Guest Post: CDI specialists can help lead the way in effective EHR implementation
By Karen Newhouser
Historically, the limitations of the traditional paper health record have made data extrapolation a difficult, time-consuming process. Deciphering handwriting and digging through volumes of information after discharge was an inefficient and error filled process. The birth of the electronic health record (EHR) has dramatically changed this process and the government recognizes the benefits of that change.
The Patient Protection and Accountable Care Act (PPACA) of 2010 gives CMS the authority to provide incentives to hospitals based on performance for certain quality measures. Starting October 2012, Medicare will begin paying hospitals for quality measures, according to a CMS fact sheet released April 29. (Read a related article in the July edition of CDI Journal.) The new hospital Value-Based Purchasing (VBP) program adopts performance measures under two “domains”:
- clinical process, comprised of 12 measures, and
- patient experience, comprised of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
While core measures have existed for years, the advent of VBP expands on the concept in an effort to meet those expectations. From patients to providers to third party payers, everyone expects to squeeze more value and quality from their healthcare dollar.
The promises of improving quality and managing costs drove the government to provide an incentive program for implementation of EHR and demonstration of “meaningful use” (1). While no one can dispute that EHR implementation takes time and significant resources, the benefits related to quality improvement are undeniable. A well executed EHR can streamline workflow, reduce errors due to inaccurate translation of handwriting, allow multiple user access from varied locations, and provide standardized processes using flow sheets (2).
As implementation of EHR continues, most assume it will drive more efficient, safer, and higher quality of care (3). The reality is that as the EHR emerges, the efficiency, safety, and quality of the documentation within that record will continue to be directed by the CDI specialist. That’s because the data available via new EHR initiatives is only as good as the documentation which spawned it. This is where the value of a CDI program really shines. In the age of EHR, the CDI specialist’s role will most likely expand to include concurrent monitoring of the EHR for accuracy, consistency, and completeness of the electronic documentation as the foundation for improvement in the quality of the care provided.
As the CDI specialist reviews the record, gaps in documentation or terminology as well as inconsistencies can be identified early. The CDI staff can quickly discuss gaps in the electronic system with the IT and/or HIM department and thus serve as an early warning system for EHR problems.
Where the traditional paper record review process required hours to days, the EHR review process requires minutes or hours for the expert CDI specialist. The EHR has capability to increase CDI staff productivity for a number of reasons.
First, the ability to review a record from any location has increased efficiency dramatically. No longer does the CDI specialist need to make multiple attempts to locate and review a record related to a patient in surgery or testing. The CDI staff members can access the patient record in proverbial “real-time.”
Missing pages in a paper record were always a source of frustration for the CDI specialist and of significant error for those coding or querying from the record. The EHR, however, is a non-thinned, complete record which enhances the quality of CDI and coding efforts.
Finally, the time saved in not having to decipher handwriting is priceless. The EHR eliminates spontaneous ‘huddles’ where team members gather to analyze some signature or symbol.
The use of clinical decision support mechanisms within the organization’s electronic health record system is pivotal to a streamlined CDI process. Tools incorporated into documentation templates, order sets, and computerized communication lead to a safer, less costly, higher quality of care (4).
The EHR in the hands of the CDI team becomes a complete record. The CDI program’s inherent complete and holistic approach to record review, timely and accurate quality data collection, and effective communication with all EHR users will undoubtedly provide the higher quality of care and increase value sought after today.
“The biggest thing is getting people to understand that measuring what we do is important—just as important as taking care of the patient,” says Eric Dobkin, MD, director of the surgical ICU at Connecticut’s Hartford Hospital. (5)
The CDS is here, now, and ready to measure and lead.
REFERENCES
- Jha, A. K., DesRoches, C. M., Kralovec, P. D., & Joshl, M. S. (2010). A Progress Report On Electronic Health Records In U.S. Hospitals. Health Affairs, 29:10, 1-7. doi:10.1377hlthaff.2010.0502
- Downs, C. G., (n.d.). Electronic Medical Records Mark a Landmark Shift in Record Keeping. ONS News, 21:4, 9.
- George, J., & Bernstein, P. S. (2009). Using electronic medical records to reduce errors and risks in a prenatal network. Current Opinion in Obstetrics and Gynecology, 21, 527-531.
- Glaser, J., (2008). Clinical decision support: the power behind the electronic health record. Healthcare Financial Management, http://findarticles.com/p/articles/mi_m3257/is_7_62/ai_n28092995/?tag=mantle_skin;content
- Haugh, R., (2003). Pressures converge in the ICU. Hospitals & Health Networks, 12, 56-59.
Editor’s Note: Karen Newhouser, RN, BSN, CCM, CCDS, at the time of this article's release is a CDI specialist at Miami Valley Hospital in Dayton, OH. Her background in critical care nursing and case management gave her the solid foundation to be successful with CDI since 2004. She finds great rewards in sharing her expertise and imparting her knowledge through teaching.