EPIC EMR

nursronnam

Hello,

Just wondering if anyone is using the CDI model in EPIC EMR? I would love to talk about your build if anyone has any information??

Ronna Mahlen, RN, BSN, C-CDI
Valley Medical Center, Renton, WA 98054
ronna_mahlen@valleymed.org
425-228-3440 x 3610

fentona@bronsonhg.org

We are using EPIC....started in May this year. We created our own work flow for it. I understand the next version of EPIC is out, but we are not live with it yet. The next / newest version
Amy Fenton, R.N.
Clinical Documentation Specialist
Bronson Hospital
Quality and Safety
601 John Street
Box 59
Kalamazoo, MI 49007
Phone 269-341-8442
Fax 269-341-8330
E mail fentona@bronsonhg.org


supposedly has a CDI workflow system in it.

angelamckee@uh.org

We have just started EPIC with an original go live date of 6/12, postponed to 10/12 and again postponed to 12/12. We are told there is no EPICCDI module at this time although they are working on a CDI module for the next version. We are separate from HIM and work under PI, however,the Coding Manager and EPIC team have decided how we will use EPIC. The in-basket that coding will use for their post discharge queries has been assigned for our use. This does not allow us to place a clarificationon the chart for all physicians on the case to see. When rotation occurs for physicians we are told we will have to go into the system to changeclarification to present physician. If we want to assign a clarification to more than one physician we will have to enter separate clarifications for eachphysician. We were told that we could assign deficiencies for our clarifications using the in-basket. Now we are informed that deficiencies cannot be assigned until after discharge, which defeats our purpose. During out last meeting with EPIC we found out we will not be able to code in the system even with a stand alone 3M. We are presently coding and assigning DRG's. Are any of you using EPIC in a different way? Do you use Sticky notes, cosign notes or shared notes for your clarifications? I will appreciate anyadvice our CDI Talk team can share. Thank you,

Angie McKee, RHIT, CCDS, CCS, CCS-P
AHIMA Approved ICD 10 Trainer
Clinical Documentation Specialist
Performance Improvement
University Health Care SystemAugusta, Ga. 30901angelamckee@uh.org
706-774-7836

cynthia.a.goewey

We have been using EPIC for 1.5 years now. We query the physicians via their In Basket to a folder labeled "Coding Follow-Up" which is where post-dc queries go (not my favorite place). We are able to assign a priority with our query. The physicians must then place their response in a progress note, op report, DC summary or amend a note. We also tend to e-mail the MD that we have placed a query in their In Basket with the folder name. Some physicians have found their In Basket to be overwhelming as so much information gets delivered to multiple folders.
We do not use EPIC for any of our other work. We have a separate program where we place our information, DRG assignment, etc.
Cindy

cynthia.a.goewey

I also meant to add that it is possible to query more than one MD at the same time, can enter multiple names in the "To" section. I also like the fact that is possible monitor the status of the query, one can monitor when the MD read the query and when they have marked the query "done". Doesn't mean they have done anything with the information but you are able to tell that in their mind they are "done" with the query.
Cindy

megan.barton

We have been on EPIC for over 3 years. Currently we send queries through the in-basket and the provider has to make many "clicks" to respond to the query. In the next few months we are changing and will have a tab in the notes section that will be labeled "query." The CDS will put in a query as a pending note and the physician will answer and sign the note. It will be a permanent part of the record.


Megan Barton RN, BSN
Manager Clinical Documentation Improvement
Health Information Management-Mercy East
Ph: 314-251-6192

mdominesey

Megan,

Can you private email me so I can chat with you about this aspect of querying in Epic?

Thanks so much,

Mark
mdominesey@sibley.org


Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695
W: 202.660.6782
F: 202.537.4477
mdominesey@sibley.org
http://www.sibley.org

angelamckee@uh.org

I also would like a private email.
Thank you,

Angie McKee, RHIT, CCDS, CCS, CCS-P
AHIMA Approved ICD 10 Trainer
Clinical Documentation Specialist
Performance Improvement
University Health Care System
Augusta, Ga. 30901angelamckee@uh.org
706-774-7836

cynthia.a.goewey

Hi Megan,
We would be interested to hear more...our MD's are very frustrated with all the "clicks" it takes to answer a query. We would like to hear further details on how this will work. Cynthia.a.goewey@hitchcock.org
Thanks,
Cindy

sharon.cole

Megan,
I wonder if you could arrange a conference call since you have several people interested. Our docs are moving to CPOE and we have the EPIC system. We have been told we'll be querying through EPIC but no one knows how, too busy with everything else to worry about us. I hate the not knowing and am putting all the emails about EPIC into a file so I'll have some ideas when they get to our portion!
Thanks,

Sharon Cole, RN, CCDS
Providence Health Center
Case Management Dept
254.751.4256
Sharon.cole@phn-waco.org

megan.barton

Sharon,

I will email you what I sent to the others. If there is a desire for a conference call I am more than happy to arrange. I can share what we currently do and what we will be doing in the near future.

Thanks!
Megan

sharon.cooper@owensborohealth.org

Megan,
Could you please also forward to me? We are continuing to work on our query process in Epic.
Thanks,
Sharon

Sharon Cooper, RN-BC, CCS, CCDS, CDIP
AHIMA-Approved ICD-10-CM/PCS Trainer

Owensboro Medical Health System
Manager Clinical Documentation & Appeals
P.O. Box 20007
Owensboro, KY 42304-0007
(270) 688-1277 Office
(270) 316-9088 Cell
(270) 688-2737 Fax
sharon.cooper@omhs.org

TEAM = Together Everyone Accomplishes More!

mary.mcgrady@accuityhealthcare.com

I am interested in participating in this call. We went live with Epic last year for Hosp Billing and Coding, we use a home grown Abstract tool for CDI and communication between coding and clinical documentation specialists. We go live in Dec. with Epic for clinical documentation. I think we can learn from hearing how others are using Epic.

