Special Topics in Vendor Specific Systems Unit 4

Special Topics in Vendor. Specific Systems Unit 4 EHR Functionality

Outline • EHR functionality – Results Review – Computerized Provider Order Entry (CPOE) – Documentation – Billing – Messaging Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 2

Results Review • • • Laboratory results • Linked to laboratory information system – Linked to laboratory information system • e. g. , bacterial cultures, complete blood count, therapeutic drug –levels e. g. , bacterial cultures, complete blood count, therapeutic drug levels Imaging results – Linked to radiology (imaging) information system • Linked to radiology (imaging) information system Systems (PACS) • Used with Picture Archiving Communications • Used with manage Picture Archiving Communications Systems (PACS) which digital radiography manage reports, digital radiography – which e. g. , radiology X-rays, CAT scans, MRI images • e. g. , radiology reports, X-rays, CAT scans, MRI images Vendor system differences – Critical results notification Vendor system differences Viewing formats • –Critical results notification • Table/flowsheet format • Viewing formats • Graph for display • Table/flowsheet formatof trends • Graph for display of trends Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 3

Computerized Provider Order Entry (CPOE) • System used for direct entry of 1 or more types of orders by a provider into a system that transmits those orders electronically appropriate department providerto the into a system that(Armstrong, 2000) transmits those orders electronically to the appropriate department (Armstrong, 2000) Medications, Nursing, Laboratory, Radiology/imaging, Provider referrals, Blood bank, Physical therapy, Occupational therapy, Respiratory therapy, Rehabilitation therapy, Dialysis, Provider consults, Discharge and transfer • Medications, Nursing, Laboratory, Radiology/imaging, Provider referrals, Blood bank, Physical therapy, Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 4

CPOE (cont. ) • Potential to alleviate patient safety problems by limiting Potential to alleviate patient problems by limiting – Illegible handwriting – Use of dangerous abbreviations –Illegible Verbal orders. Use of dangerous handwriting abbreviations – Transcription errors Verbal orders Transcription errors • Unintended Consequences – Wrong patient selected from list – Wrong drug selected from list – Changes workflow, may decrease interdisciplinary communication Unintended Consequences Wrong patient selected from list Component 14/Unit 4 Wrong drug selected from list Health IT Workforce Curriculum Version 1. 0/Fall 2010 Changes workflow, may decrease interdisciplinary communication 5

CPOE: Vendor System Differences • Online formularies • e-prescribing Online formularies – Medication prescriptions in ambulatory setting – Health plan formulary – Transmission of the prescription directly to pharmacy e-prescribing • Medication prescriptions in ambulatory setting • Health plan formulary • Transmission of the prescription directly to pharmacy Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 6

CPOE: Vendor System Differences (cont. ) • Decision Support Functionalities – Dosing recommendations and calculations – Customized order setsand calculations • Dosing recommendations • Customized order sets technology – Bar coding scanning • Bar coding scanningadministration technology process (pharmacy – administration) • Medication process (pharmacy – administration) • Right administration patient gets the right drug at the right time • –Right patient gets the right drug at the right time Alerts • Allergy alert • Drug-interaction checking • Laboratory alerts • Medication reconciliation process. Department – Hospital Admission – Inpatient – Outpatient – Emergency Course – Hospital Discharge • Outpatient – Emergency Department – Hospital Admission – Inpatient Course – Hospital Discharge Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 7

CPOE Meaningful use criteria: Non-hospital setting: Hospital setting: • CPOE used for at least 10% of all used for at least 80% of all • • CPOE Non-hospital setting: orders used for at least 75% • • e-prescribing CPOE used for at least 80% of all orders of all prescriptions • e-prescribing used for at least 75% of all prescriptions • Medication Hospital setting: reconciliation performed for at least 80% of relevant encounters & transitions of care • CPOE used for at least 10% of all orders • Medication reconciliation performed for at Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 8

Documentation: Multiple disciplines • Physician • Nurse • Physician Social worker Nurse • Physical Therapist • Respiratory Therapist Physical Respiratory • Other clinicians Therapist Component 14/Unit 4 Therapist Health IT Workforce Curriculum Version 1. 0/Fall 2010 Social worker Other clinicians 9

