Memorial Herrman Streamlines Systems

Prior to implementing an electronic query application from Meta Health Technology in 2010, the query process at Memorial Hermann was completely manual and extremely time-consuming. To submit a post-discharge query, the coder created a Word document and sent the query to the inpatient coding coordinator for review.

The coordinator then determined if the query was required and faxed it to the physician’s office along with a blank progress note for physician response. If the physician responded, the coordinator sent the response to the HIM department secretary. The secretary forwarded it to the scanning team at the corporate HIM department to be scanned into the record.

Additionally, the coding supervisor sent an email to the coder indicating that a response was available and to complete the coding of the record. If there was no response after 30 days, the coder completed coding the chart without the response.

Clearly, our query process was ripe for automation. Internally, Memorial Hermann had set specific objectives for improving clinical documentation and eliminating manual processes wherever possible throughout the facility. Further, we knew that unanswered physician queries were affecting our reimbursement, yet we had no way to track and report on response rates and the associated financial impact.

The right fit

We had the opportunity to view an early demonstration of Meta’s ePhysicianQuery software. Since Memorial Hermann utilizes a combination of concurrent and post- discharge queries, a team comprised of representatives from HIM, HIS and our CDI initiative evaluated the new software.

We concluded that the application offered the functionality we needed and would integrate seamlessly with both our document management system and the physician in-box in Care4, Memorial Hermann’s core clinical application. Equally important, the query software would integrate with the facility’s EMR, so that the documentation provided electronically by physicians would automatically become part of the legal medical record.

Easy for physicians

One of Memorial Hermann’s objectives was to automate the query process so it would be easy for physicians to respond to queries. Previously, physicians received queries by fax, and then had to locate the record, find the documentation in the record that prompted the query, and take a separate action to create an addendum. Now, queries are emailed to the physician’s in-box, already sorted by facility, along with attached documents containing the relevant patient records. Physicians are provided with a blank electronic progress note, allowing them to easily provide the necessary documentation and quickly close out the query.

To ensure that physicians would be comfortable using the software, our information systems staff provided a web-based training video available in the doctors’ lounge, as well as convenient pocket cards highlighting key functionality of the application.

Immediate benefits in HIM

As a result of implementing the new query software, we saw a number of important benefits. The HIM Department experienced immediate improvement in streamlining workflow. Now our coders easily generate a query directly from within their abstracting workflow using the new application. They simply click a button, and the query window opens, with all the patient demographics and physician data automatically populated.

Additionally, tracking queries is effortless, as coders can immediately determine what queries are outstanding as soon as they open the application. To gain maximum benefit from the software, we have developed a set of templates for our most common queries. These queries are now standardized, so the message to physicians is consistent, and we don’t need to spend time creating queries from scratch.

From a user perspective, the new query software has been a success. We surveyed our inpatient coding staff to assess their response to the software, and the feedback was uniformly enthusiastic. With the query templates and minimal data entry, coders can work quickly and efficiently.

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