Next week, the UNOS Transplant Management Forum takes place in Orlando. It is a remarkable environment, where administrators and other transplant leaders come together to discuss ideas, share their expertise and thoughts on best practices.
As the 2017 UNOS Transplant Management Forum rapidly approaches, I've been reflecting on the impact Extract has made with our transplant customers over the last year. It seems like yesterday that I was writing my reflections on UNOS TMF 2016 (you can read that here).
In most healthcare institutions, medical procedures are associated with orders or encounters. An order (or standing order) can be defined as rules, regulations, protocols, or procedures prepared by the professional staff of a hospital or clinic and used as guidelines in the preparation and carrying out of medical and surgical procedures. An encounter can be defined as a health care contact between the patient and the provider who is responsible for diagnosing and treating the patient.
Earlier this month, Dr. Thomas Starzl, the father of organ transplantation, died at the age of 90. In reading an article about all that he did to ultimately discover what was needed to successfully transplant organs, one cannot help but to be awed by the uncertainty and risk that he needed to “work around” in order to make progress.
So, you're thinking of migrating to Epic's solid organ transplant module Phoenix? Or did you recently switch? The Phoenix product has come a long way since its initial release around 10 years ago. It is a great way to effectively manage your transplant population within the fully-integrated Epic suite of products. I helped to support the first 40 or so Phoenix go-lives during my Epic tenure and take great pride in the application.
If you've read prior HealthyData blogs such as this one, then you know that we're doing some pretty "classy" things when it comes to handling your incoming documents. This includes putting those documents into the correct section of the EMR chart with nothing more than a quick once-over. This is something we're very excited about and are quite confident that it will change the way document handling is viewed by your organization.
Our previous blogs on Quality Assessment and Process Improvement (QAPI) in this series have focused on designing objective measures and using those to monitor key aspects of our transplant programs. Today, we want to discuss what to do with those measures and how to translate them into successful process improvement projects.
Recently, Andy Slavitt, the CMS acting administrator, announced that CMS will likely end the Meaningful Use program this year.
Does that mean that the hopes of an internet-worked healthcare system that’s able to seamlessly share health information are completely dashed before interoperability truly got off the ground?
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.
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.
The Initial Evaluation
The evaluation process is really the lifeline of your program. If not done properly, your program will lack good candidates for transplant or will have insufficient patients to transplant. This is a critical topic! In our first blog of this series, we focused mainly on what happens when a new patient is referred to your program.
Yesterday, the prestigious Institute of Medicine (IOM) announced a soon-to-be-released report highlighting diagnostic errors as a persistent “blind spot in the delivery of quality health care” and urges the healthcare industry to change in order to address the prevalence of diagnostic errors, which the IOM defines as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.”
You have successfully set up your outreach program and established a strong local presence (please check out my 4 previous posts on this topic). What now? In order to achieve sustainability, you will have pressures to improve efficiency, reduce costs and demonstrate value. It is important to have in place a methodology by which you track your activity from both a quantitative perspective as well as to be sure that the quality delivered matches the quality of your main program.
In our first three blogs of this series, we discussed how educational outreach can lead to opportunities to facilitate more effective patient care locally and strengthen relationships with referring providers. We have focused on the structure of these efforts; now we will focus on the provision of these services and how to differentiate your efforts from others to ensure your investment pays dividends.
As I’m standing in line at my favorite coffee shop, I’m thinking about how baristas have perfected workflow; and now have improved perfection by allowing me to eliminate the line entirely by ordering in advance with my smart phone. It always excites me when I see a sequence of steps refined for optimum efficiency. I know it's odd, but I'm really strange like that.
In our first two blogs of this series, we discussed outreach programs beginning with education and facilitating improved patient care in the local community. What happens when the success of these efforts require a more frequent and sustained presence in the local medical community, particularly if the main facility is at a distance and precludes frequent visits by your team? In these cases, it may be beneficial to consider establishing your own brick and mortar facility to provide services to the patients on a routine basis.
In an article in Forbes business magazine today, Peter Ubel, begins to investigate the question of whether or not we should be striving for a world in which all transplant candidates should have access to LearJets so that they can place themselves on multiple waiting lists and have a greater chance of reaching the top of that list in time? No matter how you feel personally or professionally about this issue, an important point that he raises in the world of transplant is this: as technology (planes, drugs, etc.) improves and allows for greater possibilities of organs for a greater pool of candidates, how can we be sure that waitlists are always accurate and up to date.
As we discussed in our first outreach blog, step one is to establish a relationship with a provider or a network of providers through education or other interactions. Once you’ve created this relationship, you will want to capitalize on the potential additional volume for your program and institution, as well as be able to continue to provide the outstanding service your program is known for. In order to do this, you must be able to make working with you seamless and easy, without increasing the actual or perceived burden to the organization’s patients.