Extend the Value of Picis ED PulseCheck in the Emergency Department

How long does it take to report your AMI, HF, and Pneumonia Core Measures in the ED? If your answer is weeks or months, you’re like the majority of hospitals in this country. Why? Because you’re overburdened with chart abstraction, free-text/unstructured documentation analysis, and what I like to call, “manual process fatigue”. That’s ok though, because some hospitals have started making progress automating their ED processes with applications like Picis’ ED PulseCheck. Deciding to evolve from a paper-based to electronic system in your ED is the easy part; implementing an ED Information System can be much more difficult (I know I know…”thanks Captain Obvious”). There are steps, though, that can make your journey much smoother.

There are ways to extend the value of an application like ED PulseCheck from the very beginning. It is a great application for integrating charge capture and the clinical documentation necessary for full reimbursement; it’s interoperable with other hospital systems; it’s ARRA compliant; the list goes on. Aside from the out of the box functionality, there are ways to morph this type of application into a larger asset than most Picis clients even consider. One example relates to Core Measure compliance. As I mentioned in my opening, the average hospital will report August 2010 Core Measure compliance sometime in October or November (when will you?). This is because it takes teams of people countless hours to sift through any number of paper or scanned documents and free-text narrative clinical documentation to identify the words and phrases necessary to satisfy the stringent CMS requirements. If you want to drastically reduce the timeframe to report Core Measures start by considering these and other reporting requirements when you first implement, upgrade, or extend your EDIS. One more advantage to an application like Picis ED PulseCheck is the fact that it is malleable and can be easily customized to the user’s needs. I’ve helped customize the tool to embed the exact language CMS expects for Core Measure compliance right at the point of data entry so your clinical staff is not responsible for memorizing the CMS rules, especially because they change twice a year. Removing this burden improves your compliance and in addition, wins over the staff by reducing the time spent documenting their care. Instead of continuing to allow unstructured data entry in that Picis memo field, create a drop down menu of available options for what the clinician should be documenting aligned with CMS standards. One example we delivered to an IDN in the southwest was a drop down list of antibiotics included in their pharmacy that met the requirements of the PN-5 measure for antibiotic timing. In this way, the clinicians could discretely document the drug given, no manual written or typed entry was necessary, and the nurse abstractors could simply run a query that monitored the field for the right antibiotic administered, along with the date/time field of administration and the date/time field of when the patient arrived, to ensure compliance with the 6 hour mandate.

How are you extending the value of ED PulseCheck in your hospital? I’ll collect the stories and feedback I get and post a response to this blog at a later date.

Ryan Hayden
Principal Consultant
Email: rhayden@edgewater.com

Picis Exchange Global Customer Conference – “It’s All About the Data”

The Picis Exchange Global Customer Conference went off without a hitch last week in Miami. The main information sessions were categorized by the four areas of a hospital Picis specializes in: Anesthesia and Critical Care, Emergency Department, Perioperative Services, and Revenue Management Solutions (via its acquisition of LYNX Medical Systems). I was able to attend a number of sessions, network with both the company and its customers, and hear what the top priorities for this diverse group are over the next few years. As I reviewed my notes this weekend, thinking back to all the conversations I had with OR Directors, Quality Compliance Managers, Clinical Analysts, Billing and Coding Auditors, Anesthesiologists, and IS/IT Directors, one theme emerged – it’s all about the data!

The most frequent discussions centered around a few major challenges the healthcare industry, not just Picis clients, must deal with in the coming months and years. These challenges vary in complexity and impact on the 5 P’s [Patients, Providers, Physicians, Payers, and Pharmaceutical Manufacturers]. Picis customers and users, who collect, analyze, present and distribute data most efficiently and effectively related to the following challenges, position themselves as stable players in an increasingly turbulent industry:

  • Meaningful Use – “What data must I show to demonstrate I’m a meaningful user of Healthcare IT to realize the greatest number of financial incentives available? How can I get away from free-text narrative documentation and start collecting discrete data in anticipation of the newly announced HIMSS Analytics expanded criteria?
  • Quality & Regulatory Compliance – “How can I improve my quality metrics such as Core Measures and keep them consistently high over time? How can I reduce the amount of time it takes for me to report my data? How can I improve my data collection, analysis, and presentation to enable decision makers with actionable data?”
  • ICD-9 to ICD-10 Conversion – “What data and processes must I have in place to demonstrate use of ICD-10 before the looming deadline? Is my technical landscape integrated and robust enough to handle the dramatic increase in ICD-10 codes? Does my user community understand the implications of the changes associated with this conversion?”
  • Resource Productivity – “How can I reduce the amount of time my staff spends chasing paper, manually abstracting charts, and analyzing free-text narrative documentation? What percentage of these processes can I automate so my staff is focused on value-added tasks?”
  • Revenue Cycle Improvement & Cost Transparency – “How can I integrate my clinical, operational, and financial data sets to understand where my opportunities are for enhanced revenue? How can I standardize these as best practices? Can I cut costs by reducing inventory on hand and redundant vendor/supply contracts or by improving resource utilization and provider productivity? How will this impact patient volume? Am I prepared for healthcare reforms’ “call for transparency?”

All of these challenges, although unique, have fundamental components in common that must be established before any progress is made. Each instance requires that processes are established to standardize the collection of data to ensure accuracy and consistency so users can “trust the data”. A “single version of the truth” is essential; without this your hospital will continue to be pockets of siloed expertise lying in Excel spreadsheets and Access databases (best case), or paper charts and scanned documents (worst case) that are laboriously re-validated at every step in the information lifecycle.

Picis did a wonderful job of reinforcing its commitment to its customer base. It promised improved product features, more intuitive user interfaces, an enhanced user community for collaboration and idea sharing, and more opportunities for training. Fundamentally, Picis is a strong player in a market that seems ripe for consolidation and its potential for growth is very high. Yet, Picis will always be just that, a product company. The healthcare industry no doubt needs strong products such as Picis to drive critical operations, and collect the data necessary for improved decision making and transition from paper to automation. But Picis acknowledged, through its evolving collaboration with partners such as Edgewater Technology that understand both the technical landscape and clinical domain, that the true spark for change will come when the people and processes align with these products more effectively. This combination will be the foundation for a heightened level of care from an integrated data strategy that propagates a formula of superior patient outcomes from every dollar spent.