The Falcon Insights
Providing thoughtfully developed insights from our industry experts through an innovative lens
Providing thoughtfully developed insights from our industry experts through an innovative lens
In a recent press-release, Walgreens acknowledged it will begin implementing Epic Systems Corporation’s EHR, EpicCare, at its more than 400 clinics across the country. The implementation is slated to kick off in early 2016. The move to implement Epic and its CareEverywhere interoperability platform echoes several industry trends that we have seen over the past several years. First, the scope and penetration of retail medicine through urgent care centers and clinics like those at Walgreens and CVS continues to increase, as billing guidelines for midlevel providers continue to become more broadly defined, making it possible to staff retail clinics with fewer physicians at lower cost. Similarly, the increased number of insured patients across the country increases access to clinics like those at Walgreens and CVS.
Walgreens’ Epic implementation is similar to that announced by CVS several years ago. CVS announced its implementation of EpicCare Ambulatory in 2014, and has since brokered numerous data-sharing partnerships with leading health systems across the country that also use EpicCare, including Sutter Health in California and Millenium Physicians Group in Florida. Both projects focus heavily on interoperability and the importance of exchanging data with other healthcare providers. Dr. Patrick Carroll, CMO of Walgreens Healthcare Clinics, stated the project will enable Walgreens to “deliver better health outcomes through greater care coordination and interoperability” (http://www.healthcareitnews.com/news/walgreens-goes-epic-ehr, 2015). CVS’s program focuses similarly on interoperability.
The increased focus on interoperability has become a hallmark of EHR implementations over the past several years. As Meaningful Use matures and enters into Stage 3, providers will be held increasingly accountable for their ability to coordinate care with other physicians and provider organizations. According to the Stage 3 Objectives, provider organizations will also have to interact with health information exchanges when referring patients and transitioning care to another institution for a notably high percentage of encounters (40%). CVS and Walgreens are notable examples of large organizations choosing to begin implementing CareEverywhere in advance of the CMS directive and will therefore assist with our ability to effectively transmit data between healthcare providers.
According to Carl Dvorak, Epic President, Walgreen’s implementation of CareEverywhere will make them the largest member of the “nation’s largest network of care organizations securely sharing patient information with hospitals, laboratories, private practices, federal agencies, local care providers and state HIEs” (http://news.walgreens.com/press-releases/general-news/walgreens-healthcare-clinics-to-implement-epic-electronic-health-record-platform.htm, 2015). This development is significant because it underscores the increasing and paramount importance of data-sharing, privacy, and coordinated care to our healthcare system. By coordinating care between physicians and streamlining medical records between organizations, providers will have the opportunity to view a patient’s medical history in its totality. This will enable better clinical outcomes, more robust reporting options, and a better overall patient experience.
Large-scale projects like these underscore the importance of investing wisely in interoperability early and ensuring your systems are capable of transmitting patient data securely to other organizations and to your patients themselves. For more information about Falcon’s work with interoperability and clinical outcomes, please reach out to Steve Weichhand at email@example.com.
Falcon Consulting has relocated its National Headquarters to 70 W Madison Chicago, IL. This move represents a further embodiment of innovative and collaborative culture, which Falcon leadership is adamant defines who they are as a firm. Brendan Downing, CEO, says “It was time we relocated to an office that matched the innovative, collaborative and strategic culture we pride ourselves on”. The new office boasts a bright and open floor plan with no personal offices and, from the 26th floor, expansive views of Chicago’s best assets – the bustling loop and the beautiful lake. Downing added, “We approach our engagements exclusively through industry leading teams of experts, and we wanted to reinforce that approach with space that is interesting to work in, invites collaboration and fosters a collegial environment between our clients and practitioners”. Falcon Consulting has seen tremendous growth and the new headquarters is one that will support continued success and enhance an already impressive firm culture.
Employees of the firm are raving about the environment and how the space has really improved their ability to quickly create solution teams, solve client problems, and brainstorm through new innovative service offerings. “I love walking through the loop to work every day and can’t imagine a better place to support me taking my career to new heights”.
A pressure ulcer is predominantly a HAC that commonly affects the elderly. Medicare data shows a pressure ulcer rate of only .20%, but surveillance data suggests an actual rate 10 times higher than that. This discrepancy indicates that coders are either missing provider documentation related to pressure ulcers, or that providers are not documenting or under-documenting this condition.
Clinical documentation improvement specialists (CDI) or coders generally limit querying to cases where some documentation exists related to the pressure ulcer. At many organizations, mid-level providers, such as wound care nurses, physician assistants, and nurse practitioners, help deliver better clarity in documentation, but the hiring of mid-level providers adds significant costs.
