Automating the extraction of all required information from faxes or other non-interfaced sources, ensures your patients’ safety and complete, compliant information in the EMR. Any solution you use should be matching patient and order level data, collecting physician demographic information, and capturing...
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.
Non-interfaced data in healthcare is the “bane” of all clinical and administrative staff. If data is not interfaced, it’s not in the fields of the EMR, not in flow sheets, reports, trend analysis, etc. It causes more work for it to be moved, stored, and made accessible in EMR as scanned documents or otherwise. It makes continuation of care and quality of care much, much harder.
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.
Should you receive a letter from the Centers for Medicare and Medicaid Services (CMS), the focus will likely be on a failure to meet one of the Conditions of Participation, most likely related to either graft or patient survival relative to expected results. Under the authority of 42 CFR §488.61, a transplant program may request that CMS consider mitigating factors in the re-approval process. There are three general areas that will be reviewed to determine whether a program can be approved based upon mitigating factors. These areas include, but are not limited to, the extent to which the outcome measures are met or exceeded, the availability of Medicare-approved transplant centers in the geographic area or extenuating circumstances that may have a temporary effect on the program's ability to meet the Conditions of Participation.
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.
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.
In my previous post, the fourth in a series of seven blog posts that discuss some of the misconceptions about lab interfaces and intelligent clinical data extraction software, I addressed the belief that if a hospital has an in-house laboratory, all test results will be integrated with the patient record in the EMR.
In a recent Health Informatics Journal article reporting of “true integration” of electronic laboratory results, it was mentioned that transcription errors remain a bottleneck with comprehensive electronic health records. This shouldn’t come as a surprise to those who encounter paper labs every day in their daily workflow. For most hospitals, a significant number of records are interfaced. But if you are working with paper daily, you might think it debatable that manual data entry is insignificant.
As with every study, the article laid out the limitations of this particular study, which focused on blood pressure only, before getting into the detailed results of their work. The seven limitations they named were quite typical, including possible duplicate data and possible non-reporting of improved patients, but the limitation that seemed most unnecessary and raised my blood pressure indeed was, “Sixth, incentive program CQM reporting was based only on the data available in the EHR system of the health care provider. If a patient transitioned to another provider, such as a specialist, the original EHR might not have subsequent, possibly improved, blood pressure values recorded.”
Recently there was a new report that got the attention of my colleagues here at Extract Systems. The headline was “Urgent Change Needed to Improve Diagnosis in Health Care or Diagnostic Errors Will Likely Worsen.” According to this report issued by the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine, most people will experience at least one diagnostic error – or inaccurate or delayed diagnosis – in their lifetime.