Photos University of Michigan: mediabank.med.umich.edu

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1 1 Leveraging the EMR to Enhance CDI Rishi Bakshi, DO Medical Director, Clinical Documentation Improvement Assistant Professor, Physical Medicine and Rehabilitation Michigan Medicine Ann Arbor, MI Michigan Medicine 1000 beds Academic structure 20 FTE CDS Epic site Photos University of Michigan: mediabank.med.umich.edu 2 Outline Brief introduction to structured problem solving EMR strategies to enhance CDI Focus on primary documentation Easy and advanced options Enhancements to CDS workflow Discussion and next steps 3 1

2 4 Learning Objectives At the completion of this educational activity, the learner will be able to: Identify opportunities within progress notes and the discharge summary to improve primary documentation Develop EMR based strategies to strengthen CDI reviews Structured Problem Solving Problem identification Determine goals S.M.A.R.T. Understand primary causes Emphasis on firsthand knowledge Consider countermeasures Standardized work Error proofing Minimal disruption to workflow Develop operational plans/reassess 5 Traditional CDI Interventions Provider education Tip cards Queries CDI specialist interaction Physician advisor Teach Query enforcement Photo provided with permission by J. Billi, MD 6 2

3 7 Why Is CDI Difficult for Providers? Barriers Knowledge that this is a problem Busy treating patients Don t know what to document, where to do it, or how to do it I m not a coder! No standardized processes Solutions are typically outside of provider workflow Results in queries EMR Based Interventions Streamlined, within workflow Epic smart tools (e.g., dot phrases ) Standardized notes CDS clinical indicator worklists 8 Malnutrition Dietitian Provider Types.nutritiondx 9 3

4 10 Outcomes Documenting Coexisting Diagnoses Two new sections in the Discharge Navigator Pertinent Results and Coexisting Diagnoses were added to allow providers to easily document a patient s comorbidities 11 Documenting Coexisting Diagnoses Pertinent Results section displays information needed for decision support to address the Coexisting Diagnoses section 12 4

5 13 Documenting Coexisting Diagnoses Pertinent Results a closer look Documenting Coexisting Diagnoses Select Coexisting Diagnoses from within the Discharge Navigator Select the appropriate Patient Type this drives the comorbidities/diagnoses options for selection 14 Example: Nutrition Diagnosis and CKD Click the appropriate diagnosis button to select it the selected option(s) appear highlighted in blue The selections made here are pulled into the discharge summary 15 5

6 16 Use Two Sections Together for Decision Support A. A prompting reminder is displayed when pertinent results are available B. Use the displayed information for decision support when selecting items in the Coexisting Diagnoses section C. Selected option Use Two Sections Together for Decision Support Example using chronic kidney disease 17 Documenting Coexisting Diagnoses Click Close when complete. Scrolling down may be necessary to locate the Close button. 18 6

7 19 Appearance of Coexisting Diagnoses in the Discharge Summary Context of Coexisting Diagnoses Within the Signed Note 20 If the Patient Does Not Have Select Comorbidities 21 7

8 22 What if the User Skips the Coexisting Diagnoses Section? Coexisting Diagnoses Tool Use 23 Coexisting Diagnoses Tool Reporting Coexisting Diagnoses Section Audit Report For discharges from 01/29/2017 to 02/04/2017 Discharge Service Discharge MRN Name Coexist Discharge Note Discharge Note Date Nav Used Created By Signed by (Yes/No) Surgery Trauma Orthopaedics 02/02/2017 No VADER, DARTH REN, KYLO Surgery Trauma Orthopaedics 02/03/2017 Yes SKYWALKER, LUKE SOLO, HAN Surgery Trauma Orthopaedics 02/03/2017 Yes COSTANZA, GEORGE SEINFELD, JERRY Surgery Trauma Orthopaedics 02/03/2017 s Yes BURR, AARON HAMILTON, ALEXANDER Surgery Vascular Adult 01/29/2017 Yes MADISON, JAMES JEFFERSON, THOMAS Surgery Vascular Adult 01/30/2017 Yes BACCA, CHEW KENOBI, OBI WAN Surgery Vascular Adult 01/30/2017 Yes FLANDERS, NED SZYSLAK, MOE F Surgery Vascular Adult 01/30/2017 Yes SCHUYLER, ANGELICA SCHUYLER, PEGGY 24 8

9 25 CC/MCC Capture Can We Use the EMR to Help CDS? Yes! We provide patient lists with query opportunity based on presence of clinical indicators. 26 Cardiac Reports 27 9

10 28 Renal Disease Reports Next Steps Consider provider, ancillary staff, and CDS workflow Connect with an EMR analyst Connect with an EMR report writer Don t take that s not possible for an answer 29 Thank you. Questions? In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide