need) was to reduce the risk factors associated with chemotherapy management, inventory tracking and associated billing. Risks Factors PegasusEMR process engineers worked with several oncology groups through Michigan and Ohio to determine the NEEDS vs. the WANTS for the Oncology industry. During an 18 month period, PegasusEMR identified numerous significant errors of unacceptable risks associated with chemotherapy management. Dosing Calculations Dosing was done primarily by hand. It was/is difficult at best to ensure the correct weights are available as well as the correct lab results. Once calculations were complete, a second resource would spend time to verify the calculations. Inventory Tracking Inventory was primarily based on Min/Max quantities. In order to eliminate the Min/Max the nursing staff would need to spend significant time weekly to determine the upcoming volumes required. Billing Calculations Chemotherapy calculations were completed in 1 of 2 methods. 1) Nurses would determine the Billing codes via standard KITS, 2) Billers would review all nursing documentation and perform calculations on each treatment to determine correct administration codes.

7 PegasusEMR Oncology Case Studies Risks Factors (Cont d) Treatment Scheduling Chemotherapy scheduling was communicated between Nursing and the Front desk schedulers. This resulted in constant communication back and forth due to the complexity of the chemotherapy treatments. Day 2 may be 20 minutes, Day 3 may be 3 hours. Identified Errors Understand the errors listed below are real life scenarios. These errors are not the result of unskilled resources but are the direct results of inefficient manual processes. Incorrect Billing (Nursing) Nurses are and should be responsible for Medications, Administration and Patient care. They should not be required to know and be familiar with which codes to use for each insurance or which code to use for 120 minutes vs. 180 minutes. Incorrect Billing (Billers) Consistent errors were found by Experienced billing departments due to the number of calculations being performed. Any person when calculating 40 treatments in a day will transpose 120 vs. 180 resulting in loss revenue of $50 per occurrence. If this happens on 1 time a week, this is a $200 / month loss to the practice. Incorrect Dose Calculations Several examples were found where doses were calculated on Old lab details or Old vitals information. The user believed they had the correct data; however, the current system was not conducive to the user having the correct information. Other examples included dosing based on Expired lab results. An example of this process involved a Creatinine value that was 18 days old. Incorrect Treatment Schedules Chemotherapy treatments can become extremely complex when patients are experiencing delays due to blood counts being too low/high for treatment and the general health of the patient is not conducive to treatment. Errors were discovered where patients may have received extra Cycles of treatments due to this complexity level.

8 PegasusEMR Oncology Case Studies PegasusEMR Solutions Scheduling PegasusEMR provided a two stage approach. The first stage was to eliminate the complexity of chemotherapy scheduling to allow a non-nurse level resource to schedule the treatments. This was accomplished by linking Future Labs, Office Appt, Preferred Times, and Duration required for the appointments. This processed solved the immediate problem for non-nursing to schedule chemotherapy. The next stage provided a scheduling system that was so user intuitive and efficient that a Nurse level resource could complete all schedules and print a chemotherapy calendar for the patients. Billing The key solution to the billing issues was to first remove inappropriate functions from the users. Nurses should not be determining billing codes and billing should not be reviewing the detailed nursing notes to determine what was done. The PegasusEMR solutions were the first to develop a Dynamic Chemotherapy Billing generator. Our designers were told many times that this COULD NOT BE DONE. The current billing generator has been in use for over 2 years. The primary benefit is the computer will never make a simple mistake between 120 minutes and 180 minutes. Additional requirements were needed to insure chemotherapy documentation is complete. Several tools were generated to allow the users to compare what was Pulled from inventory and what was Administered to patients. Dose Calculations The next solutions was to automate the dose calculations, and insure the most recent and valid Vitals and Lab results were available. Several key rules exists which ensure doses are recalculated when a patients weight changes by +/- 10%. The user can view all dose calculation based on industry standards to compare the valid doses. Recalculation of doses are handled via percentages of the original order. This provides the consistencies required between treatments. Incorrect Treatment Schedules PegasusEMR provided a seamless and automated process to allow the nursing staff to Move/Hold treatment dates for future dates. PegasusEMR maintains the Relationships between all future treatment dates, Lab test and Diagnostic orders. This allows the nurses to not maintain in process notes to verify that these functions are completed.

9 PegasusEMR Oncology Case Studies PegasusEMR Oncology Summary This has been a summarized case studied based on the three criteria requested by OPR. Several additional features and functions were/have been added over the past several months to further enhance and improve the efficiencies in the chemotherapy offices. These enhancements include billing features to ensure correct payment at the drug level, additional rules, dependencies and authorizations related to chemotherapy treatment to ensure reimbursement from payers and detailed verification functions to handle the increased changes in patient coverage. PegasusEMR provides an Estimation process which communicates to the billing department the anticipated billing for any given patient for the next 3-6 months. This process allows the biller to ensure that the 20-60k treatments have the insurance verified based on the Risk factor of the patients insurance. Thank you for your time reviewing this case study. If you would like more information or a detailed presentation, please contact our office for a PegasusEMR presentations. Alan Geyer CEO / PegasusEMR