Archive for the 'Meaningful Use' Category

Clinical Documentation Improvement and Your TouchWorks V11 Note Forms

We all know ICD-10 is coming. We know that ICD-10 compliance is more than just knowing which code to assign. We know that the increased specificity of the ICD-10 code sets will require physicians to provide documentation that support the assignment of these codes. However, that does not mean physicians will need to document more. It just means that their documentation needs to be more specific.

Implementing strong, physician-focused documentation tools, like customized TouchWorks V11 Note Forms, as part of a Clinical Documentation Improvement plan, is an efficient way to improve physician clinical documentation. By making a few key design decisions and customizing your V11 Note Forms, you can dramatically and positively impact your organization’s transition to ICD-10. The result will be improved patient care, increased physician and coder productivity, and protection of reimbursement and cash flow.

Quality and Continuity of Patient Care

Strategically designed V11 Note Forms offer physicians the benefit of an easier, more efficient workflow. The use of standardized clinical decision prompts adds value by facilitating comprehensive documentation, resulting in a more complete story of the patient’s condition. This allows the patient’s entire care team the ability to manage the patient proactively, resulting in higher quality of care and improved outcomes.

Efficiency and Productivity

Physicians

There is a tendency to address inadequate clinical documentation after the patient encounter. The level of specificity needed with ICD-10 will increase the need for the physician to document a complete and accurate description of the patient visit at the point of care. Customizing the layout of your V11 Note Forms adds the advantage of guiding physicians to document the required clinical information efficiently, ensuring their documentation complies with the ICD-10 coding guidelines, before the patient leaves the office.

Coders

Today, coders address clinical documentation deficiencies reactively by submitting queries for missing documentation. This is a less than ideal approach for two reasons:

  1. It adds several unnecessary steps, slowing the timely completion of the medical record. Without thorough documentation of a patient’s full clinical presentation, coders will have to query the physician for clarification. This will lengthen the medical record completion process.
  2. It ignores the fundamental principle that it is the physician’s responsibility for complete and appropriate documentation to describe the patient’s encounter.

The lengthy query process leaves organizations liable for deficient records, as well as delays in reimbursement due to the additional time spent waiting for physicians to respond to the queries and create the required documentation addendums.

Reimbursement

Proper documentation at the point of care that supports the coded diagnoses and justifies the medical necessity of procedures will:

  • Reduce the number of returned or denied claims
  • Capture the details needed so that physicians and facilities are reimbursed the most appropriate amount for patients’ Severity of Illness, Risk of Mortality, and the care provided
  • Protect payments received from being taken back during payor audits

The Galen Clinical Documentation Improvement (CDI) team comprised of senior-level, certified V11 Advanced Note Specialists, possess a vast working knowledge of both Allscripts TouchWorks V11 Note and the new ICD-10 documentation requirements. The CDI team can help customize your organization’s V11 Note Forms to ensure your physicians are prepared to not only document correctly based on the new ICD-10 coding guidelines, but to also complete their documentation as efficiently as possible.

Galen welcomes the opportunity to partner with your organization to help fast track your physician documentation improvement initiative. To learn more about how Galen can assist your organization move toward ICD-10 documentation compliance successfully, please contact Cynthia Gerson at education@galenhealthcare.com.

Context Matters: Patient Engagement

Patient Engagement has been lighting up my twitter feed like a Christmas tree with aspirations of Rockefeller Center. As a social worker by professional training and an HIT consultant in this era of rapidly growing and changing technology, this excites me. As a Fitbit-wearing mom of two, sister to someone living with stage IV cancer, and daughter to an aging mom, it also excites me, but in different ways. The very definition of this “Patient Engagement” buzzword varies depending on context and who is doing the talking.

The reality is that our healthcare systems are entering an era where health policy is encouraging/mandating certain degrees and types of engagement between patients and providers. In the case of Meaningful Use, it’s receiving the ever elusive patient-generated secure message; in the case of Patient Centered Medical Homes and Accountable Care Organizations, it includes getting and using information from patient surveys, or being available to answer phone calls after business hours. These policy mandates are steps on a journey, and healthcare organizations range from taking their first few steps to being well down this road.

When talking with physicians, there is a whole different conversation happening. Engaging with patients is more about time and follow through. “How can I engage with patients when I see 60 patients a day? How can I get my diabetic population to do a better job of monitoring their blood sugar?” Physicians sometimes get a bad rap in the twitterverse, and there is a perception that they do not want to engage. The truth is, physicians got into this business because they want to help people. Their experiences and the culture of medicine have shaped their behaviors. No, most doctors do not want another mandate that drives new workflows, requires another application, or creates additional clicks, especially if it is an empty, time-consuming policy that provides no real value (think MU2 patient lists & patient reminders). For providers, if Patient Engagement could mean less patients per day, but for those that they do see, the software fades into the background and the patient rises to the forefront, they’d be all in.

