IHS - EHR

1. IHS - EHR Indian Health Service - Electronic Health Record Cherokee Indian Hospital Chris Lamer - CAC Steve Doane - Pharmacy Mary Anne Farrell - Medical Staff Colleen Hayes - QA/QI John Hughes - Lab Judy Iskandar - Radiology Tracy Wolfe - Nursing

2. Overview • Visit demonstration • Observe how RPMS and the EHR are utilized in a patient visit. • Preparing for EHR • Discuss how various departments have changed processes to incorporate EHR. • Lunch • Department visits • Hands on practice • Quality improvement and lessons learned

3. Cherokee • Located on the Eastern Band of Cherokee Indian Reservation. • Enrolled Members = 12,669 • Hospital User Population = 10,842

4. Cherokee Indian Hospital • Cherokee Indian Hospital is a 29 bed facility that features a busy outpatient department and other services: • Pharmacy • Physical therapy / wound care • Dental • Contract health services • Eye clinic

5. Mission Statement • To continuously improve the health status of the Eastern Band of the Cherokee nation through a comprehensive health care system sensitive to the culture and values of the community.

6. GOOD AFTERNOON Welcome to RPMS HEAL ER ADMIN RPMS • Resource Patient Management System (RPMS) as the database for patient information. • Developed in the 1970s • The Patient Care Component (PCC) and the Indian Health Service Electronic Health Record (EHR) are tools to enable the entry of patient data into the database. • PCC developed in the 1980s • A number of packages have been added to improve the functionality of the RPMS system.

7. Case Management RCIS Surgery PCC Data Entry Behavioral Health System Elder Care PCC Patient Database Patient Registration Dental Women’s Health Laboratory Emergency Room Immunization Public Health Nursing Radiology Pharmacy CHR Appointment System

8. Case Management RCIS Surgery PCC Data Entry Behavioral Health System Elder Care PCC Patient Database Patient Registration Dental Women’s Health Laboratory Emergency Room Immunization Public Health Nursing Radiology Pharmacy CHR Appointment System EHR

10. EHR Demonstration

11. MEDICAL RECORDS CODING / DATA ENTRY Elista Long

12. Objectives for this Session • PCC Coding Process • PCC Error Report • Pros and Cons

13. PCC Coding Process • Coders and data entry are separate • One coder is dedicated to EHR • Coder utilizes PIMS for provider visits made with EHR • Code from EHR/RPMS not the paper chart • Corrections communicated to provider via • Coding/data entry template • Notification • Broadcasting

15. Demonstration • Broadcasting • Notification

16. PCC Error Report • In addition to data entry clerks, data entry functions are enhanced by clinical providers • Frequent Error Reports should be run • Most Common Errors: • Missing POV • Missing E&M Code • Now E&M codes are mandatory (notifications) • .9999 - Uncoded diagnosis • Duplicate Visits • 2 visits created on the same day – have to be merged • Patch coming

17. PCC-Business Office Communications • Bills are generated before coding has a chance to review the visit • Coding queue is under development

18. Pros & Cons • Pros • Enjoy Paperless • We don’t have to bring the chart to the provider to fix, we can communicate • Incorrect Patient Selected-easier to fix • Cons • Providers can’t correct a code after the claim has been approved

19. Questions?

20. Laboratory John M. Hughes, MT(ASCP), MHS

21. Objectives for this Session • Finishing the Lab Order in RPMS • Lab Only Visits • View Lab Results in EHR • Lab Process Changes • Pros and Cons

22. Patients present to the laboratory, lab is called about an order, or a sample arrives with: • Order sheet • Order number • Neither, but states labs have been ordered • Laboratory must • Find Order in RPMS, or • Enter Order in RPMS (from outside sources) Finishing the lab order in RPMS…..

23. Finishing the Order in RPMS Test Urgency Status Accession -Lab Order # 61840 Provider: LAMER,CHRISTOPHERCLAYTON URINE CLEAN CATCH URINE CULTURE ROUTINE Requested (SEND PATIENT) for: 02/24/2005 Sign or Symptom: Pain on Urination No orders for 02/23/05 No orders for 02/22/05 No orders for 02/21/05 No orders for 02/20/05No orders for 02/19/05 No orders for 02/18/05 No orders for 02/17/05 No orders for 02/16/05 No orders for 02/15/05 Orders for date: 02/14/05 OK? Yes//

24. Lab Only Visits Need to Create Visit for Laboratory? • In house orders – no • Same day orders on-site– no • Orders from different day – yes • Off-site orders – yes • Private sector orders – yes Create PCC+ Form or Add Visit in EHR

25. Lab Only Visits in EHR

26. Lab Only Visits in EHR

27. Lab Only Visits in EHR

28. Lab Only Visits in EHR

29. Lab Only Visits in EHR

30. Lab Results in EHR

31. Lab Process Changes • Patients continue to present for service with or without orders • Visits are created in EHR, no PCC+ forms necessary • “Signs and Symptoms” (lab POV) to the lab are available in EHR • Add on labs continue to be entered in RPMS or EHR and the lab notified

32. Pros & Cons • Visits are created in EHR, no PCC+ forms necessary • “Signs and Symptoms” (lab POV) to the lab are available in EHR

33. Questions