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003 Dr. Keith Kramer Day One.ppt - Cardiology Customer Summit

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003 Dr. Keith Kramer Day One.ppt - Cardiology Customer Summit Powered By Docstoc
					Functional Automation
   within an EHR
    Keith Kramer, MD, FACC
   Wellmont CVA Heart Institute




                                  1
Outline

•   Workflow process improvements
•   EMR “enhancements”
•   Electronic decision support
•   Appropriate Use Criteria
•   Charge capture
Workflow Process Improvements

  •   Define your problem issues
  •   Streamline clinical care
  •   Gain support from providers
  •   Efficiency
  •   Make the product work for you
Enhancements




               •Bonnaroo 2004
Options for HPI


  •   Template
  •   Free text
  •   Follow up (example – CAD follow up)
  •   VR/Dragon
  •   Dictate
Order Automation
     Order Automation
Bundled Order Sets


 • Amio – 6 mo

 • CAD – 1 yr
 • CAD – add HgbA1C

 • CHF – 2 wk

 • Lipid – 3 mo
Internal Messaging




        Have a consistent
  Internal Messaging
            method
Doctor Note
RN Communicate
Task to Checkout
Electronic Decision Support
  Electronic Decision Support
Appropriate Use Criteria
   Appropriate Use Criteria
Appropriate Use Criteria


 • Define “when to do” and “how often to do” a given
   procedure in clinical context
 • AUC for cardiology
 • AUC provide tools to measure variability and look at
   utilization patterns
EMERGE Medical Solutions


 •   Collaborative relationship to develop support for specific
     clinical pathways
 •   Clinically driven
 •   Provides electronic decision support
 •   Specific clinical pathways - expanded
EMERGE Pathways


 •   Nuclear appropriateness
 •   SCD
 •   Sleep
 •   A fib quality measures
 •   PAD/ABI
Nuclear Appropriateness
Nuclear Stress Testing
Emerge SPECT MPI
   Application

•   Emerge applications  rules engine functioning
    within the NextGen EMR
•   Implemented the SPECT MPI application in October
•   22% increase in average monthly SPECT MPI’s
    ordered since implementation
•   12% increase in “order rate” (ratio of SPECT MPI’s
    ordered to E&M office units)
    EMERGE & SCD
EMERGE & SCD
SCD - Recommend Echo
SCD - Recommend EP/ICD
Recommend EP/ICD
Sleep Protocol

 Yes to 2 or more questions


                              Recommendation
Sleep Triggers

   Witnessed sleep apnea

                           Recommendation
A-FIB
A fib
    EMERGE & PAD
EMERGE & PAD
ABI Trigger
Claudication Symptoms
                        Additional “linked” testing
Business Implications of AUC

 •   Profile your group against the AUC and MedAxiom
 •   “over” or “under” utilizer, RBM expanding role
 •   Financial Impact
 •   Leverage your data with payers, self-insured
     employers, payer relationships
 •   Strategic position – high quality/low cost
 •   Transparent reporting of utilization and
     quality/outcomes data
 •   Negotiate better “per CPT code” rates in recognition of
     lower utilization
Clinical Implications of AUC


 •   Provider buy-in
 •   Quality (low EF, A fib, PAD detection, etc.)
 •   Automation for disease detection and management
 •   More guideline-driven patient care
 •   Efficiency in providing good care to complex patients
Charges


 The following charges are automatically generated for EPM
   • E & M Charges – The provider can select a higher level on the checkout
     screen.
   • ECG
   • ABI
   • Smoking Cessation
   • ePrescribing gCodes
   • PQRI Codes
   • Bio-impendence
Charge Capture
Summary


 •   Define/modify your workflow processes to make your
     EMR function for you clinically
 •   Use enhancements
 •   Electronic decision tools can improve your patient care,
     utilize AUC and can have significant business and
     clinical implications
 •   Automation can be applied to charge capture

				
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posted:5/14/2013
language:English
pages:37
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