Probably no one gets more excited or energetic about the conversation of Patient Engagement than the patient advocates themselves. This is truly an exciting time where the industry is being compelled to ask, “How do we engage?” There are patients lining up, clamoring at the door to say, “We have ideas. We have lived this. We have been sick and hurting within your walls, and we know what can help”. Patient advocates are a fantastic resource for both the experiences they have lived and the knowledge from the vibrant support communities that they are a part of.

What does Patient Engagement look like? There is no simple answer. It is contextual. It is ever evolving. My favorite story of real Patient Engagement is one of a woman with COPD and a compromised immune system. It is important that she get to the doctor regularly, but at the same time she is rightfully afraid of being in the clinic surrounded by sick people. She also sleeps most of the day and wakes up in the evening when her husband comes in from work. Her doctor’s office has worked with her to develop this plan: when she needs to be seen, they schedule her for the last appointment of the day, and then call her when their last patient has gone home. Her husband takes her to the office where they go straight to an exam room that has been wiped down. They have no internet, no wearables (unless you count the oxygen tank), no fancy smart phones – but she is engaged. Her husband is part of her care team. It is beautifully simple and elegant.

We need to address both our human systems as well as our software systems to increase Patient Engagement in a meaningful way. We need to be mindful of the context for all stakeholders and that different approaches may be needed for different settings.

Can HL7 solve your Meaningful Use needs?

By now most healthcare organizations are knee-deep in Meaningful Use (MU) – but a new year means a new stage of MU, which means new requirements, new opportunities for solutions, and new pressures to find the right solution for your organization. That’s where we come in.

Next week Wednesday, February 18, Galen will be presenting a webcast on HL7 interfaces and how they fit into the Meaningful Use puzzle. The focus will be on Meaning Use Stage 2, as only 1% of hospitals and Eligible Professionals completed attestation for that stage in 2014; the bulk of qualified organizations will attest for Stage 2 in 2015 and 2016. The webcast will cover this year’s requirements, thresholds for attestation, new menu objectives, and Clinical Quality Measures.

TIMELINE FOR MEANINGFUL USE:
HL7 timeline

We will also give a brief overview of HL7 messaging and its role in interoperability. The HL7 standard is used by 95% of U.S. healthcare organizations and boasts backwards capability – meaning HL7 is able to be integrated into nearly any existing information system. We will select seven MU2 objectives (shown below) and take an in-depth look at which HL7 interfaces would be appropriate as solutions.

hl7

Next week’s webcast is intended for an audience that have already been exposed to the basics of both Meaningful Use and HL7. However, we have previously presented separate webcasts for beginners on both topics, which can be found on Galen’s Wiki (notably, here are the links for the HL7 Fundamentals webcast and the MU2 Requirements webcast).

You can register for the “Your HL7 Interface and What It Means for Meaningful Use” here.  We hope you can join us!

Looking Forward to MU Stage 3

boy-looking-away-his-palm-background-cloudy-sky-sea-horizontal-42859858

Every year Galen carves out a few days to regroup internally, looking towards the future of the healthcare IT industry, as well as recapping where we’ve come from.  As we do this, I’d like to do the same with Meaningful Use (MU) – reflecting on lessons learned from the past four years, as well as looking forward to MU Stage 3.

The goals for the three MU stages can be summarized as:

Stage 1: Data capture and sharing

Stage 2: Advanced clinical processes and decision support

Stage 3: Improved outcomes

The three stages were originally geared to support the healthcare industry’s move towards controlling costs, increasing quality, and improving patient health outcomes. Since the start of the meaningful use initiative in 2011, the healthcare industry has experienced significant changes with a particular shift toward Accountable Care Organizations (ACOs), where providers specialize in managing outcome risks for patient populations through patient care coordination.

Last month, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) announced a delay to the start of MU Stage 3 to 2017, listing the following benefits for the changes to the MU Stage 3 timeline:

  • More analysis of feedback from stakeholders on Stage 2 progress and outcomes;
  • More available data on Stage 2 adoption and measure calculations – especially on new patient engagement measures and health information exchange objectives;
  • More consideration of potential Stage 3 requirements;
  • Additional time for preparation for enhanced Stage 3 requirements;
  • Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization.

The delay impacts participants who began MU Stage 1 in 2011 or 2012, as they will now demonstrate MU Stage 2 for a third program year in 2016 before proceeding to MU Stage 3 in 2017.  For those who did not begin in 2011 or 2012, the last year to start participation and receive a payment was 2014.  Beginning January 1, 2015, eligible providers (EP) who do not successfully demonstrate meaningful use are subject to a negative payment adjustment. EPs who attest for the first time in 2015 will not receive an incentive payment, but can still avoid the penalty.

