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Only 1.5% of the nearly 3,000 nonfederal hospitals in the United States reported the use of a comprehensive electronic medical record (EMR) system, according to a March report published in the New England Journal of Medicine. With so few facilities employing EMRs, why should CDI program managers consider implementing an electronic query system (EQS)?
“Simple,” says Jonathan L. Elion, MD, FACC, founder of ChartWise Medical Systems, Inc., in Wakefield, RI. “We are going electronic. Maybe kicking and screaming, but the healthcare system will eventually use an electronic health record. When that happens, where will your CDI staff stick their sticky notes? Where will they put their paper queries?”
Even if your facility has not made the EMR shift or has no plans to employ an EMR in the coming year, it still makes sense to start planning for EQS implementation now, says Elion.
Define EQS expectations
Traditionally, CDI programs use some form of paper queries. These are either a formal query template (developed in-house or provided by a consultant) or a form of sticky note placed in the patient’s medical record. Some facilities develop special colored forms and dub their queries the “pink” or “blue” or “purple” sheet to capture the physician’s attention.
Many programs also manually track their query data—physician query response rates, CDI/HIM agreement rates, DRG improvement statistics, etc.—using Excel® spreadsheets.
“Spreadsheets are fine,” but electronic systems can help analyze and track data in new ways—ways that can help prove the value of the CDI program as well as outline educational opportunities for CDI staff, says Terry Demers, vice president and chief software developer for Milford, NH–based Demers, Negrete & Associates, Inc., creator of the software package CDIP.web.
Prior to pursuing an electronic query vendor, CDI program managers need to determine their own definition of an electronic query and what they hope to gain from their new query system, says Barbara Hinkle-Azzara, RHIA, chief product strategist for Meta Health Technology, an HIM software developer based in New York.
“What is an electronic query?” asks Elion. “Is it a program that simply performs electronically what you already do in paper form? Or is it something else?”
If the facility is implementing a new CDI program, for example, it may want an EQS that includes a library of sample query templates. Some vendors provide this feature but others do not, says Hinkle-Azzara, adding that both parties need to establish a firm understanding of their definition of standard query templates.
“Is the system you want one where you pick your query from a database, print it, and put it in the paper chart? Is that the level of ‘electronic query’ you’re looking for? Does it provide you with some sort of additional benefit?” asks Elion.
Even though The Miriam Hospital in Providence, RI (where Elion serves as a practicing cardiologist) boasts of its fully integrated EMR, Elion says staff members continue to print the progress note and place it in the patient medical record. Why? To ease the transition to EMR, he says. “Everyone has some sort of hybrid medical record,” says Todd Johnson, president of Salar, Inc., in Baltimore. “The trick is in determining how the EMR bridges traditional modes of communication.”
Analyze current query process
Begin your search for an EQS vendor not externally, but internally—within your own CDI department. First, assess your CDI program’s work flow, says Hinkle-Azzara. Consider the following:
- Do you keep queries as a permanent part of the medical record?
- Have you developed a documented set of query policies and procedures?
- Do you have a compliance policy in place?
- Does the CDI team review only concurrent records?
- What role, if any, does the CDI staff have in handling retrospective queries?
- How does the facility manage CDI/HIM reconciliation?
“The process and goals you outline will help define your requirements for the software vendor and help them better address your needs,” says Hinkle-Azzara.
“Information systems are great tools, but you need to know your own systems first for the electronic component to aid your process,” says Robert S. Hodges, BSN, MSN, RN, clinical documentation specialist at Aleda E. Lutz, VAMC in Saginaw, MI (Hodges’ views do not necessarily represent those of the VAMC).
Hodges has the benefit of a 100% fully integrated EMR that allows him to review all documentation from his desktop. But a full EMR has its own difficulties that CDI specialists may not consider.
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