Does your hospital use the Epic software system? Let’s hear about it
Hi ACDIS members, I’ve had a few questions recently regarding the Epic software system. It was a subject of a member’s question on the most recent quarterly conference call, and I’ve since received a few additional e-mails from facilities that are going to Epic, or plan to do so, and are looking for help from experienced Epic users who have been using the system to leave electronic queries and interface with physicians.
If you would like to share your e-mail address, please feel free to leave it right here by leaving a comment on this post, or you can e-mail me directly at bmurphy@cdiassociation.com.
With more and more facilities going electronic, it would be great to see members sharing best practices, implementation strategies, and other ways of helping one another out with this important transition.
Take care,
Brian
About the Author: Brian Murphy, CPC, is director of the Association of Clinical Documentation Improvement Specialists (ACDIS). Brian is also an executive editor in the revenue cycle division of ACDIS’ parent company HCPro, Inc.
Melissa Varnavas | Sep 23, 2009 | Reply
At the New England Regional Chapter meeting today, the folks at North Shore Medical Center in Lynn, MA, demonstrated its version of the 3M e-query system. It generated a very interesting conversation regarding hybrid records, e-query systems, how different vendor programs interact with each other, and how CDI programs use e-queries.
This is a great post that I hope will generate some conversation about Epic specifically and the larger needs of CDI in the coming EMR world.
Don | Sep 25, 2009 | Reply
We are in the struggle / development stages of electronic queries. We are in a slow transitional stage between paper and electronic PN, etc.
There are several potential avenues that I see in EPIC, including the FYI flag, the ‘yellow sticky note’ type section of interdisciplinary communication, in-basket or actual progress notes.
Our struggle is mostly with the medical staff having previously had resistance to the in-basket function (major draw back with the in basket for us as a teaching institution is that many providers are involved on the primary team and AIUI, the query via in-basket only goes to one provider). The resistance from the providers seems to be not wanting to be overwhelmed with too many items, as the it is used for a number of other communication elements. There are also several political aspects to this process for us.
We are using both paper queries and the yellow sticky note section. That section has a real draw back in that it is not readily visible (no pop-up, not at the top of the screen — need to scroll down). However, those providers that are actively interested in participating with the CDI process easily find, read and respond with that tool.
I had just heard about an organization that has successfully deployed using the progress note route, haven’t gotten more info than that at the present time but do plan to pursue further.
One very important aspect to keep in mind, the avenue that you may adopt WILL directly affect whether the query ends up being part of the legal medical record. This may be a significant change to prepare for in ways other than IS.
Don
Dexter DCosta | Sep 27, 2009 | Reply
Stanford Hospital & Clinics exclusively uses electronic queries via EPIC to send documentation queries to Attending MDs. Our physician query response rate (concurrent) is 85-90%.
We have been using EPIC housewide (with CPOE) since July 2008, and transitioned from paper queries to e-queries via EPIC INBOX.
It mght be a good idea to form a small work group of hospitals/users using electronic queries to develop recmmendations/best practice strategies for new users of e-queries.
Dexter Dcosta
Manager, Clinical Documentation
Stanford Hospital & Clinics
Palo Alto, CA
Offce: 650-723-5343
Cell: 573-529-1791
Email: dd’costa@stanfordmed.org
Brian Murphy | Sep 30, 2009 | Reply
Thanks for sharing your information, Dexter and Don.
Kim Hamdani | Sep 30, 2009 | Reply
Please send info on New England Chapter.
Patty Steinbach | Oct 1, 2009 | Reply
Carilion Clinic in Roanoke, Virginia is a 800+ bed teaching facility. We have been using EPIC for Coding queries since July 2008 and CDI inquiries since July 2009 (We implemented EPIC July 2008 and our CDI program April 2009). The CDI documentation of their work is done in SoftMed.
We are a new CDI program but have instituted the following processes:
The CDI inquiries are not a part of the permanent chart,which as Don mentioned, is a major determination of how the inquiries can be provided.
