Decentralized Scanning Implementation and the Impact on Release of Information

By: Clarice Smith, RHIA, CHPDirector HIM, AnMed Health

Agenda

• Review of the decision to decentralize scanning• Review preparation for implementation• Review the challenges encountered following implementation• Review remediation activities• Discuss the impact on release of information

AnMed Health• 461-bed acute care hospital in downtown Anderson

• Level II Trauma Center• Primary Stroke Center• LifeFlight helicopter service• Heart and Vascular Center• ICU/CCU/CVICU• Inpatient and outpatient surgery• Interventional pulmonology• Behavioral Health Center• Accredited Chest Pain Center

• Women’s and Children’s Hospital – 72 beds• Cancer Center• Rehabilitation Hospital• AnMed Cannon: Pickens, SC• 55 Physician Practices – across large geographic area

Release of Information

Centralized release of information – why?

• Epic project – one patient, one chart philosophy• One application to release information across the organization

• Patient requests for information in HIM across the organization• Physician practices

• Audit requests – managed by Ciox audit team• ROI vendor unable to address

• Consistency in applying regulatory requirements

Release of information at AnMed Health

• Centralized release of information across the organization –implemented in May prior to Epic go live - managed by HIM

• Ciox selected as single vendor - for billable requests and audits • Point of service requests to be released at point of service• PRISM integrated with Epic for ADT• All release of information processed through Epic

• ROI Navigator• Manual entry to close requests in Epic

• Quick Disclosure

The Journey…

Why decentralize?

• Timeliness of scanning• Practices scanned daily - many times at the time of service• Preference of the practices to decentralize• HIM scanned daily; Monday - Friday

• Decrease in scanning volumes as a result of integration with Epic – reduced burden

System and scanning assessment• Physician practices:

• Allscripts• GE, and • eMD• Unique scanning process in each practice• 55 practices

• Hospital – OneContent• Some registration documents scanned at the time of service – drivers

license, insurance card, consents• Typical patient care documents scanned following discharge/service• Several stand-alone systems requiring scanning

The work begins…

• Evaluated the documents in each system and each practice• Number of years to load into Epic/OneContent• Consistent document master between the practices and the hospital• Documents to be loaded into Epic• Years of MPI to load • MPI clean-up • Inventory of hardware• Review of staffing• Epic vs OneContent scanning

Results…• Each office scanned independently• Same documents had different names at different offices• Allscripts predominant system – no consistency• No one person was responsible for oversight of scanning in the

practices• Documents from the hospital represented a significant volume of

scanning • Staff printed documents for some physicians who did not want to log

into the system• Volume scanned – 100,000/month - practices• Volume scanned – 195,000/month - hospital

EHR configuration prior to Epic

• McKesson - clinical documentation and patient accounting• Lab – Cerner

• OneContent document management system – 17 years of medical records

• 3 physician practice EHRs – legacy• Home Health – separate EHR• Occupational Health – separate EHR – HIM does not release

Implementation plan

• Deploy the consistent document master between the physician practices, home health, occupational health and the hospital

• Train all staff in the practices on the system and the forms• Designate one person in the practices/area to be the “go to”

person for scanning• Select staff to serve as “trainers”• Determine which scanners were compatible and develop a list

of scanners to purchase by office

Training• Computer based training• Classroom training• Competency test

• User granted access to system• Tip sheets

Train Train

Train

Physician practice scanning

• Documents scanned in the offices (non-registration)• Consents• Records from other care providers• Records submitted by the patient• Advance planning documents• Results for diagnostic procedures performed outside of AnMed Health

Go live issuesPractices went live first• Typical hardware, software and access issues at go live created frustration

• Access issues even though ID’s were validated prior to go live• Practices under-estimated the change and training

• Buy-in • Hundreds of people to train

• Scanning staff turn-over• Lack of understanding between clinical and non-clinical scanning

• Scanners not deployed in convenient locations for clinical staff • Staff overwhelmed with the amount of change• Some offices quickly developed backlogs

Issues encountered post-go live• No show stoppers!!!• Continued reliance on the legacy system• Auditing quality of scanning - imperative

• Forms consistency • Feedback re: forms• PNS decision re: what to call certain forms

• Follow-up• Retraining – physician office staff

• Corrections• Launching into OneContent for certain documents• Reliance on HIM to search for documents – very limited

• Medicaid sterilization consent process and scanning – physician signature• Colonoscopies• Eye exams • Cardiology reports

Remediation

• Retraining – globally• Individual follow-up with re-training• Meetings with PNS leadership and physicians as indicated

• Review of audit results• Consensus• Implementation of the plan• Individual accountability• Re-audit

Success

• Standardization across the organization• Finding scanned documents easier• Reduction in scanning by 57% as a result of Epic

implementation and one-chart philosophy• Reduction in staffing in HIM by 7 FTEs • PNS and HIM relationship enhanced• Medical staff working with HIM to problem solve

issues• MRA, HEDIS, etc.

• All information is available –one stop shopping a year after go live

• Multiple systems during transition

Recent developments…

• Incentives from a payor to remotely access charts• Other payor requested the same access

• Helping to improve scores – more timely data• Payor requesting data feed – in process• Epic’s eHealth

• VA requesting direct access – volume impact in HIM• DSS requesting release through Epic’s eHealth app – 2nd largest

volume at AnMed besides audits• Epic’s Gateway – life insurance requests

Thank You!

Questions?