With our 10.5 software release we formally introduced a lot of the features we've been humming about for the last several months in regards to document classification and indexing.
If you are in healthcare, then you likely know what CPOE is. In case the acronym is not familiar to you, computerized physician order entry (CPOE) is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
As you likely know by now, Extract’s document handling platform can save your users time, improve accuracy, increase EMR adoption, and improve patient care. But what you may not know, is that with a few tweaks of your EMR build and workflows, Extract’s data extraction software can become even more efficient and effective.
The year is now 2017 and we have been a digital society for quite some time, but if you talk with people in the healthcare industry, you will find that paper is still floating around. In 2016, we worked with two major hospitals and you would be amazed by not only how prevalent paper documents are, but how these paper medical documents get copied and moved to different people through the hospital, this is what we call the “Paper Shuffle”.
Aurora sought a way to pull paper results into their lab interface in order to eliminate paper-based results completely while removing the slow and laborious, manual data-entry process. At first, Aurora scanned documents into the EMR, requiring providers to open up scanned documents to view results; but what providers really wanted was to have discrete, trendable lab results in one central location.
UW Health is an integrated health system serving 618,000 patients each year in the Upper Midwest and beyond with 1,400 physicians, 16,500 employees, six hospitals, and 80 outpatient sites. UW Health is governed by the UW Hospitals and Clinics Authority Board, UW Health supports patient care, research, educations and community service missions of the UW School of Medicine and Public Health. UW Health was voted the best hospital in Wisconsin. UW Health has a large transplant program that has been serving WI for over 40 years.
One of the major attractions of having an EMR system is the ability to track and trend patient data. Ideally, with a click of the mouse a clinician should be able to instantly see trending lab results to influence their diagnosis. According to a studyby Mayo Clinic, 60-70 of clinical diagnoses and treatments are based off of lab results. In fact, the importance of having complete and accurate lab results in the EMR was included in step one of the Meaningful Use guidelines, as stated on HealthIT.gov.
In the medical field, if you are an organization that receives incoming faxes of documents, you could have dozens of different categories. However, if you are part of the organization that manages lab results, the most important documents are those lab results, then everything else. In a world consumed by managing documents, proper classification and routing is critical to controlling these lab results. CAP Today outlined the need for lab documents control in their article, Bedeviled by Documents, Labs Seek Control.
Let’s be honest. We could all use an extra hour in the day. Or two… or three… or even just 30 minutes!
In working with labs we have found one of the biggest pain points is the inability to find the time to scan or fax in lab results and manually enter the data into the EMR. This is an enormous issue, considering if these results aren’t entered into the EMR quickly and accurately, someone’s life could be in harm’s way.
What I know for Sure:
Discrete, trending data is the bread and butter of a specialty clinic.
Hunting and pecking through the media tab to track down information on a patient is infuriating! And not only for the doctors. For nurses. For abstractors. For the patient! Trending a post-transplant patient's drug levels alongside their medication doses, rejections, infections, transplant history, UNOS data, procedures, and relevant transplant-related scores is of paramount importance to a clinician and is very time sensitive. Getting all patient data into the EMR is the holy grail when it comes to specialty medicine.
Specialty clinics, especially transplant clinics, are mini-ACOs.
When you are treating an acute, chronic disease it is critical that everything about the patient is known regardless of where they are being treated on a daily basis. Luckily, we now live in a world of Care Everywhere, CCD documents, and reference labs…BUT, despite what everyone wants to believe, these things are not a panacea.
Paper is very much alive and well in the healthcare world.
Sometimes clinicians are "closet paper users," other times they just lay it out there. But don't make any mistake about it…they are using. In the transplant world, you may be familiar with the "wall chart." Also known as "the flowsheet" or "the flowchart." You know the one. The monstrous grid that is the holy grail for the transplant clinic, but is the disdain of the HIM team and the project team trying to migrate clinicians to the EMR. But there are good reasons for this chart and the other paper being used. Many hospitals have not implemented effective document management strategies that classify documents in useful ways. And many hospitals don't have the resources to support entering (and QAing) important data discretely as it comes in from external sources (or even internal sources such as the pathology lab).
