Don Sepulveda, Clinical Consultant
GE Healthcare
Clay Williams, Clinical Consultant
GE Healthcare
Peggy Romfh, Project Manager
Baylor College of Medicine
Centricity Physician Office
2005 User Summit
EMR Orders Implementation in
an Enterprise
Baylor College of Medicine
¾
Academic medical center located in the Texas
Medical Center in Houston
¾
Three year plan to implement electronic medical
record (EMR) in all clinical specialties including 600
providers
¾
Technology integration
¾
GE Centricity Physician Office EMR
¾
Clinical Content Consultant (CCC) forms and voice-to-text
technology
¾
IDX® practice management software
¾
Interfaces from multiple hospital, lab, and radiology systems
GE Healthcare – Centricity Physician Office November 17, 2005
Presentation Objectives
¾
Describe the set-up and basic orders functionality
in the EMR with a focus on service and test orders
¾
Describe alternatives in the orders processes that
optimize provider and staff efficiency
¾
Show how service orders can be integrated with
the practice management system
¾
Share implementation methodology that includes
use of Six Sigma and Lean
Service Orders
Capture of charges associated
with a visit or procedure
¾
CPT codes
¾
ICD-9 codes
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders: Project Plan
Define
Measure
Analyze
Improve
Control
Project CTQ’s
¾ All Users: no paper
¾ Provider: easy process; seamless
¾ Coder: immediate chart access; easy communication
for corrections
¾ Billing Staff: legible; correct; continuous flow of work
¾ Manager: less work for Front Desk before and after
visit
¾ Compliance: audit of documentation, coding and
corrections
Service Orders: Project Plan
Define
Measure
Analyze
Improve
Control
Team Charter
¾
Goals:
¾ Eliminate all paper ‘Super Bills’
¾ Streamline coding/coder review function
¾ Integrate charge capture with charge entry
¾ Team – Operations, IT, GE partnership
¾ Scope:
¾ Pilot in Family Medicine
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders: Current Process
Define
Measure
Analyze
Improve
Control
Front Desk
Front Desk
Sort
MA
Transport
Provider Charge
Capture
Front Desk
Sort, Batch
Med Records
Pull Charts
Coder
Review
Transporter
to Billing
Billing Sort,
Reconcile
Billing Enter
Charges
Billing Edit
Charges
Archive, File,
Scan Forms
PROCESS MAP: Cycle Time 4 to 10 Days
Service Orders: Current State
Define
Measure
Analyze
Improve
Control
Measurement System Analysis
Waste in Current Process
$ 92K
Super Bill forms cost
$ 75K
Labor – forms printing, sorting, printing
$ 36K
Labor – transporting forms to billing
$ 75K
Labor – Medical Records, Coder follow-up
$ 30K
Labor – Billing sorting, batching
$ 76K
Scanning/filing costs of Super Bills
$384K
Total Annual Waste in Process
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders – Analysis of Gaps
Define
Measure
Analyze
Improve
Control
R
E
W
O
R
K
C
O
N
TIN
U
O
U
S
F
LO
W
Service Orders – New Process
Define
Measure
Analyze
Improve
Control
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders – Provider Charge
Capture with Orders Module
Define
Measure
Analyze
Improve
Control
Service Orders – Provider Charge
Capture with Orders Module – Cont.
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders – Missing Charges Report
Define
Measure
Analyze
Improve
Control
Service Orders – Coder Work List
Define
Measure
Analyze
Improve
Control
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders – Coder Work List
Define
Measure
Analyze
Improve
Control
Service Orders – Billing Report
¾Location Of Care
¾Provider Name
¾Visit ID
¾Patient Name
¾IDX Acct #
¾CPT-4
¾ICD-9
¾Modifier
¾Date of Service
¾Signed By
¾Complete Date and Time
Define
Measure
Analyze
Improve
Control
Billing Report Data Elements
Organized by IDX charge entry screen
and grouped by provider
GE Healthcare – Centricity Physician Office November 17, 2005
Service Orders - Training
Provider and Assistants
¾
Orders functionality
¾
Selection of Visit ID
¾
Selection of all Service orders
Coder
¾
Orders functionality
¾
Missed Charges Report
¾
Create Coder Work List
Biller
¾
Billing Report by Location of Care and Complete Date
Define
Measure
Analyze
Improve
Control
Service Orders – Process Control
Define
Measure
Analyze
Improve
Control
¾Improvement Goals Met
¾Eliminated paper
¾Decreased coder
review/cycle time
¾Used single document
from EMR for charge
entry
¾Mistake Proofing
¾EMR set-up optimized
¾Re-training coder, biller
¾Validation of reports
¾Process Control Plan
¾# Missing charges
¾# Missed/wrong codes
¾# Work in process – coder
¾Lag Days to charge entry
Process Capability
and Control
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders
¾
Provider orders for diagnostic tests,
procedures, and therapies in EMR
¾
Selection of service providers for each
¾
Printing of order forms for each service
provider selected
Test Orders – Project Plan
Project CTQ’s
¾All Users: minimum ‘clicks’
¾Provider: custom order form; easy search for additional tests
¾RN/MA (Assistive Staff): minimum effort to choose service
providers; no duplication onto service provider order forms
¾Service Providers: same test order information and codes
found on service provider form
¾Manager: less work for Assistive Staff to process orders
¾Patient: legible order form; location on testing identified;
patient instructions clear
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders – Project Plan
Define
Measure
Analyze
Improve
Control
Team Charter
Goals
¾ Implement EMR Orders and/or CCC test
management forms
¾ Optimize set-up of tests, prompts, and
service providers
¾ Eliminate service provider order forms
Team – Operations, IT, GE partnership
Test Orders – Project Plan
Scope
¾
Pilot in Family Medicine
¾
Implement in all clinics during EMR rollout
Outside Scope
¾
Approved service providers linked to patient
insurance
¾
Interfaces to service providers
Define
Measure
Analyze
Improve
Control
Team Charter
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders – Current Process
RN or MA finds
service provider
order forms
0 0 0Provider orders
tests on custom
form, verbal order,
or in chart note
0RN or MA
manually
completes all
order forms
needed.