Instead of relying solely on queries or additional staff, organizations can improve both the capture and specificity of documentation by properly leveraging their EHR. The methods discussed here will empower your experts to identify and describe the pressure ulcer and allow your providers to sign off on the documentation and incorporate it into their notes.
Who are your subject-matter experts? Wound care nurses assess and document pressure ulcers every day, but how can we take advantage of their knowledge in a way that improves provider capture of pressure ulcer diagnoses? By empowering them with the ability to update the EHR-based problem list manually.
If a provider never mentions the pressure ulcer in a note, then coders are unable to code it, and the condition can’t be reported for quality and financial purposes. By allowing wound care nurses to add, change, or remove a pre-defined set of pressure ulcer problems, and by promoting a partnership between nurses and providers, your organization can achieve better capture of pressure ulcer diagnoses not only on the problem list, but also in provider documentation.
If wound care nurses can add a pressure ulcer diagnosis to the problem list, they must understand the language and/or wording that will yield the greatest detail and specificity for the diagnosis, particularly with the upcoming transition to ICD-10. For pressure ulcers, this detail should include:
Using this embedded information as a guide, your wound care nurses will be able to document with greater specificity during the pressure ulcer assessment. After completing the assessment, nurses should then add the appropriate pressure ulcer diagnosis to the problem list. The problem selected should contain as much detail as possible and reflect the documentation captured during the assessment. “Pressure Ulcer of foot” and “Pressure ulcer of foot, stage 3,” for example, have the same ICD-9 code, but different ICD-10 codes. While nurses are not diagnosing the patient – they are communicating the condition to the provider –they need to choose a problem that includes the relevant clinical details to assign an ICD-9 or ICD-10 code.
If, at your organization, floor nurses normally assess the majority of pressure ulcers, provide floor nurses with access to update the problem list as well. If floor nurses assess, but do not always stage, pressure ulcers, consider configuring your EHR so that the capture of pressure ulcer documentation by a floor nurse triggers the patient to be added to a custom worklist. Wound care nurses monitoring this work list can then assess the patient, document an ulcer stage, and update the problem list after that.
Once a pressure ulcer diagnosis is on the problem list, it can be incorporated into the provider’s note seamlessly. Many EHR systems support tools – commonly referred to as “links” – that allow providers to pull information into their notes from elsewhere in the patient’s chart. Additionally, most EHR systems support the development and use of note templates, which may include links to important patient clinical information, such as recent vitals, lab results, and current home medications. While coders cannot code based on the problem list, they can if the problem list is included in the physician’s note, so we suggest including a link to the patient’s problem list as well. Your wound care nurses have already completed the difficult task of identifying, classifying, and adding the pressure ulcer diagnosis to the problem list. If your IT team embeds a link to the problem list in all provider note templates, the provider won’t need to remember to document the condition, for it will be linked into his or her note automatically.
At this point in the workflow, your clinical documentation specialists are happy. The pressure ulcer problem, as added by the nurse and now seamlessly displayed in the provider’s note, includes detail related to site, laterality, etc. Certain key information, however, such as gangrene presence, may have been missed. Coders also like to see documentation regarding any additional associated conditions (if applicable). Therefore, in the next and final step of this workflow, the provider can add, remove, or modify the pressure ulcer documentation as necessary. The provider then signs off on this documentation by filing the note to the patient’s chart.View News Article
While Meaningful Use Stage 3 (MU3) requirements have yet to be set in stone, information regarding them has been released to the public. Stage 3 is a sweeping initiative, and the proposed regulations currently weigh in at some 300+ pages. With that in mind, we are focusing on a specific topic contained within the legislation that is being updated for MU3. It reads as:
Proposed Objective: The EP (Eligible Professional), eligible hospital, or CAH (Critical Access Hospital) provides a summary of care record when transitioning or referring their patient to another setting of care, retrieves a summary of care record upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their EHR (Electronic Health Record) using the functions of certified EHR technology.
Proposed Measure 1: For more than 50 percent of transitions of care and referrals, the EP, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care: (1) creates a summary of care record using CEHRT (Certified Electronic Health Record Technology); and (2) electronically exchanges the summary of care record.
Proposed Measure 2: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP, eligible hospital or CAH incorporates into the patient’s EHR an electronic summary of care document from a source other than the provider’s EHR system.
Proposed Measure 3: For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP, eligible hospital, or CAH performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets:
This information, gathered from the federal register, reveals that MU3 places a renewed emphasis on summary of care documentation at three points: sending, receiving, and consolidating information. Each of the proposed measures has specific implications for organizations as they struggle to comply with Meaningful Use regulations, but they all impact two core components- workflow and clinical outcomes.
