Data Abstraction & Conversion Best Practices for New Epic System Go Live (Part I)

The EHR market is set to grow to $39.7 billion by 2022. As patients and providers alike push for better access to data for informed care management and decision-making, healthcare organizations are making significant investments in their EHR systems for cohesive care coordination in the transition to value-based care.

If you are like many leading health IT professionals today, your organization has made a multi-million-dollar purchase of a new Epic EHR system. Now what? After months, and possibly years, of planning for your new Epic system, one of the biggest issues for IT end users has been the first Epic ambulatory visit with patients. Why? As with anything new, the system is a major change for your providers and staff. It will take time for your them to learn the new system functionality and develop muscle memory to navigate through seamlessly.

One of the most important things you can do to improve the go-live process is to make sure key patient data is entered prior to both the go live and the first patient visit. Minimum key data points on each patient should include schedule visits, allergies, active medications, active problem list, immunizations and preferred pharmacy.

How can you smooth the new system adoption process?

In part I of this two-part blog series, consider the following three takeaways for EHR system data abstraction and conversion:

  1. Legacy system data cleanup
    12 months before your Epic go live, begin cleaning up the key data in your legacy system. Why so early? Many patients only visit their doctors once a year. By beginning the cleanup processes one year prior, you will have plenty of time to make sure the most accurate information is transferred into your new system. This is especially pertinent for the problem lists and medications. Doing so greatly speeds up data load into the new system and ensures with each subsequent visit that providers are addressing the active patient problems. Keep in mind though that if you have data in your legacy system that is no longer valid, this is your opportunity to start fresh.
  2. New Epic system patient data entry
    How much time does it take to enter the data into the new system? Depending on the complexity of your patient population, it can take anywhere from 5-10 minutes per patient to enter and validate a patient’s data into Epic for the first time. Remember, this is a new skill for your staff to learn, so it will likely take them longer at first to enter data as they learn the new system.
  3. Data pre-loading best practice
    How soon do I begin entering this data into Epic? The best practice is to pre-load your first 2-3 weeks of scheduled patients into Epic prior to go live. This allows your staff to have the patient data ready during the first few weeks of actual new system use. It also reduces stress on your staff, allowing them time to learn and adapt to the new system. Depending on the number of active patients and scheduled appointments, multiply the average of 5-10 minutes for best and worst-case proactive planning of time needed for data entry prior to the go-live date.

Check back for part II covering data conversion staffing solutions, CCD load and auditing.

-Lisa Alkin-Imhof, Epic Practice Director

12 Times Nurses Made a Difference in Disaster Relief

In celebration of National Nurses Week, check out the following guest blog:

Throughout history, countless stories endure of nurses rushing to the frontline for those in need. To honor the vital role nurse play in healthcare, the U.S. celebrates National Nurses Week each year May 6-12. From founding the American Red Cross to recent natural disaster relief response, dedicated nurses shed their scrubs to serve others in any setting. Today, let’s highlight 12 times nurses made a difference with hurricane and earthquake relief.

Nurses Serve After Hurricane Maria

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Regarded as the worst natural disaster on record in Puerto Rico and Dominica, Hurricane Maria took the lives of 550 people and caused an estimated $103 billion in damage. The September cyclone left 80,000 Puerto Ricans without power or medical supplies, leaving medical relief largely to foreign aid organizations.