ONC and CMS have also proposed a new approach to the Certified EHR Technology (CEHRT) certification process, though the “2014 Edition” will still remain the baseline.  Vendors who have certified applications to the 2014 Edition will not need to recertify their products, and providers participating in incentive programs will not be required to upgrade beyond a 2014 Edition CEHRT application.  Per CMS, the goal of the new approach is to “to provide public input on policy proposals, enable our certification processes to more quickly adapt to include newer industry standards that can lead to greater interoperability, and add more predictability for EHR technology developers”, all the while allowing vendors more time to react.

As of January 12, 2015, CMS has not released a notice of proposed rulemaking (NPRM) for Stage 3, or the corresponding ONC NPRM for the 2017 Edition, or proposed interim 2015 Edition of the ONC Standards and Certification Criteria.  They document current recommendations for Stage 3 on their website.

CMS and ONC will continue to review all stakeholder comments before the final rules are published. The following is a sampling of feedback that has already been presented.

Stage 1 Lessons Learned

In the beginning, providers and healthcare organizations were challenged to understand what was needed. It took the organizations time to assemble teams with the right skills, build the infrastructures, and learn new processes to support Stage 1 requirements.  And while the incentive money has been a valuable motivational tool for providers and organizations, it took time to gain their attentions and to learn new requirements.

Stage 2 Lessons Learned

Transitions of care require community infrastructure and cooperation, with a reliance on patient actions and costly technology. To meet the new criteria, organizations have had to define new strategies, processes, and workflows for referrals and transitions of care.  It was, and still is, challenging to implement additional technical and organizational infrastructure in time for attestation.

Resource needs are greater in Stage 2 to develop the understanding of the requirements of the multiple activities and the coordination between the multiple vendors (MU, ICD10, PQRS, eRx, Direct Message IDs, etc.).

Key Takeaways and Recommendations for Stage 3

One of the biggest lessons learned is to allow enough time, especially when the objective is to improve outcomes and reduce costs, all the while emphasizing interoperability, care coordination, and quality of care.

Stage 1 and 2 are two-year reporting cycles, but the implementation required more, sometimes up to five years. The Stage 3 implementation could take even longer considering the stricter vendor requirements, higher user adoption, the fact that obsolete systems must be replaced, and that new systems must be integrated to support these measures.  CMS and ONC need to allow sufficient time for those changes in organizational infrastructure and workflows, meaning all required materials, such as CQM specifications, need to be available at least eighteen months before the start of Stage 3.

In addition to important time considerations, recommendations from providers and healthcare organizations include:

  1. Providing additional incentives for interoperability.
  2. Improving financial incentives for ACOs to assume risk and reward providers that do share risks.
  3. Streamlining high-value quality measures.
  4. Considerations for the impact on usability, development and implementation costs.
  5. Reconsideration of the “all or nothing” approach to attestation and full year reporting.
  6. Allowances for group reporting as is done with PQRS.
  7. Avoiding measures that require third party action (patients and other care settings). Engage patients, but do not force their engagement.

Healthcare organizations and EPs have gone through many challenges since the beginning of MU.  CMS and ONC responded to the providers’ feedback by delaying the start of Stage 3, and their intent is to deliver a final rule with smaller, more incremental changes that will be smoother for organizations to adopt. In addition to incorporating the lessons learned from Stages 1 and 2, organizations recommended that Stage 3 align with other pertinent healthcare initiatives such as ACOs.  We look forward to receiving the Stage 3 final rule sometime in Q1 or Q2, with new requirements that will hopefully result in the adoption of positive, manageable changes for healthcare organizations.

Reference: http://www.cms.gov/eHealth/ListServ_Stage3Implementation.html

Syndromic Surveillance

Syndromic

Syndromic surveillance is a method of collecting and using clinical data for the early detection of potential disease outbreaks. For Meaningful Use Stage 2, there are several scenarios in which Eligible Providers (EP) can meet the Syndromic Surveillance Menu Set measure.  Each of those scenarios can be grouped into one of two categories:

Syndromic Surveillance is Available in your State

The first scenario occurs when an EP has been submitting information using an ONC certified EHR prior to the EP’s MU Stage 2 attestation, and continues to submit during the reporting period.  At this point in time, very few EPs fall into this category, but for those who do, no changes are necessary.

The next scenario happens when an EP registers intent with the state within 60 days of the reporting period and achieves ongoing submission of data for the reporting period.

Syndromic Surveillance is not Currently Available in your State

For many states Syndromic Surveillance is not yet up and running, so ongoing submissions are not an option for meeting the measure.  In this scenario CMS requires you to register intent with your state within 60 days of the start of your reporting period. Once you’ve registered, intent your organization will need to engage in the required validation and testing, or wait for your state to approach you about validation and testing process.

The key to this measure is to register intent within 60 days of your EP’s reporting period.  For 2015 that would be March 1st, so make sure to mark that date on your calendar.

 

Sources:

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5301a3.htm

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_1_SyndromicSurveillanceDataSub.pdf

 

 

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