SMMC has been working diligently with eClinicalWorks (eCW) towards an enterprise wide scheduling go-live followed 1 month later by a phased EMR go-live of our 11 clinics. Since August 2008, there have been 2 delays in the timeline, and we are now planning for the scheduling go-live in Spring 2009. The major impediments have been difficulites in mapping our charges to be captured in eCW to our Invision HIS billing system, and testing failures requiring multiple break fix cycles. The charge mapping has been challenging as SMMC is using a billing system originally designed for inpatient activity for our outpatient visits, and this has lead to significant customization and a proliferation of chargemasters, making mapping a nontrivial task. The testing failures were somewhat expected due to the sheer number of systems operating at SMMC and the multiple interfaces we plan to have with these systems and our AEMR. There was also a difference in perspectives between SMMC and eCW when considering what testing really means and the methodologies necessary to conduct tests meriting final SMMC approval. These difficulties have been overcome and we are moving forward to the Spring go-live.
I wanted to share a draft of the scanned documents indexing list we are working with as there had been some discussion about this at our recent meeting. I welcome any comments for additions or deletions or reorganization.
Index Headings for Scanned Documents
Laboratory Tests
Hematology
Urine Tests
Coagulation
Microbiology
CSF/Fluid Tests
Drugs/Toxicology
Serology/Immunology
Blood Bank
Public Health Lab Micro/Lead
Radiology
Routine Xrays
CT Reports
Ultrasound
Nuclear Medicine
Mammography
Interventional
MRI Reports
Cardiology
Neurology
Pulmonary Function
Pathology
Psychiatry
Advance Directives
Immunizations
Outside History and Physicals
Outside Discharge Summaries
Outside ER Notes
Outside Clinic Notes
Outside Consultant Reports
Diabetic Log
Blood Pressure Log
Fever Log
Seizure Log
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4 comments:
Michael -
Thank you for sharing the details of the code mapping challenges as well as the scanned documents categorization. I have two questions for you - the first is about the testing process and eCW's perspective on that. Did you negotiate specific performance or acceptance criteria into your contract as payment milestones?
The second question is really about eCW functionality. I'm wondering if these scanned documents are also organized by episode of care or by diagnosis so that you could see all the labs, consults, etc. related to a specific condition without having to "page through" the electronic chart?
Thanks for posting this - the mapping sounds painful but well worth it to do it up front rather than discover problems later. Clean up seems to be much harder than careful planning and testing!
SA
SA -
Great questions. In regards to your first, we did negotiate specific performance criteria into our contract, but these criteria were not tied to payment milestones. The criteria focused on end user utilization of the eCW application, so they involved outcome measurements taken well after first productive use had commenced (and most payments made). The contract requires eCW to supply additional training at their cost for those end users not meeting the performance criteria. We have other requirements in place regarding our acceptance of eCW functionality which are tied to payment milestones occurring throughout the implementation phase.
In answer to your second question, scanned documents in eCW are placed in folders, but there can be no further levels of hierarchy created (i.e. no nesting allowed). Additionally, the documents are arranged by date only (this date can be customized at time of scan). Clinically, I would rather just see them organized by type of test (i.e. chest xray, CT chest, CT abdomen, etc.) and by admission event, rather than specific condition as the mapping of tests to conditions is not one to one.
This is from our Health Information Services Director about our chart scanning organization. We have actually modified this list once or twice. The more we can directly interface with and not scan the better. Searching for documents in scanning folders can often be a huge challenge. She sent the list as an excel file so I have to try to see about posting it as such if not I will cut and paste.
Dean:
These are all of our categories with respective document types. The gray area represents areas that still contain documents but are being phased out to ensure clarity when clinicians are looking for a document.
Alexis Parsons, RHIT, MA
Director HIS
Privacy Officer
530-246-5735
SCHC
I could not attach the excel file so I have tried to paste info below (sorry for the length):
Grayed area represents categories/doc types that will be discontinued.
