Making eCW Your Own

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• Making eCW Your Own

Kameron L. Wells, ND and Dori McLennan,
LCSW-R CHCANYS Clinical Forum Statewide Annual
Conference October 14, 2009
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Challenges for Large FQHCs

• Documentation by multiple disciplines in the same
  progress note
• Capturing data to satisfy UDS, NYC NYS DOHMH
  standards and grant deliverables
• Configuration of EMR to meet Article 28 Article
  31 Standards
• Might have limited technical training time, which
  leads to trial error during configuration
  phase

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Challenges for CHN

• Multiple Sites (9) Clinics (1) Mobile Unit
• Multiple disciplines documenting in EMR
• Medicine
• Dental
• Podiatry
• Behavioral Health
• Nursing
• HIV Counseling Testing
• Social Work
• Nutrition
• Health Education
• Specialty Programs

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Plan of Action

• Create key Administrative Team for patient
  workflows and EMR configuration
• Review and revise Policies Procedures as
  necessary
• Involve ALL departments and specialty programs in
  EMR configuration
• Create Super Users Committee for post-mortem
  feedback and revisions

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EHR Timeline

• Finalize configuration of EMR to meet
  documentation needs of ALL clinical staff
• Training, Go-Live Post-Mortem for 1st Site
• Training of 2nd Site

• Go-Live for 8th Site
• Training Go-Live for 9th 10th Sites
• Post-Mortem for ALL clinics

Jan 08 Feb 08 Mar 08 April 08 May 08

• Training of key EHR Super User Administrative
  Staff by eCW
• Finalize Workflows for all types of office
  visits
• Configure sections of EMR to meet documentation
  needs of ALL clinical ancillary staff

• Go-Live at 2nd Site
• Training Go-Live for 3rd, 4th, 5th, 6th
  7th Sites
• Training of 8th Site
• Introduce Bio Reference Lab Interface

• Revise configurations from post-mortem feedback
• Weekly Super Users Committee Conference calls
• Weekly Conference calls with Bio Reference
  regarding Lab Interface issues

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CHN Work Around Areas

• Abnormal Lab follow-up
• HIV Counseling and Testing
• Nutrition
• Behavioral Health

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Wheres that chart with the Abnormal Lab?
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Abnormal Lab Follow-Up

• Revised Abnormal Lab Policy Procedure to
  incorporate EMR workflow
• Created Abnormal Lab Bucket as a resource for
  each clinic
• Follow-Up of Abnormal Labs became sole
  responsibility of RN Managers

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HIV Counseling Testing

• Created (7) CT Visit Types for billing,
  productivity and data collection purposes
• Configured HIV Pre-Test Post-Test in HPI
  section as structured data in order to capture
  all documentation required by NYS DOHMH standards
• Trained HIV Counselors, Nurses, Social Workers
  Health Educators on proper documentation of CT
  visits

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Nutrition

• Created (4) Nutrition Visit Types for
  productivity and data collection purposes
• Configured Nutrition documentation in HPI section
  using primarily free form data vs. structured
  data
• Created section for Pertinent Labs as work
  around for single dumping of lab results from
  patients chart panel on right

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Behavioral Health

• Built completely from scratch using the paper
  chart as a guide
• Configured in HPI section
• Mix of structured data and free form data
• Geared to meet NYS Article 31 Regulations

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Components of BH Module

• Screenings
• Psychiatric Component
• Evaluation
• Re-Evaluation
• Medication Management
• Biopsychosocial Assessment (28 sections)
• Health Screening
• Treatment Plan
• Progress Notes
• Individual
• Group
• Discharge/Transfer Planning
• Utilization Reviews

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Lessons Learned for BH

• Before
• Time consuming process to review
  notes/documentations and verify across multiple
  sites
• Communication between providers was largely
  verbal and undocumented
• Charts often grew large, which consumed limited
  space
• Missed opportunities for billing or risk of
  erroneous billing

• After
• Can take as little as 10 minutes to verify that a
  days worth of notes and treatment plans have been
  completed and locked
• Offers ability to document in writing the
  communication between providers, thereby
  increasing client adherence, response and care
• Space for charts is no longer an issue
• Substantially decreased loss of potential revenue
  and overbilling

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Lessons Learned for BH

• PROS
• Creating templates can save time for staff
• Enables daily tracking
• Admits/Discharges/Screen Outs
• Treatment Planning
• Staff scheduling
• Notes
• Across multiple locations
• Practically eliminates over and under billing
• Enables a way to document communication between
  providers that used to be primarily verbal and
  unable to track

• CONS
• Very time consuming to build
• Requires a degree of trial and error as well as
  a tech savvy person
• Not very fluid in appearance
• Limited data access

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Final Thoughts

• Able to design, configure and change to meet
  needs
• Staff input and ideas are extremely invaluable
  and necessary
• Need to put in a good amount of pre-EMR time to
  become a knowledgeable user
• Once your eCW is built, the upkeep can be limited
  except for minor revisions as a result of staff
  feedback and changing clinical practices
• Limited structured data access from COGNOS
  reporting system
• Enormous time investment up front, but it pays
  off in the end with much easier tracking and
  accountability

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Time and Effort Leads to Your Own Super eCW Win!!