Multiple Queries in EPIC

evanspx@sutterhealth.orgevanspx@sutterhealth.org
in CDI Talk Archive
For those that use EPIC, or something similar, do you send a query to only one clinician or do you send the same query to multiple clincians?

Here is the issue: Although inefficient, one may achieve more responses by sending a query to both attending and house officer or PA/NP to maximize response rate but a caveat would be that if they offer conflicting responses we need a clear policy as to which “trumps” the other. Or, should we continue to send only one query to the Attending, only? I would like to know how others handle this situation. Thanks,

Paul Evans, RHIA, CCDS

Comments

  • cynthia.a.goeweycynthia.a.goewey
    edited May 2016
    We use EPIC and we send the query to both the resident/mid-level and the attending. The attending always trumps the resident/mid-level in the case of conflicting documentation.

    Cindy
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We use Cerner but we have the same issue. We send one query to whomever is caring for the patient currently when we do concurrent reviews (except in specific scenarios). Retrospectively, most queries go to the attending to clarify.

    We do not send to multiple providers for the reason you listed, I would be concerned about conflict. It seems like this would be a prime denial target even if you had a policy regarding which one would actually be coded. It brings question as to the validity of a dx.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • kshumpertkshumpert
    edited May 2016
    We use Cerner and I forward queries to multiple providers as needed. We do not always know when physicians are rounding and had queries that were unanswered.

    Thanks,
    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Community Howard Regional Health
    3500 S Lafountain
    PO Box 9011
    Kokomo, IN 46902
    Office 765-864-8754
    Cell 765-431-0123
    Fax 765-453-8447
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We have access to the Hospitalist schedule so we generally know who is caring for a patient on a given day. When we have queries go unanswered we will check to see if the queried physician is on the schedule, if they have gone off-service, we will forward the query to the appropriate MD caring for the patient.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    We have the same model as many in that rotating Hospitalist or other specialist may or may not be the 'attending MD" of the day, or for a few days or for a week. Meanwhile, multiple consultants render diagnoses that may or may not be entirely consistently with notes made by other clinicians. The fundamental problem and concern for me would be the issue of dissonance or inconsistency that may be introduced by issuance of multiple and concurrent queries for the same clinical process - what happens when the query responses are in conflict? Example: One MD states the Fluid Overload is acute diastolic CHF and another states this is 'acute non-cardiogenic pulmonary edema".

    We are all aware that ultimately the attending has the final word, but at large and complex centers, there is not even common agreement regarding attribution of the formal attending.


    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I agree with you Paul. This would be my concern too. There may be ways to reduce the impact, we do have a way to retract a query from the MD's inbox in our system so if we were monitoring queries closely, we would retract the unanswered queries after the first response but it would require the CDI to be frequently checking the status of existing queries. Though it may not be happening yet, it seems to me that this would be an easy target for denials. If two providers came to two different diagnoses (or severity of a dx) it seems like this would add vulnerability to the record?

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    IMO, Katy, yes, it could add doubt regarding the validity of a coded condition. Plus, the added work to retract unanswered queries is problematic, and could be considered a questionable practice by many, particularly those sites that consider the query to be a permanent part of the record - (one would not want to delete a query that did not provide the 'desired' response)......


    So, another layer of complexity that is vexing....

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • sabullocksabullock
    edited May 2016
    We have developed an Epic query process where it goes to all the members of the provider (Attending, Residents, NPs) treatment team to begin with and then if not answered it is reassigned to the attending and then goes to his Epic inbasket. Our queries do show in the notes but are not a part of the legal med record but part of the business record and this is determined by "print groups".

    We have a column on the "My List" and "Census" list that the providers use and it alerts them there is a query on the record when they are rounding. This has been slow to implement as we tested and piloted for some time with the adult and peds hospitalist group, then to MICU, Cards/CV and this week Oncology. By Jan. 1, 2014 we will have all services on this process (hopefully).

    It seems to be working well.
    Shelia

    Shelia Bullock, RN, BSN, MBA, CCM, CCDS
    Director, Clinical Documentation Improvement
    University of Mississippi Health Care
    2500 North State Street
    Room H139
    Jackson, MS 39216
    T: 601-815-3079 F: 601-815-9505
    sabullock@umc.edu
    umhc.com
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Shelia

    I would like to share your process outlined with the EPIC build team and also our Chief of Medicine. Do you have any written policies or procedures or work flows you could share with me via e-mail and even with the group at large? Our team is VERY new to EPIC and we have much to learn about the system - it can be overwhelming. Since use of the Electronic Health Record will be standard fare for more and more of us, it may be very helpful for you to consider sending this to Melissa so that ACDIS could consider storing this and sharing in our library as a tool?

    Thank you.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • [Deleted User][Deleted User]
    edited May 2016
    Agreed. I would love to be able to share this on the Forms & Tools Library.


    Melissa Varnavas  |   Associate Director
    ACDIS  |  75 Sylvan Street, Suite A-101, Danvers, MA 01923
    P 781-639-1872, ext. 3711  |   www.acdis.org
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