  • They Begged for More Aid — The nation’s largest nurses’ union, National Nurses United, sent more than 50 nurses to Puerto Rico and Dominica in the days following the hurricane as part of the organization’s Registered Nurse Response Network. The nurses returned home and shared shocking conditions with the media, urging the federal government to send more relief.
  • They Set Up Urgent Care Centers — Haiti is no stranger to natural disaster, so naturally, Heart to Heart International’s Haitian Response Team jumped into action after the devastating hurricane. A team of 10 Haitian doctors and nurses brought medical and humanitarian aid in the form of a makeshift urgent care center. They were some of the only humanitarian responders to provide care in rural Puerto Rico.
  • They Helped the Elderly — According to CNN, after the hurricane, a team of nurses helped deter an elderly woman’s suicide by alerting the mayor of the situation. They also assisted a woman trapped inside an assisted living facility, who had not eaten in three days.
  • They Transported Patients to the Mainland — According to nurse Camrai Damore and respiratory therapist Mark Puknaitis — two Chicago area Maria responders —nurses aided the sick and injured by transferring those with serious medical conditions to the mainland for better quality care.
  • They Visited the Sick at Home — One of the most devastating effects of Hurricane Maria was the total crumble of the infrastructure of many cities. As a result, nurses made in-home visits to suffering Puerto Ricans who were unable to leave their homes. They also helped to set up temporary shelters that were more accessible than hospitals and clinics.

Healing After Harvey

Back in the continental U.S., the country was recovering from another natural disaster. In August, Hurricane Harvey became the first major hurricane to make landfall in the U.S. since 2005. It inflicted nearly $200 billion in damage and displaced more than 30,000 people in the process, primarily in the Houston metropolitan area. It didn’t take long after the storm settled for nurses to come to the rescue from all over the country.

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  • They Responded by the Hundreds — Within four days following Harvey, more
    than 300 nurses made their way to Houston to provide essential medical relief to
    the masses, stethoscopes and all. The group of nurses had a broad range of specializations, including NICU, OR and ER nursing.
  • They Brought Supplies — That massive wave of 300 nurses didn’t head to Houston empty-handed. Instead, they brought generators, linens, water tanks, food and medicine. This was especially important due to the fact that Houstonians were forced to completely evacuate several hospitals, but still needed to be prepared for a massive response. Supplies allowed them to administer care just about anywhere.
  • They Covered Shifts — According to reports, a large volume of Houston medical professionals were left homeless due to water damage. Nurses from other parts of the state and the country flocked to Houston to help cover shifts of medical professionals who were forced to deal with personal fallout from the storm.
  • They Helped Clean Up — Days after the storm, medical professionals were forced to return to work, where much had been destroyed due to moisture, mildew and mold. Many nurses who flocked to the region after the hurricane spent their evening hours cleaning up debris and handing out supplies.

Administering Urgent Care to Earthquake Victims

Just weeks after Hurricane Harvey rocked the nation, central Mexico was hit with a 7.1-magnitude earthquake that left 370 people dead and more than 6,000 injured in and around Mexico City. The strong shakes lasted for about 20 seconds, collapsing more than 40 buildings in the process.

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  • They Jumped to Action Immediately — According to the Red Cross, some 500 volunteers — many of them nurses — jumped to action in the hours immediately following the disaster. The Mexican Red Cross deployed more than 90 ambulances and several hundred paramedics, who provided life-saving aid within hours.
  • They Cared for Kids and Babies — Among the collapsed and damaged buildings were a series of schools, many of which had children inside. One of the greatest challenges for responders to the Mexican quake was figuring out how to care for the many injured children. Makeshift hospitals were set up, and nurses jumped into action to provide care.
  • They Delivered Babies — In one inspiring tale from the quake, nurses delivered a healthy baby in the middle of the quake in one of the worst affected neighborhoods. While the rest of the hospital evacuated, nurses ushered Jessica Mendoza to a safe place, so she could give birth to a healthy baby boy.

These heartwarming tales are just a glimmer of the heroic work nurses conduct each day. Keep these stories in mind this week as you thank the nurses around you.