Categories Document Types
Admittance Admittance
Advanced Directives #PAQ - Advance Directive
Advanced Directives Advance Directive
Advanced Directives Conservatorship
Advanced Directives Durable Power of Attorney for Healthcare (POA)
Advanced Directives Guardianship Records
Case Review Case_Review
CHDP CHDP
Clinic Notes Clinic Notes
Clinic Notes #PAQ - Clinic Notes
Confidential HIV/AIDS
Confidential Confidential
Confidential #PAQ - Minor Confidential
Confidential Minor Confidential
Consultation #PAQ - Consultations
Consultation Allergy
Consultation Audiology
Consultation Cardiology
Consultation Consultations
Consultation Dentistry/Oral Surgery
Consultation Dermatology
Consultation Endocrinology
Consultation ENT (Otorhinolaryngology)
Consultation Far Northen
Consultation Gastroenterology
Consultation General Surgery
Consultation Genetic
Consultation Gynecology
Consultation Hematology
Consultation Immunology
Consultation Infectious Disease
Consultation Internal Medicine
Consultation Nephrology
Consultation Neurology
Consultation Neuropsychiatric Testing
Consultation Neurosurgery
Consultation Obstetrics
Consultation Occupational Therapy
Consultation Oncology/Hematology
Consultation Ophthalmology
Consultation Orthopedics
Consultation Other Consulations
Consultation Pain Management
Consultation Physical Therapy
Consultation Plastic Surgery
Consultation Podiatry
Consultation Psychiatry
Consultation Psychology
Consultation Pulmonary
Consultation Rheumatology
Consultation Sleep Studies
Consultation Speech Pathology
Consultation Urology
Correspondence #PAQ - Correspondence From Patient
Correspondence #PAQ - Correspondence To Patient
Correspondence Correspondence
Correspondence Correspondence - From Patient
Correspondence Correspondence - To Patient
CPSP/WIC #PAQ - CPSP/WIC
CPSP/WIC CPSP/WIC
CT #PAQ - CT Abdomen/Pelvis
CT #PAQ - CT Cervical Spine
CT #PAQ - CT Extremities
CT #PAQ - CT Head
CT #PAQ - CT Lumbar
CT #PAQ - CT Thoracic
CT CT Abdomen/Pelvis
CT CT Cervical Spine
CT CT Extremities
CT CT Head
CT CT Lumbar
CT CT Thoracic
Dental Hope Dent - Prescriptions
Dental Hope Dent - Xray
Dental Hope Dent - Treament Notes - Pre Nov08
Dental Hope Dent - Referrals
Dental Hope Dent - Consent
Dental Hope Dent - Dental History
Dental Hope Dent - Services Planned
Dental Hope Dent - Treatment Notes
Dental Hope Dent - Patient Registration/Privacy
Dental Hope Dent - Health History
Dental Hope Dent - Financial
Do Not Copy Third Party Do Not Copy
Do Not Copy Do Not Copy
Do Not Copy #PAQ - Third Party Do Not Copy
Echocardiogram Echocardiogram
Echocardiogram #PAQ - Echocardiogram
EKGs EKG
EKGs #PAQ - EKG/Cardio
EOB EOB -Test
Financial #PAQ - Financial/Assistance
Financial #PAQ - Financial/Government
Financial #PAQ - Financial/Insurance
Financial #PAQ - Financial/Miscellaneous
Financial #PAQ - Financial/Prior Authorization
Financial Financial - Assistance Programs
Financial Financial - Government
Financial Financial - Insurance
Financial Financial - Miscellaneous
Financial Financial - Prior Authorizations
Flow Sheets Flow Sheet - Anticoagulant
Flow Sheets Flow Sheet - Colorectal
Flow Sheets Flow Sheet - Coumadin
Flow Sheets Flow Sheet - Diabetic
Flow Sheets Flow Sheet - EIS
Flow Sheets Flow Sheet - Growth
Flow Sheets Flow Sheet - Misc
Forms #PAQ - Forms/Government
Forms #PAQ - Forms/Insurance
Forms #PAQ - Forms/Miscellaneous
Forms Forms - Gov.
Forms Forms - Ins.
Forms Forms - Misc.
ICF #PAQ - ICF
ICF ICF
Immunizations #PAQ - Immunizations/Other
Immunizations #PAQ - Immunizations/History
Immunizations Immunization - Other
Immunizations Immunization - History
Labs #PAQ - Lab/Results
Labs LAB - Results
Mammography #PAQ - Mammogram
Mammography Mammography
Medical Legal #PAQ - Medical Legal
Medical Legal Attestation
Medical Legal Death Certificate
Medical Legal Medical - Legal
Minor Confidential Minor Confidential
Minor Confidential #PAQ - Minor Confidential
MRI #PAQ - MRI Abdomen/Pelvis
MRI #PAQ - MRI Arthrogram
MRI #PAQ - MRI Cervical Spine
MRI #PAQ - MRI Extremities
MRI #PAQ - MRI GI
MRI #PAQ - MRI Head
MRI #PAQ - MRI Lumbar
MRI #PAQ - MRI Thoracic
MRI MRI Abdomen/Pelvis
MRI MRI Arthrogram
MRI MRI Cervical Spine
MRI MRI Extremities
MRI MRI GI
MRI MRI Head
MRI MRI Lumbar
MRI MRI Thoracic
Nuclear Medicine Nuc Medicine
Nuclear Medicine #PAQ - Nuc Medicine
OB Care OB Flow
OB Care OB Misc
Other Facilities #PAQ - Other Facility
Other Facilities #PAQ - Other Facility Family Planning
Other Facilities Cal Pacific
Other Facilities Hospice
Other Facilities Mayer's Memorial Hospital
Other Facilities Mercy Medical Center
Other Facilities Northern Rehab Hospital
Other Facilities Other Facility
Other Facilities Other Facility - Family Planning
Other Facilities Others
Other Facilities Patient's Hospital
Other Facilities Prior Physicians Records
Other Facilities Shasta Regional Medical Center
Other Facilities Skilled Nursing Facilities
Other Facilities St. Elizabeth's Hospital
Other Facilities Stanford
Other Facilities Sutter
Other Facilities UC Davis
Other Facilities UCSF
Other Facilities University of the Pacific
Pathology #PAQ - P/P/Colpo
Pathology #PAQ - P/P/Paps
Pathology #PAQ - P/P/Pathology
Pathology P/P - Colpo Flow Sheets
Pathology P/P - Paps
Pathology P/P - Pathology Reports
Patient/Clinic Agreements (PCA) PAC-Misc.
