Rules Based Orders Good For Your Practice Today And Tomorrow
Pat Wolfram Liaison Healthcare Director EMR-to-Lab Integration 971-255-9282 pwolfram@liaison.com
What We ll Cover Today Adding Order Intelligence To Centricity EMR Orders (CPOE) Today s CPOE benefits to the clinic for the lab for the imaging center For an ACO EMR-Link Orders and Interfaces: Architected To Support Future Generations of Centricity
Adding Intelligent Orders To Centricity Today s Rules: Medical Necessity Lab Routing Based On Insurance Lab Routing Based On Test Type Grouping tests according to specimen (per lab requisition) Adding Other Intelligence To The Order: Test prices Helpful with high patient co-pays Converting EMR orders to lab requisitions Not a 1-1 ID relationship More Rules and Intelligence On The Roadmap High cost genetic testing Redundancy tests Image appropriateness
Medical Necessity (aka ABN) Checks Financially -- affects Medicare reimbursements to the lab. But the check/documentation must be performed at the clinic (where there is little motivation to do so) Some labs write off up to 5% of all Medicare tests due to missing supporting documentation. Each lab requires it s own set of ABN rules They use the same base set, but each lab adds rules for their custom panels Practice Benefit 10 doctors ordering 2000 tests/month Lab Benefit Lab running 70,000 tests/month 20% Medicare (14,000 tests) Limits Callbacks 480 $9600 Limits Callbacks (10% of Medicare tests) Limits Write-offs (3% rate) 3318 hours $59,000 $198,000
Lab Routing: Insurance Based Usually due to national reference labs arrangements with insurance companies Aetna agreement with Quest United Health agreement with LabCorp Most useful for larger clinics with multiple labs Patient insurance evaluated, correct lab chosen Practice Benefit Lab Benefit Varies. Simpler ordering workflow for physicians Varies. Insures the tests they receive are meant for them
Lab Routing: Based On Test Type More common for larger clinics with multiple labs Routing based on clinic preferences: To specialty pathology lab To genomic labs To local physician office lab Clinical tests default to local hospital lab Practice Benefit Lab Benefit Correct volumes and number of vials collected (some blood to hospital lab, some to office lab, some to.) All POL tests default to local lab (unless insurance rules override), with a billing message to PMIS Lab receive the right tests those meant for them
Test Grouping Groups tests according to their specimen type Practice Benefit Lab Benefit Workflow efficiency for nurse and phlebotomists Lab receives the right volumes of blood, correct number of vials.
Where The Intelligence Resides ABN validation Valid provider EMR-Link Order Entry Questions Test Pricing Routing Splitting of lab requisition Lab Compendium Lab Compendium Order Routing Req splitting Test directory ABN rule checks AOE questions Specimen info Requisition per lab spec Label printing HL7 translation Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
And Apply The Intelligence In The Practice Workflow ABN validation Valid provider EMR-Link Order Entry Questions Test Pricing Routing Splitting of lab requisition Lab Compendium Lab Compendium Order Routing Req splitting Test directory ABN rule checks AOE questions Specimen info Requisition per lab spec Label printing HL7 translation Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
Over 300 Labs and Imaging Centers On-Boarded EMR-Link Radiology ABN validation Valid provider Order Entry Questions Test Pricing Routing Splitting of lab requisition Compendium Compendium Reference labs Clinic s EHR Order tests Result review Draw and Order complete Orders Results Order Completion Result code xref management Report bundling Hospital labs Physician Office lab
CPOE/Orders: Practice Benefits Real-time ABN check: Reduced calls back to the clinic requesting justifying diagnoses No calls from lab-to-clinic asking for more patient or insurance information. Almost 100% chart match for the result Matches a result to the right ordering provider (instead of responsible provider) Reconciles (autocompletes) the EMR order status One ordering category, not one category per lab One workflow for multiple labs Auto splitting of the tests (based on test or specimen) Routing to the right lab (based on insurance rules)
Annual Practice Savings 10 physician group ~200 orders per physician Medical Records (matching/routing errors) Clinical Staff (result tracking and order status updates) Billing-Reduction of Tracking down DX Hours Saved Dollars Saved 150 $1,500 480 $7,200 540 $6,480 Total 1170 $15,180
Let s See Some Of The Workflow Steps EMR-Link ABN validation Valid provider Order Entry Questions Test Pricing Routing Splitting of lab requisition Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
Today: Adding Intelligence To The Order Workflow EMR-Link ABN validation Choose the lab Order Entry Questions Test Pricing Routing Splitting of lab requisition Draw and Order complete Orders Order tests Clinic s EHR Result review Results Order Completion Result code xref management Report bundling Lab
The ABN Check.. Dr. Stays In The EMR Check is in the background. Zero clicks
Splitting Rules For Labs Multiple tests ordered in Centricity Nurse sees EMR-Link web-form Split is automatic Auto-splits into separate requisitions
And Route To The Right Lab or Rad
Ask At Order Questions Driven by the lab s order codes But if insurance rule chose a different lab?
