Getting the Job Done

Unknown

Please forgive the following rant but I am thoroughly frustrated. Since I came to this facility in latter 2008, I have been talking with leadership about the need for E Queries. I have warned continually that 2013 will be here before we know it and we will not be positioned well for the exponential increase in required queries for accurate documentation that will effect reimbursement and quality (SOI/ROM. I did a demonstration project, had multiple conversations with various senior leaders, sit on the ICD 10 Implementation Planning and Steering Committee and repeat the mantra. It seems that this idea, electronic queries is being treated as just something that would make CDI's life easier. No matter what I say, I don't feel that I am impacting the key peoples' minds in such a way so that they grasp that this has a dramatic impact on the facility's viability.

I know some have at least a working plan in place for an E Query solution in partnership with Cerner. I don't have even a committment yet that is even close. I am truly trying REALLY hard to do the job I was hired to do but frequently feel we are an after thought. What am I missing or not saying?

Help!!!! Please. All comments welcomed, even harsh ones.
Donna

katysuegood@gmail.com

You are not alone!!

I feel your pain. I was hired less than a year ago as CDI coordinator for our tiny (2 RN)program that basically needed to be revitalized from the ground up (it has been unstaffed for a couple years). From the beginning, I expressed teh need for E queries. The hospital is supposed to be going paperless in February. Once the Drs are not in the charts (most are already doing notes electronically, its mainly orders that they write in the chart, we place queries in this section so they will see them), we will have no way to distribute queries. I also have brought up numerous times in our CDI meeting and in our ICD-10 committee the importance of this process being streamlined. For the last 11 months I have been told that our Cerner team is overwhelmed with the EMR process and the Drs are learning the new process and we can not bother them about this issue. NOW, at our last CDI meeting, our physician liason informed me that we need to have an E query process in place by the end of february!!
This is basically impossible. Also, I lack the power to make this happen and resources are not available to help (Cerner). Supposedly, CDI tried to implement E queries a couple years ago and it failed because they were just sent to message center and the MD's just signed them off without answering. I do not want to implement this same process as I feel it will fail again but I dont know what the other options are.


ARGGGGG!!!!


Katy

Unknown

It seems like this is an all too common problem. We all need to
strategize to get executive buy in. Thanks Katy.

Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com

lsipos@monument.health

No kidding! City or Rural-no matter the physician population or size of institution....we all have the same issues. Some days you have to wonder why you even do the job we do. I love my job but over and over again we see there is lack of executive support and physician buy-in. If Hospital Administrators don't back and support the CDS, there is not much of an alternative for us! If there is no consequence for not answering a query it hurts the patient, the institution and the bottom line. For our program, we espouse what we do to benefit the "QUALITY" of patient care. Our Medical Director did not want us to lead with the assumption we were "financial based" as the reason for our queries, and we really have revamped the entire program to show that quality is the reason for our jobs. Either way, it does not matter...it's a brick wall today, tomorrow and next week.
We are currently attempting pDOC (physician documentation) with very little buy in. Implementation is for January and we are designing a template for computerized Queries for Meditech with the desire to be able to place a "delinquency" for the physicians who don't answer them. Even if allowed to do this I don't know that it will make an impact. (We are very rural and there are not physicians waiting in the wings to work here). There is NO consequence now, when physicians do not answer a query-even if it increased reimbursement, increased SOI or LOS. Considering we implemented CPOE (physician order entry) months ago, with only 48% using this, I foresee no change with pDOC.
I would love to see how an institution with a successful query response rate....predictably it would be due to the "Big Dogs" barking enough for compliance of providers.....

katysuegood@gmail.com

Yes, We also have no penelty for unanswered queries. They are not even considered a deficiency. In fact, HIM can often not even get OP notes dictated for MONTHS! We regularly code very complex charts and even death charts without ever getting a death summery or discharge summery.
I personally feel like this leaves us wide-open for RAC review. But, what do i know.....

clare.garrard

Our Cerner product has implemented E queries for both CL DOC and coding. The queries are a Cerner product but can be modified by the end user. The queries are sent to the physician in the message center. They must be modified with the appropriate response prior to being signed versus click-and-sign, which is a huge teaching point for the physicians

Unknown

Thanks Clare for that response. I just found out yesterday that is the
system our facility is planning a serious move to. Donna

Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com