Patient/Clinic Agreements (PCA) PAC-Behavioral
Patient/Clinic Agreements (PCA) PAC-Medications
PET Scans #PAQ - PET Scan
PET Scans PET Scan
PFT #PAQ - PFT
PFT PFT
Pharmacy #PAQ - Pharmacy/DME
Pharmacy #PAQ - Pharmacy/Goverment
Pharmacy #PAQ - Pharmacy/Refills
Pharmacy Pharmacy - DME
Pharmacy Pharmacy - Government
Pharmacy Pharmacy - Refils
Referral Letters Referral Letters
Release Of Information Release Of Information
Release Of Information #PAQ - Release Of Information
Ultrasound #PAQ - US Abdomen
Ultrasound #PAQ - US Head & Neck
Ultrasound #PAQ - US Limbs
Ultrasound #PAQ - US Pelvic
Ultrasound #PAQ - US Thoracic
Ultrasound US Abdomen
Ultrasound US Head & Neck
Ultrasound US Limbs
Ultrasound US Pelvic
Ultrasound US Thoracic
Ultrasound OB Ultrasound OB
Ultrasound OB #PAQ - Ultrasound OB
Vascular Studies Vascular Studies
Vascular Studies #PAQ - Vascular Studies
X-Ray #PAQ - XRAY Abdomen/Pelvis
X-Ray #PAQ - XRAY Bone Scan
X-Ray #PAQ - XRAY Cervical Spine
X-Ray #PAQ - XRAY DEXA
X-Ray #PAQ - XRAY Extremities
X-Ray #PAQ - XRAY GI
X-Ray #PAQ - XRAY Head
X-Ray #PAQ - XRAY Lumbar
X-Ray #PAQ - XRAY Thoracic
X-Ray XRAY Abdomen/Pelvis
X-Ray XRAY Bone Scan
X-Ray XRAY Cervical Spine
X-Ray XRAY DEXA
X-Ray XRAY Extremities
X-Ray XRAY GI
X-Ray XRAY Head
X-Ray XRAY Lumbar
X-Ray XRAY Thoracic
These items are being phased out below:
Diagnostics #PAQ - Diagnostics/CT Abdomen/Pelvis
Diagnostics #PAQ - Diagnostics/CT Chest
Diagnostics #PAQ - Diagnostics/CT Head And Spine
Diagnostics #PAQ - Diagnostics/CT Limbs
Diagnostics #PAQ - Diagnostics/EEG
Diagnostics #PAQ - Diagnostics/EMG
Diagnostics #PAQ - Diagnostics/GI Studies
Diagnostics #PAQ - Diagnostics/Miscellaneous
Diagnostics #PAQ - Diagnostics/MRI Head And Spine
Diagnostics #PAQ - Diagnostics/MRI Limbs
Diagnostics #PAQ - Diagnostics/MRI Trunk
Diagnostics #PAQ - Diagnostics/Sleep Study
Diagnostics #PAQ - Diagnostics/Stress Test (thalium,treadmill,stress MUGA)
Diagnostics #PAQ - Diagnostics/Ultrasounds
Diagnostics #PAQ - Diagnostics/X-ray Head And Body
Diagnostics #PAQ - Diagnostics/X-ray Lower Limbs
Diagnostics #PAQ - Diagnostics/X-Ray Spine
Diagnostics #PAQ - Diagnostics/X-ray Upper Limbs
Diagnostics CT Abdomen And Pelvis
Diagnostics CT Chest
Diagnostics CT Head And Spine
Diagnostics CT Limbs
Diagnostics Dx - Misc
Diagnostics Dx - Orders
Diagnostics EEG
Diagnostics EMG
Diagnostics GI Studies
Diagnostics MRI Head And Spine
Diagnostics MRI Limbs
Diagnostics MRI Trunk
Diagnostics Sleep Study
Diagnostics Stress Test
Diagnostics Ultrasounds
Diagnostics X-Ray Head And Body
Diagnostics X-Ray Lower Limbs
Diagnostics X-Ray Spine
Diagnostics X-Ray Upper Limbs
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