WMHS Experience: EMR Assessment and Optimization Michele Martz, FHFMA, CPA Vice President Physician Enterprise @ WMHS

Cathy Zito, FHFMA, CPA, CPC Chief Executive Officer @ Lighthouse Healthcare Advisors

Who We are

Western Maryland Health System Cumberland, MD • •

275-bed hospital located in western Maryland opened in 2009, licensed beds have declined to 209-beds as of 2015 Consolidated two campuses into a new “greenfield” site

Service Area

Facts About WMHS • $330M in operating revenues for FY16 •

11,882 adult admissions per year (Down from 15,521 in FY11)

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52,875 ED visits per year

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938 deliveries per year

• Over $312M economic impact on the region annually • $37M in Community Benefit for FY15

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Located in one of the poorest counties in one of the nation’s richest states Skilled nursing facility with 88 beds Region’s largest employer with 1900 employees

Other 13% Self-Pay 1% Commercial 13%

Payor Mix Medicare 54%

Medicaid 20%

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250 physicians on staff

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One of nine Trauma Centers in Maryland and the only Open Heart Surgery program west of Baltimore

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Part of a newly formed three health system group in western Maryland called Trivergent Alliance Health

WMHS Clinics & Practices  WMHS Clinics and Practices • • • •

3 primary care offices 12 Multi-specialty practices 2 clinics 2 urgent care centers

 Employed Providers • 32 MDs or DOs • 21 Advanced Practice Professionals • 63 support staff

 Financials • $18M Operation

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EMR Implementation  eClinicalWorks implemented in 2009  Stage I of Implementation • • • •

2 offices (Cardiology & Infectious Disease) Classroom training by eCW Three days with eCW trainer “elbow to elbow” in office Fourteen days with IT Project Manager and Practice manager rotating through offices to answer questions

 Stage II of Implementation • Repeated classroom style training • Super Users identified and given additional training and expected to train others in their offices

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EMR Implementation (continued…) • Super Users identified and given additional training and expected to train others in their offices • Three days with eCW trainer “elbow to elbow” in office • Eleven days with IT Project Manager and Practice manager rotating through offices to answer questions

 Additional Implementation Stages • All practices using eCW by early 2011

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EMR Challenges  How should we ease User frustration?  Are our Workflows efficient?  Are we meeting standards for Compliance in documentation and billing?  Are there application design issues?  Are there interface issues?  Are we missing important charge capture opportunities?

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Assessment Objectives  Identify short and long-term solutions to ease user frustration with eCW  Evaluate workflow process for identification of: • • • • •

Inefficiencies Waste Gaps in process “Workarounds” Compliance concerns

 Identify opportunities to improve charge capture  Determine if application design is sufficient  Determine if interface issues need to be addressed

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EMR Assessment Plan  User-centered designed assessment  On-Site Observations • Interview staff • Observe for full day in each practice

 Information Technology • Focus on how new users are trained

 Billing Office • Interview to obtain overview of the billing process

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On-Site Observation  Checklist completed for each portion of visit via • Interviews with staff • Observation of patient flow

 Process maps created for each portion of visit • Observations are follow “stoplight” color code system Best Practice Warrants Attention Needs Immediate Attention

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Areas for Process Maps Scheduling

After Visit

Pre-Visit

Check-Out

Check-In

Encounter

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Interviews  Key Information Technology Personnel  Key Billing Personnel

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Summary of Issues  List of Issues by Practice  Categorized by type of Issue: • • • • •

Compliance Efficiency Interface Policy Security

 Prioritized as Low, Normal or High

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Findings       

Training & IT Support Policies & Procedures Charge Capture Provider Inefficiencies A/R Follow up Application Design Interfaces

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Recommendations  Develop Policy & Procedure Manual • • • •

General Operating Patient & Financial Compliance Billing & Payment

 Create Advisory Council • VP, Practice Management, Physicians, IT, Compliance • Meet Monthly

 Add Coding Manager position • Promote CPMA to Coding manager • Create Coding Certification program