Created in coordination with
Deborah Swanson, Content Coordinator, realcaregivers.allheart.com

Insights From the Sixth Annual Health IT Industry Outlook Survey

Over 300 HIT professionals shared their insights in the sixth annual Health IT Industry Outlook survey. The results focus on health IT leaders working collaboratively to stay on top of evolving staffing, EHR system and technological advancement trends for operational efficiency and proactive patient care. Hospital IT departments continue to struggle with strained resources and competing projects. As the industry pushes forward with value-based care, the ability to optimize technology and workflow within an organization is vital for success. Here are four key takeaways from the 2018 survey:

  1. Need for a cross-disciplinary team

Within the survey, measuring improvement in patient care quality was rated as the top business objective (40 percent) by health IT leaders. Outdated passive measurement processes no longer work in today’s complex health systems. Considering competitive pressure in the new healthcare landscape, each hospital department must eliminate communication silos for a cohesive strategic conversation. To proactively establish efficient workflow, reporting needs and streamlined communication, create a cross-disciplinary team from all areas impacted by a new or optimized EHR system. Healthcare organizations need to look at the full picture of patient care to make proactive decisions.

Survey Teaser #1

  1. HIT staffing solutions

Optimizing IT/EHR performance (32 percent) and overcoming IT staff shortages (31 percent) were cited almost equally as the most significant challenges in 2018 among survey participants. To strategically address staffing challenges, identify support gaps by creating a visual support map covering all facilities, applications and tools impacted by a new EHR or large-scale IT deployment. You can be creative in staffing by looking to local sources such as area colleges to utilize students in IT, healthcare administration, education, nursing or healthcare-related programs. This can be helpful during short-term projects like system go-lives or vendor upgrade support.

  1. Integration for quality care improvement

Clinical application and implementation support (32 percent) remain the top 2018 IT outsourcing requests, followed by HIT service desk support (28 percent). While EHR adoption is nearly universal across the country, there is much more depth to a full system implementation than an initial go live. Integration is essential for improving care quality and ensures that health organizations have a comprehensive, accurate and reliable perspective on their care performance reporting. HIT leaders can combat health system interoperability challenges by focusing on tight integration of IT platforms and data across internal hospitals, practices, providers and even patients at home. A clinically consultative HIT service desk can help identify siloed issues with workflow and end-user errors while serving as a single source of contact.

  1. Making MACRA a habit

Finally, the survey found that most organizations stills struggle to align reporting priorities with practices within year 2 of MACRA. Forty percent of survey participants reported feeling underprepared for year 2, and only 12 percent felt very prepared. When organizations are short-handed for IT support and optimization, it can impact other initiatives such as MACRA reporting strategy. By making the data capture and analysis more automated and consistent, preparation can be easier. The result will be more detailed documentation, better EHR utilization and QPP category maximization – making strategic MIPS participation a more simplified process.

HIMSS18 Pushes Immediate Patient-Centered Change

We have all heard the saying, “the customer is always right.” Consumers should drive how a business functions, next steps and where the industry is headed. In healthcare, it is no different. Patients expectations are raising higher standards in technology, experience and outcomes. The providers who fail to recognize the patient-centric culture forming will struggle to stay competitive.

HIMSS18 brought a multitude of insights to over 45,000 healthcare IT professionals on how to provide better patient outcomes. Technology is booming in healthcare, but adoption still lags behind other industries. Here are four themes from HIMSS18 to competitively propel healthcare providers:

  • Consumerism is here to stay. Patients are looking for a patient experience built on consumer preferences, personalization, flexibility and clear communication. This can include digital options for registration and billing, better ways to share EHRs digitally and personalized physician-to-patient interactions. Providers must use patient communities as an eye toward the next direction of their organizations.
  • Healthcare is moving from diagnosis and treatment to anticipation and prevention. Start looking at technology abilities not only as a tool or data storage, but to analyze and predict. Smart data enables insights toward physician care decision making, patient experience improvement, readmission reduction, population health management and prescription monitoring. The latter comes into play with the country’s opioid crisis, as prescribing systems are now working to flag addiction patterns and medication discrepancies.
  • Artificial Intelligence is the name of the game. AI has been introduced before, but its presence is finally in practical application in healthcare. Artificial intelligence will allow healthcare professionals to analyze the healthcare data they already have stored, alarm physicians of things that should be noted and let physicians better focus on patient experience while the machines look for gaps in data. The next step though is to make the technology accessible in practice at the point of care without adding workflow burden to end users.
  • Disruption is key. Healthcare organizations must focus on the consumer and how technology will evolve their abilities. Some say that health systems will be known as tech companies with a healthcare focus considering all of the technology advances leading to the future of healthcare.