CPOE/Orders: Benefits For The Lab/Rad Lab Receives Clean and Complete Orders Minimize call-backs to the clinic (saves time, money, and doesn t aggravate the Dr s office) Reduces Medicare write-offs (validated for medical necessity) Billing becomes automated (DFT directly to billing system) Clinical information is complete (Fasting, source of specimen, collection method,.) Tests are sent to the right lab/rad Results back to clinic are more reliable Happy Clinic, Happy Service Provider Most of the time
Annual Lab Savings Lab Operations Improvements Hours Saved Dollars Saved Reduction of Data Entry 5760 $69,120 Fewer Order Errors 288 $4320 Reduction Correction Medicare Missing Dx 3240 $38,880 Reduction in LIS Maintenance 24 $600 Total 9312 $112,920
Clean/Complete Orders For A Lab Single Lab 69,000 Accessions per month (345 ordering physicians ordering 200 labs per month) 20% of lab tests covered by Medicare Total Yearly Savings $405,000 Reduced Medicare write-offs $149,040 (assuming 3% are written off) Fewer order errors $69,000 Reduced Medicare callbacks $44,160 Reduced IT maintenance of $4,800 lab interfaces Reduced data entry $138,000
Imaging Orders Receive Clean/Complete Orders Insurance information is complete Medical Necessity Checked No calls back to the clinic (saves time, money, and doesn t aggravate the Dr s office. Billing to insurance is automated Clinical Content is complete: Critical information for test is in the order Allergies (Iodine), Conditions (Claustrophobia) The orders interface: Results back to clinic are more reliable Authorization and Scheduling Prompts
Imaging Orders Different Needs Than Labs Allergies (Iodine) Problems (claustrophobia) We also send chart obs values.
Things Will Change With ACOs.. Bundles Payments; Per patient per disease type Entire ACO Coordinates To Control Costs (Physician offices, Labs, Imaging Centers Larger patient co-pays Where Can Orders Help? Reduce redundant testing Ensure Imaging study appropriateness, per the ACR Test cost comparisons
Reduce Redundant Tests In some cases, up to 30% of testing is duplicate testing CHI Solutions Study, 2014. University of Mississippi Medical Center With duplicate test alerting in their EMR, reduced test volume by 42% A solution: Must have access to a full database of recent test result history Wherever that patient was seen Result codes MUST be harmonized Patient IDs must be harmonized (an empi) Real time queries must be at the point of order consideration
Where We d Check For Duplicate Tests HIE/CDR EMR-Link Redundant test check ABN validation Order Entry Questions Test Pricing Routing Splitting of lab requisition Lab Compendium Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
Alongside The ABN Check.. Dr. Stays In The EMR Check is in the background. Zero clicks unless
Radiology: ACR Test Appropriateness Criteria American College Of Radiology (ACR) publishes these rules Based on conditions, a given test will have an appropriateness score from 1-9 We have some experience here.
About the ACR Appropriateness Criteria The ACR Appropriateness Criteria (AC) are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition
ACR Appropriateness Criteria..(cont)
Where We d Check For Study Appropriateness EMR-Link Imaging Rules Radiology DSS ABN validation Order Entry Questions Test Pricing Routing Splitting of lab requisition Lab Compendium Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
We d Show The Score Here, With The ABN
High Patient Deductibles EMR-Link ABN validation Order Entry Questions Test Pricing Routing Splitting of lab requisition Lab Compendium Orders Clinic s EHR Order tests Result review Draw and Order complete Results Order Completion Result code xref management Report bundling Lab
Pricing Options To The Patient $34 or $48
Today: Adding Intelligence To The Order Workflow EMR-Link ABN validation Choose the lab Order Entry Questions Test Pricing Routing Splitting of lab requisition Draw and Order complete Orders Order tests Clinic s EHR Result review Results Order Completion Result code xref management Report bundling Lab
Rules Based Orders Architected For Upgrades
If GE Upgrades The Orders Module. EMR-Link Radiology EMR-Link rules don t change Interfaces to labs persist API access to the EMR-Link rules ABN validation Valid provider Order Entry Questions Test Pricing Routing Splitting of lab requisition Compendium Compendium Reference labs Next Generation GE Orders Results Hospital labs Clinic s EHR Result review Order Completion Result code xref management Report bundling Physician Office lab
Smart Orders: Conclusion Good For The Practice Today Good For The Lab Clean and Complete orders Lay The Groundwork For GE Upgrades To Orders
THANK YOU!! Questions? Pat Wolfram Liaison Healthcare Director EMR-to-Lab Integration
Meaningful Use 2 Imaging Orders Objective Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines Measure More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE Objective Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines Measure Our clients are close to 100%. Made this easy
Meaningful Use 2 Imaging Results Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Exclusion Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period. You can store the images natively or embed a link. Scanned Images may be counted in the numerator. Satisfied with ImageLink
Meaningful Use 3 -- CPOE Stage 3 is optional for EPs in 2017 and required by 2018. An EP must meet all three measures in order to meet this objective: Measure 1 More than 80% of medication orders created by the EP during the EHR reporting period are recorded using CPOE; Measure 2 More than 60% of laboratory orders created by the EP during the EHR reporting period are recorded using CPOE; and Measure 3 More than 60% of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using CPOE
Meaningful Use Timeline update