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Recommendations  Create IT training manuals & protocol • eCW training manuals • Protocol for new providers/staff • Reinstitute Super Users Groups

 Address lab interface • Contingent on overall Trivergent plan

 Clean up eCW dictionaries • Identify updates needed on most common procedures • Identify lab compendium issues

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Recommendations  Create denial reports  Re-implement eCW with focus on retraining staff with reengineered workflows

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Deciding on Affordability and Emphasis  Decision to do clinical optimization vs. re-implementation of eCW • Time constraints • Budget constraints • Future EMR considerations

 Executive decision made to perform clinical optimization • Greatest need was to ease provider frustration • Desired outcome was improved efficiencies and productivity

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EMR Clinical Optimization  Build necessary forms, screens, templates needed to implement re-engineered clinical workflow with the eCW EMR.  Develop eCW IT Training protocol for clinical processes.  Develop eCW generalized training materials for clinical processes.  Train providers and staff and provide “elbow to elbow” support with eCW.

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Clinical Optimization Results  Happier Users  More Efficient use of eCW  Identification of Areas that need additional work/development: • • • • • •

Security Maintenance of eCW database Users Group New Provider and Staff training Document Management Generic Alerts

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Survey Results  Overall Rating for Training • 50% Excellent • 45% Good • 5% Fair

 31% Response Rate  Comments • “Great week learned a lot of useful information, tips and tricks, outstanding job!” • “These sessions should be provided at a much sooner time after employment. I would suggest a providers receive basic training at the start and then within 1-2 weeks after seeing patients do more in-depth skills sessions……including covering any additional questions the provider needs.”

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Functionality Lost in the Design

“I think more investment needs to be made in supporting the development of the EHR to as closely match clinician workflows as possible ensuring it is fit for purpose. Too often what the clinician wants is not what they get and spend too much time in workarounds because the technology does not support their needs.” —Nurse Informaticist

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Closing Thoughts  Frustrated providers that substitute workarounds as a quick fix.  Unhappy users breed negativity across the work place and slow productivity.  “Almost half of the practices did not realize savings in paper medical records because they continued to keep records on paper.” (March 2013 study from University of Michigan)

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Closing Thoughts  Long term investment in thoughtful implementation and skilled optimization will lead to system adoption and utilization success.  Ease of EMR utilization and support is important to provider satisfaction and retention.  EMR utilization and efficiency improvement can directly improve financial results.  Enhanced EMR utilization leads to improved patient experience and outcomes.

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Questions ? Michele Martz Cathy Zito

[email protected] [email protected]

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Speaker Biographies Michele Martz is the Vice President of Physician Enterprise at Western Maryland Health System. Her responsibilities include the employed physician clinic and practice operations, as well as physician recruiting. Michele also serves as Executive Director of the ACO. Prior to her current position, she served as Vice President of Finance for the health system. She has 27 years of healthcare experience and began her career in public accounting at Deloitte LLP in Pittsburgh, PA. Michele holds a Bachelor of Science degree in Accounting, as well as a Master of Professional Accountancy degree from West Virginia University. She is both a Certified Public Accountant and a Healthcare Financial Management Association Fellow.

Cathy Zito is the President/CEO of Lighthouse Healthcare Advisors, LLC. She has over 30 years of healthcare experience. Her career started at Johns Hopkins in the Operations, Planning & Budget Office and she also worked at the University of Maryland Physician Faculty plan overseeing the financial operations of the managed care department. She has been providing healthcare consulting for the past 20 years. Her company motto is Vision…Direction…Success, and she is committed to guiding clients through the challenges brought on by massive change in the healthcare industry. Cathy is a graduate of University of Baltimore and a certified public accountant. She is a Fellow with the Healthcare Financial Management Association and is a Past President of the Maryland Chapter and has served as Regional Executive for Region 4. Cathy is also a member of MGMA. She is a certified professional coder and a member of AAPC. Cathy has obtained a Certificate of Achievement from Villanova University as a Six Sigma Green Belt in Healthcare.

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