Each of the three proposed measures has a significant workflow impact. The first measure requires EPs to create and disseminate a summary of care record for their patient as they transition to a new provider, the second requires that EPs retrieve a summary of care record from an outside EHR, and the third requires that EPs reconcile clinical information. All said, workflow definition and standardization is a critical component of compliance and organizational success, and as providers undergo change, it is important to reinforce them with organizational structure.
Organizational structure in this instance is a reference to providing a best practice workflow and clearly defining who qualifies as an EP. Providing optimized processes for these providers to comply with Stage 3 is important for consistent compliance with the proposed metrics. Additionally, as these providers experience change, they will require support and timely feedback from administrative staff. That means tracking provider compliance metrics and disseminating that information to the healthcare professionals that are being measured, and then determining what is and is not working for your organization.
The clinical benefit of this proposed requirement is that it provides an electronic trail of a patient’s care, and in so doing, provides additional context for clinical decisions that are made along the way. Summary of care documents are a documentation tool that a patient’s current/former provider sends to their future provider in order to have details and notes about a patient’s healthcare on hand. These files can then be used in case the patient is unresponsive, or simply to have a better understanding of the care that has been rendered. Since Meaningful Use exists largely to improve clinical outcomes, this is a step in the right direction- particularly since the healthcare arena is shifting its emphasis towards continuity of care.
An additional clinical benefit derives from the requirement to reconcile clinical information. Not all patients are compliant with their medications, and not all information that clinicians receive is up to date. This opens the door for medical errors to occur; however, the odds of these medical errors happening can be reduced by simply verifying that an EP is working with the most current information.
With the industry uncertainty our healthcare system is experiencing as organizations gear up for Stage 3 of Meaningful Use, it is difficult to predict the impact that these proposals will have and the best way to deal with them. That said, we believe this particular proposal will allow physicians to make more informed decisions and move towards an uninterrupted stream of information regarding a patient’s continuum of care.
Ultimately, it is important to take a step back and view Meaningful Use in terms of the larger picture. Many healthcare professionals see MU as just another hurdle they must jump, but we cannot forget that Meaningful Use has a purpose. It is intended to improve outcomes, save lives, reduce disparities, and empower individuals. CPOE for referrals and transitions of care summaries will be a significant step in the right direction, as integrating communication across the entire continuum of care is a core objective of Meaningful Use. If you have further questions or inquiries regarding how Falcon can help navigate this terrain, do not hesitate to reach out to our Clinical and Revenue Cycle leads, Steve Weichhand and Matt Curren, for more information.
More than ever before, patients are taking an active role in managing their own health. The Healthcare Financial Management Association (HFMA) featured a story in the April issue of HFM Magazine on the criticality of expanding patient access . The article hinges on the necessity for healthcare provider organizations to achieve the long-elusive goal of “offering patients access to the right care at the right time and in the right place” in order to attract and retain patients. That goal may sound a lot like meeting the stereotypically unrealistic expectations of the millennial generation – they want everything and they want it now – but patients of all ages are beginning to demand more comprehensive, convenient care.
Overall, increased patient engagement is a positive trend; however, rising individual engagement introduces new volatility to the market as patients question their existing care and actively seek out convenient alternatives. Patient demands and expectations become even more important in the context of value-based reimbursement, as payers move toward incentive (and penalty) structures tied to metrics such as patient retention and population health management. This rising impact of patient expectations requires providers to improve the patient experience through innovative patient outreach and expanded access to convenient care options.
Providers have responded to the increased demand for convenient and accessible care by expanding their community presence through new partnerships, mergers, acquisitions and affiliate relationships. Strategic affiliate partnerships have become particularly important, as EMR vendors have allowed organizations to sublicense functionality to Independent Practice Associations and community hospitals and clinics. Epic’s Connect program is a prime example of a tech-enabled option that can help healthcare providers to better meet patient expectations for convenient care options as part of comprehensive service offerings.
Connect programs allow organizations to take advantage of economies of scale, which is particularly advantageous when implementing high-cost, integrated EMR systems. Extension of EMR functionality to affiliates also allows for streamlined benefits administration, enhanced integration of patient care teams, improved access to telemedicine programs, and online patient portals. Developing a successful Connect program is a complex initiative, but can deliver technological, financial, and patient care benefits to all parties involved.
Healthcare providers need to start optimizing their approach now to thrive in the new patient choice-shaped marketplace. The ability to manage change strategically will be a key success indicator for providers as they work to improve patient access and engagement by implementing innovative processes and business structures. To learn how Falcon can collaborate with you to develop, implement and optimize key patient access and engagement initiatives, contact Jason Jones (Affiliate Solution Strategy and Implementation) or Paul Buonopane (Customer Engagement Strategy) and view our service line details.Read Full Article
As the healthcare industry moves toward value-based care, providers are focusing on Population Health Management as a valuable strategy to improve patient outcomes and lower costs. Broadly defined, Population Health Management is using analytics to understand a patient population, and then taking action to proactively achieve optimal outcomes. A significant focus of any successful Population Health Management strategy surrounds the selection of a Population Health Management System (PHMS) that helps an organization meet its Population Health needs.