Documentation: Electronic capture of clinical information • Clinical notes • Visit Note, Discharge Summary, Peri- Clinical – Visit notes Note, Discharge Summary, Perioperative Note • Patient • Vital Sign Flowsheet Patient assessments – Vital Sign Flowsheet • • Medication Administration Record Clinical reports (MAR) – Medication Administration Record (MAR) Advance Directives • For procedures and Consents • Advance Directives and Consents – For procedures Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 10

Documentation: Methods of information capture • Unstructured: • Narrative free-text notes Unstructured: – Narrative free-text notes • Semi-structured: – Structured withheadings some free-text entry Semi- headings • Structured with some freetext entry structured: • Structured: – Check boxes in MAR • Check boxes in MAR – Flow sheet vital signs and patient assessment • Flow sheet vital signs and patient Structured: Component 14/Unit 4 assessment Health IT Workforce Curriculum Version 1. 0/Fall 2010 11

Documentation: Potential Barriers to Implementation • Workflow implications – Increased documentation time Workflow • Increasedmay documentation time – Overuse of checkboxes impact cognitive • Overuse of checkboxes may implication processes s Component 14/Unit 4 impact cognitive processes Health IT Workforce Curriculum Version 1. 0/Fall 2010 12

Documentation: Vendor System Differences Note creation options: • Templates Macros Voice Recognition Clinical • • Clinical discipline • Combination of keys generate a user Software/Embedded • Specialty predefined text set • • Or. Specialty type of note dictation • Or type of note Structured • Macros documentation Copy and paste • Tailored assessments • Combination of keys generate a user predefined text set • Voice Recognition Software/Embedded Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 13

Legal Issues Discovery of electronic records for legal purposes • Discovery of electronic • Centers forrecords Medicarefor andlegal purposes • Medicaid and Jointand Commission – Centers for Medicare and Medicaid Joint Commission • Accepted standards for Legal • Accepted standards Legal Health Record Healthfor Record – HIPAA privacy rule • Organizations • identify “designated record set” Organizations identify record set” to provide patient care? ), not How the information is “designated used (e. g. , was it used where is resides, determines if it is part of the legal record How the information is used (e. g. , was it used to provide patient care? ), not where is resides, determines if it is part of the legal record Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 14

Billing • All vendor systems support these –All. ICD-9 -CM codes (The International Classification of Diseases, 9 th Revision, • ICD-9 -CM codes (The International Clinical Modifications) Classification of Diseases, 9 th Revision, • ICD-10 -CM in October 2013 Clinical Modifications) – CPT codes (Current Procedural • ICD-10 -CM in October 2013 Terminology) • CPT codes (Current Procedural Terminology) Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 15

Billing • • Professional billing (Physicians’ and Nurse Practitioners’ services) – ICD-9 -CM codes • ICD-9 -CM • Hospitalcodes discharge summary or Outpatient visit note • CPT codessummary or Outpatient visit note • Hospital discharge • Procedure (e. g. , surgery) • CPT codes – CPT codes E/M (Evaluation • Procedure (e. g. , surgery) and Management) • Level of evaluation & management service performed at patient visit • CPT codes E/M (Evaluation and Management) • Level of evaluation & management service performed at patient Hospital billing visit – ICD-10 -PCS • Inpatients billing by hospitals Hospital billing • ICD-10 -PCS • Inpatients billing by hospitals Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 16

Messaging • • Internal e-mail Secure email for patients EHR linked automatic text page Intraoffice group communications Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 17

Messaging (cont. ) • Copy chart or lab results to another provider with a note • Telephone message documentation • Patient scheduling • Referral letter or consultation report • Patient follow-up deficiency alerts Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 18

References • Armstrong, C. W. (2000). American Hospital Association guide to computerized physician order-entry systems. Chicago, IL: American Hospital Association Component 14/Unit 4 Health IT Workforce Curriculum Version 1. 0/Fall 2010 19