Specialty clinics are crazy busy.
There were times during my tenure at Epic that I felt stressed. That I felt my days were busy. That I felt it was hard to create work/life balance. And then I'd go onsite and spend a week in a transplant department. Wow. My workday was like a walk in the park! The chaos that is the life of a person in a specialty clinic is very hard to explain or quantify. It seems there is not a moment to breathe. And this isn't just for the doctors and nurses. Even the folks doing data entry are getting calls, being pulled into other things, being tapped on the shoulder constantly. It is nearly impossible to give something 100% of your attention.
Extract's products can help.
I'm a passionate person. I don't back something I don't believe in and I don't work for companies whose product doesn't excite me. When I first encountered the Extract product I was very skeptical. Optical Character Recognition (OCR) with clinical data? Fuggettabout it! However, I've been able to peel back the curtain. The magic isn't in the OCR, it's in the rules, logic, and processing that Extract has fine-tuned while working with numerous healthcare organizations. I've seen it in action. I've seen the product improve with features that allow more reliable mapping to patients and existing orders. I've seen it process large documents and auto-classify subsections of that document and route them accordingly (think referral packets, transplant folks!). I've seen it work. I believe in the product and think it can improve data quality, care quality, data entry efficiency, EMR user happiness, and much more.
Extract's products aren't restricted to specialty clinics.
Yes, it is very easy to see the benefit of using the product to discretely enter lab results or split/file referral packets in a specialty clinic. But once you've seen it in action, it's very hard not to let your imagination run wild. Have an HIM department that is backlogged and needs some help classifying and discretely filing data? Have a natural speech recognition engine that needs some intelligent processing and filing after the output is generated? Have Care Everywhere but wish that you could get some more discrete data from it, such as labs? Still have paper DNR, release forms, or patient surveys coming in and want them to be discrete?
Have any other ideas?
We want to hear them! You can email me directly to discuss your ideas further.
About the Author: Rob Fea
He has spent 12 years partnering with IT teams and clinicians at major hospitals and clinics worldwide during his tenure on the technical services team at Epic. For the vast majority of his time at Epic, Rob supported Epic's Phoenix product, playing a major role in project kickoffs, installation, data conversions, ongoing support, and optimization. During his tenure at Epic, he watched the Phoenix customer base expand from 0 to 55 live and installing transplant organizations. It was a terrific experience and he loved every minute of it. It gave him expansive insight into the healthcare world, especially the solid organ transplant industry. Rob has spent countless hours on the floor in transplant departments observing multidisciplinary visits, committee review meetings, data entry, data trending, reporting, medication dosing, and more.
A consultant who supports analytics for population health and quality of care recently told me that frequently, they can only access 80% or less of the total data needed for these initiatives.
If that data is truly random and characteristic of the whole body of data, than acquiring 80% of it is pretty good, perhaps even great. But what if that 80% comes largely from one population sub-group. What if it represents patients who are local - city-dwellers who live nearby and come directly to your facility for lab work and other tests - while the missing 20% is a completely different population. Perhaps this 20% is defined differently by lifestyle, geography or other variables because that population cannot easily come to your facility?
Tracking data in your transplant care software is a key component of QAPI programs, not only for CMS, but now also with UNOS debating the requirement of QAPI programs. One of the most challenging aspects of transplant program management is ensuring that your Quality Assessment and Process Improvement programs are measuring meaningful and actionable items that lead to program improvement.
Healthcare Informatics recently published an article most of us can relate to—that if you want to remember something important, it helps to write it down. Information is only useful if available. According to the article, Research: Access to Docs’ Notes Increases Medication Aherence, researchers at Geisinger Health System found that patients who had access to their doctor’s notes demonstrated an improved adherence to a medication regimen. [medical record software and information accessibility
Transplant Evaluation Process Part 3 in a 6 part blog series
Once the transplant evaluation visit has been completed, the required testing and other consults that were ordered or deemed necessary need to be completed. Frequently, this is the most time consuming segment of the evaluation process and where automation can be most useful.