Here’s a look at how several CHIME provider organizations are staying ahead with these themes: http://bit.ly/2Fs5dNU

HIMSS18 elicited many insights for the future of health IT. After all, it is not every day that you get to talk about machine learning detecting cancerous tissue. Then again, HIMSS brought up many tactics applicable to any healthcare organization despite differences in budget, patient communities, region or specific EHR. The conference teases what’s on the horizon for care possibilities but also grounds us with consideration of where reporting, CIO pain points, physician burnout and standardization need to be addressed.

Staying In the Know on MACRA

As a follow up to our last post, we want to give an update on the state of MACRA’s Merit-based Incentive Payment System and reporting tips. First, let’s address continued year 1 reporting.

Data Submission
Given feedback from clinicians across the country, CMS is working to lessen reporting confusion and burden. The center recently launched a data submission system for Quality Payment Program (QPP) participation. With the new platform, clinicians will need to create a login to submit and manage year 1 data, which is due by March 31, 2018. The system will connect clinicians to the Taxpayer Identification Number (TIN) associated with their National Provider Identifier (NPI) as eligible clinicians report either as individuals or a group. The system provides immediate feedback with real-time scoring as data is entered. However, scoring may change based on additional data input or new quality measure submission. To learn more, check out CMS’ QPP 2017 Data Submission Factsheet.

MIPS’ Future
Though CMS recently unveiled QPP year 2’s final rule, the group is now accepting recommendations for new specialty measure sets or revisions for 2019’s MIPS program year. CMS will accept suggestions until Feb 9, 2018.

While program planning moves along, pushback from the Medicare Advisory Board (MedPAC) arose. The advisory body to Congress recently suggested replacing MIPS with an alternative program model that is less burdensome and complex for participants. Meeting notes are here, and no changes have been officially made.

As each MACRA public discussion and policy adjustment occurs, clinicians may find more and more uncertainty. Our goal is to keep readers in the know, so they can focus on quality patient care.

Assessing QPP Year 2’s Final Rule

In the last leg of 2017, CMS has issued the MACRA Quality Payment Program (QPP) final rule for year 2.

After gathering feedback during the lengthy comment period, Acting Administrator of CMS, Seema Verma said, “During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients. These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system.”

As medical and health IT professionals across the country work to assess the 1,653-page published final rule, let’s address key provisions.

MIPS Final Performance Categories
In calendar year 2018, the performance categories shift in weight to Quality at 50 percent, Improvement Activities at 15 percent, Advancing Care Information at 25 percent and Cost, the most significant change, moves to 10 percent of the final score. The final rule projects Cost to increase to 30 percent of the total MIPS performance score by the 2021 payment year.

Much to organizations like MGMA and CHIME’s dismay, both Cost and Quality require a full year of reporting. The MIPS performance threshold increased as well from just three points in 2017 to 15 points in 2018. CMS is also finalizing changes to 27 existing Improvement Activities with plans to introduce an additional 21 to the inventory.

Exemption and Bonus Opportunities
For QPP year 2, the low-volume threshold for MIPS exemption stands at 200 Medicare patients, while the reimbursement threshold is $90,000 in Part B.

As seen in the proposed rule, year 2 allows up to five bonus points toward the MIPS final score for treating complex patients. Bonus is also possible under the Advancing Care category for providers solely using 2015 certified EHR technology (CEHRT). However, 2014-edition CEHRT is permitted; the bonus just does not apply.

CMS has made concentrated effort toward small practices, which are defined by MACRA as 15 eligible clinicians or fewer. Small practices can earn a bonus of five points toward the final MIPS score. A hardship exemption also applies under Advancing Care Information for MIPS, providing three points even if small practices submit quality measures below data completeness standards.

