Meaningful Use Question 3

Question 3.

Did you establish usage metrics and organizational standards post Go-Live to monitor how effectively the system is used?

a. Did you establish usage metrics and standards? What were they?
It has been widely publicized that our implementation was made difficult by the fact that we rolled out a moving target. Still, we started with basic metrics like Encounter/Note ratio to make sure all of our notes were being completed. Vitals entry, lab template use, and Immunization management were similarly monitored.
For the nursing staff, we monitor data input and use this report as a training reinforcement tool. If vitals are entered incorrectly, our lead trainer issues reports to the users and provides them the opportunity to correct their mistakes. This is all done before the encounter has a chance to close and allows for greater accuracy in our reports that rely on vitals-related data.
We monitor lab signoff by providers, scope of practice issues related to use of the medication module, settings updates for team-player nursing staff. (a great deal of functionality is based on updating location and provider as needed, we have some folks that move around considerably during the day and forgetting to update where they are and who they are working for remains a major hurdle for us.)

b. Did these metrics influence other aspects or your rollout, particularly speed or sequence of rollout to other sites? Number and type of support staff assigned to clinics?
Not really. If anything, the reports reinforced that we had lapses in the training regimen. It also helped push the development process in that it helped us create tools that could reduce the number of errors we we’re finding. Several reports also let us know who was in need of additional instruction and collaboration.

c. What sort of chart audits or usage audits are conducted on a routine basis to assure that organizational standards are being adhered to. What are you finding as a result of these usage audits?
All of the aforementioned reports are still being run though they’ve been tightened up a bit. Our Director of HIS does chart audits as does the peer review committee with the goal of establishing criteria for documenting the decision making process at point of care. We’ve discovered in the process of creating clinician report cards for population management that we had discrepancies in how our clinical staff diagnose Diabetic Patients. This afforded us the opportunity to create CME classes specific to what appear to be areas of growth. This itself is worthwhile though the long-term goal remains a thorough and accurate analysis of patient populations by provider. We’re also learning that true digital interfaces are absolutely the best practice in terms of population analysis, both from a cost and management perspective.

There are two main forms of audit from the HIS/Security perspective with respect to organizational standards; Coding/Records Completion and Security. Our E/M Audit Compliance plan involves the appropriate use of ICD-9-CM codes as well as CPT codes with an emphasis on E/M coding. Each month 6-7 provider’s records are pulled for one random day (usually with between 15-20 encounters for the day). These records are reviewed for chief complaint, HPI, Exam and Medical Decision Making. These elements are matched to the appropriate E/M code and any trends are noted and passed on to the CMOs. The areas of focus are ICD-9 capture and accuracy; E/M accuracy and chief complaint presence and/or accuracy. These audits have given valuable feedback as to inconsistencies in our chief complaint application in the electronic environment as well as uncovering education opportunities in ICD-9 and CPT coding. It also allows us to look at different uses of the EMR by providers with respect to what tools they have available to them for documentation. By learning their documentation habits in the electronic environment, we have more opportunity to assist them with streamlining their individual documentation processes, if they desire.

From a security standpoint on a quarterly basis the elements of our Security Compliance Plan are audited. With emphasis on the Administrative Safeguards (contingency plan testing, Security Awareness and incident protocol testing, etc); Physical Safeguards (work station use, device and media controls, etc); Technical Safeguards (access controls, authentication control, transmission security, encryption/decryption, etc). Included in these will be the audit of higher profile accounts as well as random access audits. This is scheduled to begin in November 2009.