MetricsMetricsLessons Learned Lessons Learned Managing RisksManaging Risks

Howard Hays, MD, MSPHHoward Hays, MD, MSPHMedical Informatics ConsultantMedical Informatics Consultant

Carolyn Johnson, RPh, CACCarolyn Johnson, RPh, CAC

Today’s PresentationToday’s Presentation

Metrics:Metrics: ProductivityProductivity Patient Care / GPRAPatient Care / GPRA CollectionsCollections

Lessons Learned / Managing RisksLessons Learned / Managing Risks

Productivity MetricsProductivity Metrics

Provider ProductivityProvider Productivity

All sites see a transient decrease in All sites see a transient decrease in provider productivity (pts/day) at firstprovider productivity (pts/day) at first

Typically takes 1-3 months to recover to Typically takes 1-3 months to recover to pre-EHR levelspre-EHR levels

Mitigate by staggering implementation, Mitigate by staggering implementation, either by provider or by function, or botheither by provider or by function, or both

Efficiencies in other areas (phone calls, Efficiencies in other areas (phone calls, chart reviews) can improve productivitychart reviews) can improve productivity

Provider Productivity (Site Provider Productivity (Site A)A)

0

5000

10000

15000

20000

25000

Feb-

A pr

'04

May-

J ul

A ug-

O ct

Nov-

J an

Feb-

A pr

May-

J ul

Visits Patients

EHR

Site C ProductivitySite C ProductivityAverage General Clinic Patients Per Day Per Provider : June-December 2004

0

2

4

6

8

10

12

14

16

18

20

Jun Jul Aug Sep Oct Nov Dec

Patient Care MetricsPatient Care Metrics

Medication Errors (Site A)Medication Errors (Site A)

0

5

10

15

Sep '03

Mar '04

Sep '04

Mar '05

Sept ̀ 05

E nd of Q tr Med E rrors

EHR

0

2

4

6

8

10

12

14

16

S ep

'03

Mar

'04

S ep

'04

Mar

'05

S ept

`05

Pharmacy Waiting (Site D)Pharmacy Waiting (Site D)

0

50

100

150

Pre-E H R Post-E H R

Pharmacy Waiting T ime (minutes)

GPRA Indicator - GPRA Indicator - Flu Vaccine 65+ (Site A)Flu Vaccine 65+ (Site A)

0

10

20

30

40

50

60

70

80

2000 2001 2002 2003 2004 2005

Percent w/ Flu vax-over65 y/o (GPRA year)

EHR

GPRA Indicator – Pneumovax GPRA Indicator – Pneumovax over 65 y/oover 65 y/o

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005(so

far)

Percent w/ Pneumovax>65 y/o (GPRA year)

GPRA Indicator – GPRA Indicator – DV Screen Age 15-40 (Site A)DV Screen Age 15-40 (Site A)

0

5

10

15

20

25

30

2000 2003 2004 2005

Percent w/ DV/IPVScreening (GPRA year)

EHR

GPRA Indicator – GPRA Indicator – Tobacco Assessment (Site A)Tobacco Assessment (Site A)

0

10

20

30

40

50

60

70

2000 2003 2004 2005

Percent w/ Tobacco UseAssessed (GPRA year)

EHR

GPRA Indicator – GPRA Indicator – Medication Education (Site A)Medication Education (Site A)

0

10

20

30

40

50

60

70

80

2001 2003 2004 2005

Med E ducation(calendar year)

EHR

GPRA Indicator – GPRA Indicator – BMI 2-74 y/o (Site A)BMI 2-74 y/o (Site A)

0

10

20

30

40

50

60

70

80

2000 2003 2004 2005

Percent w/ BMICalculated (GPRA year)

EHR

GPRA Indicators –GPRA Indicators –11stst Qtr ‘05 (Site C) Qtr ‘05 (Site C)

0102030405060708090

TobaccoScreening

TobaccoCounseling

AlcoholScreening

BMICalculated

Pneumovax

EHR Clinic Non-EHR Clinic

Collections MetricsCollections Metrics

EHR Creates the Potential to EHR Creates the Potential to Increase Collections Due to:Increase Collections Due to:

More Complete documentation with More Complete documentation with templatestemplates

Provider notifications – received Provider notifications – received automatically if they forget to enter POVs automatically if they forget to enter POVs or codesor codes

Superbills, ICD/CPT Pick Lists – make it Superbills, ICD/CPT Pick Lists – make it easier to find correct codeseasier to find correct codes