In light of recent natural disasters, year 2’s final rule automatically weights the Quality, Advancing Care Information, and Improvement Activities performance categories at 0 percent for final score for those impacted by Hurricane Harvey, Irma, Maria or other natural disasters

MIPS Virtual Groups
As previewed in the proposed rule, QPP year 2 enables virtual group participation in the MIPS program. This is helpful for small practice clinicians, since they can team up for MIPS reporting on an aggregate basis, regardless of specialty or location. Those reporting under virtual groups must opt in by Dec. 31, 2017 for QPP year 2.

Advanced APMs
Under Advanced APMs, CMS extended the nominal amount standard of 8 percent until the 2020 performance year. The Medical Home Model holds a 2.5 percent risk with plans to gradually increase over time.

Starting in 2019, qualified payers (QPs) can leverage the All Payer Combination Option. An eligible clinician must participate in an Advanced APM with CMS as well as an Other Payer Advanced APM for this.

While most of the final rule’s provisions were previewed in the proposed rule, the industry is still assessing how the 2018 plan will impact clinicians and their practices. Stay tuned for part II of our QPP year 2 final rule follow-up, discussing implications and tips for success.

Staying Afloat As a CIO Amidst Industry Pressures

Across the country, over 80 percent of healthcare organizations now have an EHR system in place. While initial implementation no longer serves as a major issue, with the new technology comes added CIO pressures, including reimbursement program requirements, technology disparities and security challenges.

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Reimbursement reporting challenges

With year 1 of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP) well underway, the healthcare industry forges ahead in the transition to value-based care reimbursement. While the shift aims to advance patient care, many providers find themselves swimming in reporting requirements or completely oblivious to the program altogether. According to a NueMD survey, 50 percent of physicians are unfamiliar with the reimbursement legislation, and 49 percent have never encountered any information about it at all.

Health IT can help clinical care fill in knowledge gaps by facilitating assessment of current patient care and technology practices that meet QPP measure requirements. By strategically aligning data capture, maintenance and analysis with outlined QPP measures while looking ahead to potential year 2 program leniencies, providers can ease burden. With a little preparation, IT can help find the low-hanging fruit for the reporting quick wins that will help avoid QPP penalties while maximizing the program’s financial bonuses.

Rural health disparity

As value-based care requirements elevate, critical access, small and rural healthcare providers lag behind. From 2008 to 2015, only one-third of hospitals surveyed by the American Hospital Association had at least eight of 10 performance management EHR functions in place. Just 33 percent of hospitals with fewer than 100 beds adopted such systems.

Discrepancies in technology advancement between rural or small providers and large medical systems creates a digital divide across the country. Small providers face the decision of closing shop, joining group purchasing arrangements, becoming part of ACOs or sticking it out on their own. These struggling providers need continued representation in HIT policy and government regulations beyond progress with the 21st Century Cures Act for vendor transparency or MACRA’s QPP year 2 leniencies.

Cybersecurity concerns

While advancing technology is vital for new patient care needs and expectations, its growing significance also puts healthcare providers at risk. In a recent MGMA survey, only 55 percent of healthcare professionals have confidence in their organizations’ IT infrastructures against cyber attacks, while almost one-third have faced a cyberattack.

As healthcare ranks poorly at 13th in U.S. industries for cybersecurity practices, more and more HIT departments are turning to outsourcing expertise. Total IT budget spent on outsourcing has increased from 10.6 percent in 2016 to 11.9 percent in 2017. Now, healthcare organizations are turning to third-party advisors to train and certify staff on security best practices, while partnering with external security providers and adding defense tools to the HIT suite of applications.

Despite these three areas of concern, by strategically planning for value-based care requirements, today’s healthcare CIO stand better equipped against mounting pressures, while assessing market trends, turning to third-party expertise and staying on top of industry policy change.