RN or MA
prints patient
instructions,
maps, or other
required
clinical data.
RN or MA
provides copy of
order to patient
and may fax order
to service
provider.
Define
Measure
Analyze
Improve
Control
Test Orders: Current State
Define
Measure
Analyze
Improve
Control
Measurement System Analysis
Waste in Current Process
$ 81K
Manual completion of forms
$ 13K
Ordering and stocking forms
$ 94K
Total Annual Waste in Process
10 – 20
different
forms
typically
stored on
each
workstation
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders – Analysis of Gaps
Define
Measure
Analyze
Improve
Control
Gap: Test Order knowledge
that resides among staff
must be translated to a
knowledge bank in the EMR.
Organizational person
Gap: Service providers need
to accept test orders printed
in standard formats from the
EMR to eliminate manual
completion of forms.
Test Orders – Set-up Strategy
Define
Measure
Analyze
Improve
Control
CLEAN UP
existing tests
and service
providers entries
ADD new tests
and service
providers
following
standards
MAINTAIN test
and service
provider tables
on an ongoing
basis
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders – System Set-up
Define
Measure
Analyze
Improve
Control
Test Orders – System Set-up
Define
Measure
Analyze
Improve
Control
Order Forms
General order form
Custom order form for
Lab with Service Provider
order codes designated
Custom order form for
high volume service
providers (e.g. partner
hospital) or BCM service
provider
Tests
Standardized format for
instructions and additional
required information
To or from service provider
To patient
Test instructions researched for
all high volume tests and
maintained accurately
Handouts and letters created
for adjunct instructions or
requested clinical information
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders– Process
Define
Measure
Analyze
Improve
Control
Provider only:
1.
Enters order in Orders Module, CCC Test
Management Form, Custom Encounter Form or
CCC CPOE
2.
Reviews orders in Orders Module and adds
information as needed (Instructions, date, Service
Provider, etc.)
3.
Signs Order
4.
Give printed order to patient
Test Orders– Process
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders– Process
Define
Measure
Analyze
Improve
Control
CCC Test Management Form
Test Orders– Process
Define
Measure
Analyze
Improve
Control
GE Healthcare – Centricity Physician Office November 17, 2005
Provider with Assistant:
1.
Provider Enters order in Orders Module, CCC
Test Management Form, Custom Encounter
Form or CCC CPOE
2.
Assistant reviews orders in Orders Module and
adds information as needed (Instructions, date,
Service Provider, Authorized Provider, etc)
3.
Assistant Signs Order
4.
Give printed order to patient
Test Orders– Process
Define
Measure
Analyze
Improve
Control
Test Orders– Process
GE Healthcare – Centricity Physician Office November 17, 2005
Test Orders – Process Optimization
¾
EMR needs additional functionality
¾
Separate instructions
from
vs.
to
a service provider
¾
Automatic pop-up of handouts and letters/questionnaires
without additional clicks
¾
Additional information about service provider – search
terms related to diseases or tests to aid in use of search
functionality
¾
Ability to obsolete Service Providers
Define
Measure
Analyze
Improve
Control
Issues:
¾
MEL_ADD_ORDER
¾
Currently lacks the ability to send Service Provider to
orders module from form components
¾
Service provider acceptance of EMR order form
¾
Service provider wants their own form also filled
out
Test Orders– Process Optimization
Define
Measure
Analyze
Improve
Control
GE Healthcare – Centricity Physician Office November 17, 2005
¾
General orders functionality training
¾
Workflow and process training
Test Orders– Training
Define
Measure
Analyze
Improve
Control
Test Orders – Process Control
Define
Measure
Analyze
Improve
Control
¾Improvement Goals Met
¾Decrease paper
¾Decreased Provider and
Assistant time to
complete orders
¾Legible order forms for
patient and service
provider
¾Mistake Proofing
¾EMR set-up optimized
¾Validation of Test Codes
¾Validation of Service
Providers
¾Process Control Plan
¾Reconciliation Reports
¾Maintenance Role
Process Capability
and Control
GE Healthcare – Centricity Physician Office November 17, 2005
Referral Orders - Summary
Set-up
¾
Use Categories for Specialty and set service provider
preferences
¾
Use Codes for generic description
Process
¾
Order from orders module, use instructions field for service
provider instructions
¾
Set disposition to Admin Hold for Referral Coordination
Limitations
¾
Cannot push from form component
Define
Measure
Analyze
Improve
Control
¾
Nursing Orders-Assisted Living
¾
Vendors needing complex information-Durable
Medical Equipment
¾
Patient care-Chemotherapy Orders
¾
Centricity Form Components
¾
CCC functionality
¾
Letters
Other Orders - Challenges
Not all orders can be handled within the Orders
Module
The Orders module may be supplemented by
using
GE Healthcare – Centricity Physician Office November 17, 2005
Other Orders - Centricity Form
Component
Form components
can be used within
an Encounter type to
create a chart note.
The chart note will
document Home
Health Care, Nursing
Home, and Assisted
living orders that can
then be directly
faxed to the facility.
GE Healthcare – Centricity Physician Office November 17, 2005
