Creating Cohesion between McKesson^® CPOE and other Paragon™ Applications
By Lauri Gilliam

You’ve just implemented Horizon Patient Folder (HPF,) an Electronic Medical Record (EMR), with your McKesson Paragon Hospital Information System and watch aghast as your Medical Records’ un-coded chart backlog balloons to over 3 million within the first month of go-live.

What to do? Assess your entire Medical Records System from soup to nuts. Then address the problems with a sound, coordinated plan of action.

And that’s what VCS can offer.

As an EMR, the hospital-wide HPF provides electronic access to all records and automated workflow for both the medical records and the business office. VCS’s assessment of this particular HPF system reveals that the Heath Information Management Department has not been utilizing its system at all. In fact, a backlog of scanning records into the HPF system has resulted in the coders having to ”retro-code” from a paper chart that became unassembled due to the prepping process for the electronic system. Further evaluation of this HPF system by VCS uncovered myriad impediments to operational efficiency and system optimization including the following:

• turnaround time (TAT) going unmet for any patient type. This delay is particularly egregious for ED records, where best practice is 12 hours
• SQL Query reveals 126 average hours (5.25 days) TAT for ER patient type
• SQL Query reveals 132.5 average hours (5.52 days) TAT for Lab, Radiology, and other patient types using SCRIPT as document trigger
• SQL Query reveals 122 average hours (5.08 days) TAT for clinic patient type using CLINIC RECORD as document trigger

Moreover, such a poorly adopted HPF can result in these inefficiencies:

• assignments in the Workflow queues not being processed for more than eight days
• inadequate training of staff and their ignorance to working electronic assignments
• document capture staff remaining uncertified to release scanned documents into HPF, so outstanding charts await supervisor review before being sent to HPF.
• unretrieved charts from the nursing floors go missing and are never scanned into HPF, so the automated workflow never triggers to send assignments to the Coders, Analysts, and Release of Information staff.

Another backlog in the paper world - for incomplete record deficiencies – further delays staff progress because processing the records requires toggling between paper and electronic environments. In this case, over 1,000 incomplete charts and 1500 deficiencies remain from the preceding year. Working this backlog prohibits staff from gaining experience and proficiency with HPF. Electronic deficiencies explode to over 4,000 records before the delinquent notification and suspension process can be executed. Even the physicians lack sufficient Physician Web station training with a focus on how to overcome their electronic deficiencies.

After its assessment determined these deficiencies, VCS takes several remedial steps to optimize HPF; included among these are the following:

• begin scanning ALL point of service documents via ILE immediately. Add SCRIPT document type to Paragon doc set in ILE
• create a PRIORITY processing shelf to address charts that come down late from the floors/units
• address backlog in REVIEWQ
• address backlog as time permits, keeping current discharges flowing to allow coding from queues
• request support from Nursing and Administration to pick up all discharges as soon as possible
• increase number of pick up times throughout the day, particularly in the ED
• establish and communicate priority processing for document capture activities (i.e late charts, ER records, input charts, etc.)
• cease scanning EKGs in color (the storage required for scanning color EKGs is not typically part of system sizing; so, there is concern that storage space will be adversely affected)
• cease scanning Nursing Kardex (the information is typically documented elsewhere
• redesign MAR to fit on standard weight 8.5x11 paper
• scan Medication Administration forms as a separate MULTIPT batch type
• provide DOCUMENT MASTER Cross Reference Tool to indexers
• add interfaced reports and non-barcode STATE or other routine forms to the DOCUMENT MASTER Cross Reference Tool
• provide accelerator keys

VCS also can make additional recommendations, such as:

• gain support from administration and medical staff leadership to address physicians with deficiencies on paper, particularly those greater than 30 days
• upon decreasing overall number of deficiencies on paper, consider scanning the remaining single pages from paper charts into HPF to assist with completion

Finally, VCS can provide HPF training to the HIM department and implement best practice processes, short cut tips and productivity standards.

So, what possibilities for “your” HPF system emerge once VCS has evaluated the situation and put a plan of action into effect?

• the document capture of the daily patient volume can be brought within best practice TAT standard of 24 hours of discharge and ED records into HPF within 12 hours
• by timely getting assignments to coders, coding backlog can be reduced from approximately 3 million to less than 750K net in DNFB within 30 days
• the overall deficiency rate can be brought into regulatory compliance from 100% down to 17%. Delinquent OP notes can be less than 1% not complete within 24 hours after surgery
• workflow queues TAT can be reduced from an average of eight days to three days
• VCS can help manage the HIM department and act as the Privacy Officer if the HIM Director is absent
• process improvement opportunities that affect the Health Information Department can be implemented across the healthcare provider’s facilities
• nursing personnel can be trained on HPF to allow them to access information and allow Health Information personnel to attack their backlogged processes

And you know what? With a smoothly running HPF, you should experience increased cash flow, more satisfied personnel, and successful implementation of other Paragon systems such as Clinical Care Station (CCS), Pharmacy, and Computerized Physician Order Entry (CPOE).

What to do when HPF or any implementation is not running at peak efficiency? Call VCS.

To learn more about VCS’ solutions for, McKesson, Allscripts/legacy Eclipsys, Epic, Cerner, MEDITECH, Siemens and PMO and Ambulatory practices call 610.444.1233, email vcs@getvitalized.com, or visit www.getvitalized.com.