Mary McGrady, MSN, RN
Associate Director Clinical Documentation Program
Department of HIM
NYU Langone Medical Center
560 1st Avenue, TH-193 A
New York, NY 10016
212-263-8557
Mobile: 646-588-9208

angelamckee@uh.org

I would be interested in a conference call.
Thank you,

Angie McKee, RHIT, CCDS, CCS, CCS-P
AHIMA Approved ICD 10 Trainer
Clinical Documentation Specialist
Performance Improvement
University Health Care System
Augusta, Ga. 30901
706-774-7836

vdavis2

We may be going with EPIC in the near future because of our merger with another hospital system. We would like to listen in to the call as well.

Thanks-V

Dana Walker and Vicki Davis with ARMC

Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com

"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens

megan.barton

Great! I will arrange for a conference call/web meeting. If you would like an invite please email me at:

megan.barton@mercy.net

dvitalone1

We went live with EPIC last October. I wouldn't mind being on conference call if possible.


Dawn M. Vitalone, RN, CCDS

dvitalone1

Let me add that we go live with CPOE next week....FUN! FUN!


Dawn M. Vitalone, RN, CCDS

nursronnam

Hi Angie,

Were are two weeks out from go-live. We do have the CDI model within EPIC but it is very primative. Nothing like what I am used to so we have a lot of things we need to figure out

We decided to write our queries as a progress note that every physician can see. It is a two step process in which we identify the type of query and who it is assigned to within the CDI tab then go into the hospital chart and write a progress note using smart text. The physicians are being taught they must respond to the query with another progress note. When CDI reviews chart again and sees the MDs response we are then going to delete the progress note and mark the query complete in the CDI tab. Still working with EPIC on identifying a follow-up system to make sure the notes are deleted??

We are also trying to decided how to calculate the CDI financial benifit. We have an Initial DRG and working DRG option. We are leaning toward comparing the intial to the final?? Any thoughts on this would be great.

Ronna

angelamckee@uh.org

Ronna, Thank you so much for your information.
Thank you,

Angie McKee, RHIT, CCDS, CCS, CCS-P
AHIMA Approved ICD 10 Trainer
Clinical Documentation Specialist
Performance Improvement
University Health Care System
Augusta, Ga. 30901
angelamckee@uh.org
706-774-7836

cynthia.a.goewey

Hi Ronna,
When calculating the financial impact I would suggest being careful using the initial DRG compared to the final DRG. You must review to see if anything else impacted the DRG besides the query. For instance someone comes in with a diagnosis of COPD exacerbation but after study the MD's determine the patient had pneumonia and not COPD exacerbation. If the CDS queried for respiratory failure and this was documented in the scenario of initial compared to final would be a DRG change from 192 to 193, however the query was not for the principal diagnosis. Therefore the impact would be from 195 to 193. We have not found a way to not have some type of manual review to verify the impact of the query.
Hope this helps,
Cindy

cynthia.a.goewey

I neglected to include that part of the manual review is to verify that our cc or mcc was the only cc/mcc. We do not take credit for the DRG change if there are other cc/mcc's on the case.
Cindy

mdominesey

I agree,

For my own abstraction, I also remove from consideration any case that already had a CC or MCC - those cases I will not make a financial impact. I still query and review because I make a quality and severity impact by querying for further specificity.

You still could affect the principle diagnosis selection like with Sepsis, excisional debridement vs non-excisional debridement, Nonrespiratory w/ ventilator vs respiratory w/ ventilator, etc - and this often makes a financial difference.

If you review for severity and risk, the reimbursement will follow.

Mark


Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695
W: 202.660.6782
F: 202.537.4477
mdominesey@sibley.org
http://www.sibley.org

don.cdi.rn@gmail.com

Exactly Mark.

I want to emphasis the work & effort that can be involved with the type of abstraction that Mark describes -- one has to actively determine if the condition that you queried for was coded and then how the case would group without that specific diagnosis prior to deciding if one has made an impact (whether financial, ROM or SOI).

It is certainly quite possible that one can not make an impact but still measurably contribute to the specificity and quality of the data captured for the case.

In a sense, the primary purpose of a working DRG is to help organize and prioritize one's concurrent work and activity. A working DRG is not helpful in calculating financial impact UNTIL the manual audit process several of us have described is performed. At that point adjustments can be made to the working (or initial) DRG to compare to the final coded DRG.

If anyone is attributing the potential gains ($, ROM, etc) that have been missed by physician lack of response, a similar process also needs to take place.

Don

don.cdi.rn@gmail.com

Ronna,

Your process sounds intriguing.

What version of EPIC are you installing?
Ours has no CDI model (I think we are still on 2009 and working toward 2010).

Do be very careful about the progress notes as you describe. Don't let yourself be pulled into writing a progress note that the physician only co-signs (or adding to the active medical problem list). IMHO, there is risk there for argument about how carefully the physician reviewed the note especially if the documentation is not carried forward consistently.

Why do you want your query notes deleted? For many organizations though not necessarily even a majority, the concurrent and post-discharge queries are part of the legal medical record. The AHIMA guideline leaves this decision up to the individual organization.

Looking back through the on-line polls, 20% CDI queries in 2008 were part of the LMR & then in 2010 29%. The 2010 Benchmarking report released Jan 2011 was about the same (23% yes, 10% some queries are, other queries are not).

Don