We have a customized CDI “Create Inquiry” link in the patient’s record. Access is given to CDS staff only. This link enables us to create an inquiry that has the message at the top of the screen, followed by a patient summary and links to the patient’s progress notes, labs, other document flowsheets.
The inquiry is routed to a customized Physician/Provider Clinical Documentation Folder that is restricted to messages from our custom link only. The folder is also restricted to the provider “owner” access to ensure inquiries are not delegated to other non physician/extender staff.
The provider can view the inquiry and launch directly into the patient’s notes to document. The requirement for physicians is to complete their CDI inquiries within 24 hours. CDI staff check their outbasket for “completion” of the inquiry and the EMR for documentation or none. CDI then complete their inquiry documentation in SoftMed as agreed, disagreed, or unanswered so we can track compliance.
However, as you all know face to face discussion is usually more successful. If we do not get compliance with an inbasket inquiry, the CDS call and/or meet with the physician to discuss the case.
~Patty
Melissa Varnavas | Oct 2, 2009 | Reply
Hi Kim, you can learn about our local chapters by visiting http://www.cdiassociation.com. Or click on the Tag “local networking” on the right side of this blog.
Also, Patty Spry, RN, Clinical Documentation Specialist at Emerson Hospital in Concord, MA, and Adrienne Gmeiner, RN, CCS, of Lawrence (MA) General Hospital co-chair the New England ACDIS Chapter. The group, active for more than a year, boasts more than 50 members. For information, e-mail PSpry@emersonhosp.org or adrienne.b.gmeiner@lawrencegeneral.org.
Jennifer Woodworth | Oct 6, 2009 | Reply
We have been using Epic w/ CPOE for exactly one year. We transitioned this Spring from paper clarifications to what we named the “E-Clarification” which is an electronic process directly in the progress note. We investigated the ‘In-Basket’ route initailly but physicians reacted negitively to having more messages to read. So far, we have been quite successful but still rely on speaking with the providers as nothing replaces the face-to-face interaction between CDS and Doc.
Let me know if I can provide any more details that might be of help!
Brian Murphy | Oct 7, 2009 | Reply
Thanks Jennifer! I have been sharing e-mail addresses with folks who have contacted me regarding Epic (both those looking for guidance, or those who are using it successfully and are willing to help others). Please contact me for the list of e-mail addresses if you’re interested.
Brian
Julie Weiss | Nov 4, 2009 | Reply
We are a brand new CDI program initiated in August ‘09. Epic was already up and running for some time prior to our program starting. We have had many albeit small, hurdles to overcome. These range anywhere from where in the record do we place the query to physician’s ‘active hospital problem lists’ which tend to be copied and pasted into the record.
We currently place our queries in the ‘physician snapshot’ page of the chart, typically this is seen immediately upon opening a patient’s chart. This is not part of the permanent record.
Overall, I think we are on our way to being quite successful, although I know we have more hurdles to overcome.
I would love to hear from other Epic users and their hurdles.
Jennifer Smith | Nov 19, 2009 | Reply
We have introduced EPIC in the Family Medicine portion of the College of Medicine, and are having some inquiries regarding how other institutions handle the progress note section from a compliance standpoint. Basically we are trying to get a better feel of the auditing process you have in place in regards to office visits and connecting the history portion of the exam. As of right now, when a physician goes in and reviews the past, family, social history and marks it as reviewed, it does not pull it into the progress note. I perform educational chart reviews for the Faculty and am unable to see when they actually do review this information, which prevents me from giving them “credit” for doing this. Have you experienced anything such as this? Do your progress notes pull in any section the physician marks as reviewed?
Thanks so much for your help with this. This has been a rough transition on us all, but we are trying to make sure we stay compliant as it is being implemented rather than years later!
Thanks Again!
Jeni Smith, CPC
Coding/Reimbursement Analyst III
Community Health and Family Medicine
P.O Box 100237 Gainesville,FL 32610
(w)392-4541 x 250(f)846-1825(c)494-5606
j.smith@ufl.edu