It can be quite challenging to determine a best-fit system when selecting a PHMS. One way to help facilitate vendor selection is to specify what crucial functionality must be available in order to realize organizational goals. For example, many organizations, such as the Anthem Blue Cross ACO, have implemented systems that can aggregate data on patients with multiple chronic diseases. This functionality allows providers to target, and cater services toward, the sickest segments of their patient populations.
According to an article by HealthITAnalytics, the Anthem Blue ACO program saved $7.9 million in one year following the implementation of its PHMS. Thomas Balsbaugh, medical director at UC Davis Health System, one of the six health systems in the ACO, commented on the success of the program: “We’ve observed a decrease in cost per chronic episode. We’ve standardized processes – including care in between episodes. Our case management team has reduced emergency department use, and our care managers have helped patients improve their adherence to medications. But most importantly, we’ve maintained our quality scores while reducing costs, and we have a high rate of satisfaction for both patients and providers.” The Anthem Blue ACO is a fine example of a way in which the organization-specific selection of a PHMS can further a health system’s success.
In addition to selecting an organization-centric PHMS, a simplistic approach to implementing and managing the PHMS is critical. To achieve this simplicity, providers must locate a vendor that is compatible with systems already utilized within the organization. Interoperability allows for the compiling of a large amount of data that an organization can then easily manipulate to discover new knowledge about its patient population. This in turn leads to improved processes, focused service offerings and the relief of care gaps.
The long-term importance of successfully selecting and implementing a PHMS must be understood in order for a health system to properly understand the gravity of system interoperability, maintenance requirements, and its own Population Health goals. In an era where the healthcare industry is consumed by technology and data, many healthcare providers are introducing a PHMS as a means of setting themselves apart from their competitors. By leveraging big data, these innovative organizations have the ability to better understand their patient populations, manage costs, and effectively improve the overall patient experience. To learn how Falcon can help guide you in your PHMS selection process, please contact Matt Rosenthal (Population Health Strategy and Implementation) or Paul Buonopane (Customer Engagement Strategy).View News Article
In Politico recently, Dr. John Halamka, the well-respected Chief Information Officer of Beth Israel Deaconess Medical Center, wrote an article about the importance of transparency in sharing patient information across organizations. He made the point that he himself would not be concerned if his medical records were hacked, as he had already made them public by choosing to participate in the Personal Genome Project. This means that his DNA and health information are public record and reachable/readable by anyone. For him personally as a patient, an HIE, for instance, would be unnecessary as any physician anywhere in the country could retrieve his health information. He even makes a rather bold statement:
”Millennials post changes in their relationship status on Facebook. Is openly sharing immunizations, allergies, and physician orders for life-sustaining treatment any more controversial?”
The importance of patient privacy differs immensely from the act of updating one’s relationship status on Facebook to “It’s Complicated.” Let’s consider the impact using Dr. Halamka’s model of patient-determined privacy choices or, electronically, application settings. Firstly, as savvy as people are with today’s social media platforms, countless individuals are caught off guard when they find out what their boss, spouse, or parent learned about them due to a change in policy or privacy settings on Facebook. As a society, we have become more technologically advanced, but few social networkers are as vigilant as they should be in monitoring “who” sees “what.” Secondly, we should question whether patients are knowledgeable enough to know what they should be sharing. Many patients do not understand why they are taking certain medications, why certain labs are drawn, or why their family history of arthritis might be meaningful to their dermatologist (you get the picture). Lastly, although Dr. Halamka mentions he has yet to experience negative effects from releasing his records – not from his employer, family, friends, or insurer – it is sensible to assume that this good fortune will not be the norm.
Currently, according to HealthAffairs, at least 59% of US Hospitals have an EHR. For vendors and expert consultants working in this space, there is an opportunity to educate healthcare organizations on the security implications of available technology. For hospital and clinic IT support, there is an opportunity to advise organizational subject matter experts and stakeholders on decisions surrounding security. For subject matter experts, there is an opportunity to educate patient-facing end-users on the functionality and security available through organizational transparency initiatives and technologies such as patient portals. This model of engagement will ideally prompt an educated decision from the patient regarding how to proceed in matters related to patient privacy.
Clearly, the technologies referenced above are available today, and by opening a dialog and changing the way we communicate across the healthcare technology spectrum, we could very well set the stage for what Dr. Halamka has predicted will occur – the hacking of health records may become obsolete.View News Article