Coding Tools and Training with EHRCoding Tools and Training with EHR

Automatic NotificationsAutomatic Notifications

Superbill link to BillingSuperbill link to Billing

RPMS Billing Package

Coding Tools in EHRCoding Tools in EHR Links to coding sites, reference guides, E&M Links to coding sites, reference guides, E&M

CoderCoder

Medicare/Medicaid/PI Medicare/Medicaid/PI CollectionsCollections

Revenue Site A

$2,754,676

$3,028,828

$2,000,000

$2,200,000

$2,400,000$2,600,000

$2,800,000

$3,000,000

$3,200,000

FY 03 FY 0410% increase

Itemized Billing Collections Itemized Billing Collections Partial EHR YearPartial EHR Year

PI and Medicare

$470,836$575,416

$-$100,000$200,000$300,000$400,000$500,000$600,000$700,000

FY03 FY0422% increase

Medicaid Collections (Site B)Medicaid Collections (Site B)

$2,817,798

$3,268,280

$2,000,000

$2,300,000

$2,600,000

$2,900,000

$3,200,000

$3,500,000

FY2003 FY2004

16% Increase from FY03 to FY04

PI collections (Site B)PI collections (Site B)

29.9 % Increase from FY03 to FY04

$545,798

$709,042

$0

$300,000

$600,000

$900,000

FY2003 FY2004

Podiatry Billing (Site D)Podiatry Billing (Site D)

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

Billed Collected Adjustment

1st Qtr 2004 (1081 pts) 1st Qtr 2005 (1107 pts)

Optometry Billing (Site D)Optometry Billing (Site D)

$0

$50,000

$100,000

$150,000

$200,000

$250,000

Billed Collected Adjustment

1st Qtr 2004 (2080 pts) 1st Qtr 2005 (1824 pts)

Identifying and Identifying and Managing RisksManaging Risks

The Good

The Bad

The Ugly

Lessons Learned / Managing Lessons Learned / Managing RisksRisks

Unsigned notes/orders are invisibleUnsigned notes/orders are invisible Med Rec Supervisor should run “unsigned notes/orders report” Med Rec Supervisor should run “unsigned notes/orders report”

dailydaily Server room environment is critical Server room environment is critical

Backup generatorBackup generator Backup cooling systemBackup cooling system

Decreased provider productivity at firstDecreased provider productivity at first Planned / staggered implementationPlanned / staggered implementation Monitor and adjustMonitor and adjust Tweak templates to facilitate rapid documentationTweak templates to facilitate rapid documentation Future – dictation / voice recognition for some notesFuture – dictation / voice recognition for some notes

Management plan for staffing changesManagement plan for staffing changes Proactive business process planProactive business process plan Medical Records role changesMedical Records role changes

Lessons Learned / Managing Lessons Learned / Managing RisksRisks

HIPAA/Privacy:HIPAA/Privacy: Use of CHAT instead of BROADCAST Use of CHAT instead of BROADCAST

GPRA/CRS:GPRA/CRS: Be consistent:Be consistent:

• Who enters each data elementWho enters each data element• Where/How data is enteredWhere/How data is entered• Incorporate Cheat Sheets in Your EHR Incorporate Cheat Sheets in Your EHR

Medication Order Errors/Frustration at startupMedication Order Errors/Frustration at startup Use Pharmacy Quick OrdersUse Pharmacy Quick Orders

Lessons Learned / Managing Lessons Learned / Managing RisksRisks

Lengthy PCC Error Report (everyone wants to Lengthy PCC Error Report (everyone wants to start the visit)start the visit) Keep a pulse on the error reportsKeep a pulse on the error reports Fixed by patches (soon!)Fixed by patches (soon!) Train providers on visit creationTrain providers on visit creation

Ongoing Cost of Ergonomics, ComputersOngoing Cost of Ergonomics, Computers Go-live is just the beginning – continue to meet Go-live is just the beginning – continue to meet

and train regularly afterwardand train regularly afterward Template approval process in placeTemplate approval process in place Cutting & Pasting can transfer patient A’s data Cutting & Pasting can transfer patient A’s data

into patient B’s chartinto patient B’s chart

EHR-The EHR-The WaveWave of Change of Change

Think of EHR as a tidal wave of change….Think of EHR as a tidal wave of change….How do YOU react to change?How do YOU react to change?

1.1. Do nothing…..Do nothing…..

2.2. Run…..Run…..

3.3.Ride the Wave!!Ride the Wave!!

EvaluationsEvaluations

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