Functional Automation within an EHR

1. Functional Automation within an EHR Keith Kramer, MD, FACC Wellmont CVA Heart Institute 1

2. Outline • Workflow process improvements • EMR “enhancements” • Electronic decision support • Appropriate Use Criteria • Charge capture

3. Workflow Process Improvements • Define your problem issues • Streamline clinical care • Gain support from providers • Efficiency • Make the product work for you

4. Enhancements • Bonnaroo 2004

5. Options for HPI Template Free text Follow up (example – CAD follow up) VR/Dragon Dictate

6. Order Automation Order Automation

7. Bundled Order Sets Amio – 6 mo CAD – 1 yr CAD – add HgbA1C CHF – 2 wk Lipid – 3 mo

9. Internal Messaging Internal Messaging Have a consistent method

10. Doctor Note

11. RN Communicate

12. Task to Checkout

13. Electronic Decision Support Appropriate Use Criteria Electronic Decision Support Appropriate Use Criteria

14. Appropriate Use Criteria Define “when to do” and “how often to do” a given procedure in clinical context AUC for cardiology AUC provide tools to measure variability and look at utilization patterns

15. EMERGE Medical Solutions Collaborative relationship to develop support for specific clinical pathways Clinically driven Provides electronic decision support Specific clinical pathways - expanded

16. EMERGE Pathways • Nuclear appropriateness • SCD • Sleep • A fib quality measures • PAD/ABI

17. Nuclear Appropriateness

18. Nuclear Stress Testing

19. Emerge SPECT MPI Application • Emerge applications  rules engine functioning within the NextGen EMR • Implemented the SPECT MPI application in October • 22% increase in average monthly SPECT MPI’s ordered since implementation • 12% increase in “order rate” (ratio of SPECT MPI’s ordered to E&M office units)

20. EMERGE & SCD EMERGE & SCD

21. SCD - Recommend Echo

22. SCD - Recommend EP/ICD

23. Recommend EP/ICD

24. Sleep Protocol Yes to 2 or more questions Recommendation

25. Sleep Triggers Witnessed sleep apnea Recommendation

26. A-FIB

27. A fib

28. EMERGE & PAD EMERGE & PAD

29. ABI Trigger

31. Claudication Symptoms Additional “linked” testing

32. Business Implications of AUC • Profile your group against the AUC and MedAxiom • “over” or “under” utilizer, RBM expanding role • Financial Impact • Leverage your data with payers, self-insured employers, payer relationships • Strategic position – high quality/low cost • Transparent reporting of utilization and quality/outcomes data • Negotiate better “per CPT code” rates in recognition of lower utilization

33. Clinical Implications of AUC • Provider buy-in • Quality (low EF, A fib, PAD detection, etc.) • Automation for disease detection and management • More guideline-driven patient care • Efficiency in providing good care to complex patients

34. Charges The following charges are automatically generated for EPM • E & M Charges – The provider can select a higher level on the checkout screen. • ECG • ABI • Smoking Cessation • ePrescribing gCodes • PQRI Codes • Bio-impendence

35. Charge Capture

36. Summary • Define/modify your workflow processes to make your EMR function for you clinically • Use enhancements • Electronic decision tools can improve your patient care, utilize AUC and can have significant business and clinical implications • Automation can be applied to charge capture