Scribes, EHRs, and Workflow Efficiencies in Allergy Practices.

PURPOSE OF REVIEW: In the ever-changing healthcare system, along with new advancements in the field of allergy, the workflow for the allergist continues to evolve requiring more time spent doing non-clinical duties such as documentation and reviewing reimbursement challenges in the midst of busy clinics. The use of electronic medical records and medical scribes has emerged as tactics to aid the clinic's workflow and efficiency in the modern allergy and immunology clinic. RECENT FINDINGS: The practicing allergist can implement various additional strategies in their office workflow to maximize and synthesize good medicine and good business. Optimal use of office staff, electronic health records, and various workflow efficiencies has been shown to improve job satisfaction and reduce physician burnout. By utilizing these methods and integrating them into their practices, allergists will be able to meet the demands of the healthcare system and still provide patients with evidence based, compassionate, and cost-effective care.

A qualitative evaluation of clinically coded data quality from health information manager perspectives.

BACKGROUND: It is essential that clinical documentation and clinical coding be of high quality for the production of healthcare data. OBJECTIVE: This study assessed qualitatively the strengths and barriers regarding clinical coding quality from the perspective of health information managers. METHOD: Ten health information managers and clinical coding quality coordinators who oversee clinical coders (CCs) were identified and recruited from nine provinces across Canada. Semi-structured interviews were conducted, which included questions on data quality, costs of clinical coding, education for health information management, suggestions for quality improvement and barriers to quality improvement. Interviews were recorded, transcribed and analysed using directed content analysis and informed by institutional ethnography. RESULTS: Common barriers to clinical coding quality included incomplete and unorganised chart documentation, and lack of communication with physicians for clarification. Further, clinical coding quality suffered as a result of limited resources (e.g. staffing and budget) being available to health information management departments. Managers unanimously reported that clinical coding quality improvements can be made by (i) offering interactive training programmes to CCs and (ii) streamlining sources of information from charts. CONCLUSION: Although clinical coding quality is generally regarded as high across Canada, clinical coding managers perceived quality to be limited by incomplete and inconsistent chart documentation, and increasing expectations for data collection without equal resources allocated to clinical coding professionals. IMPLICATIONS: This study presents novel evidence for clinical coding quality improvement across Canada.

Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals.

BACKGROUND: Information technology has the potential to streamline processes in healthcare for improved efficiency, quality and safety, while reducing costs. Computer-assisted clinical coding (CAC) has made it possible to automate the clinical coding process by assigning diagnoses and procedures from electronic sources of clinical documentation. Implementation of CAC requires both investigation of the clinical coding workflow and exploration of how the clinical coding professional's role might change and evolve as a result of this technology. OBJECTIVE: To examine the benefits and limitations of CAC technology; best practices for CAC adoption; the impact of CAC on traditional coding practices and roles in the inpatient setting. METHOD: This narrative review explores the current literature available on CAC. Literature indexed in ProQuest, Medline and other relevant sources between January 2006 and June 2017 was considered. RESULTS: A total of 38 journal articles, published dissertations and case studies revealed that CAC has demonstrated value in improving clinical coding accuracy and quality, which can be missed during the manual clinical coding process. CONCLUSION: Clinical coding professionals should view CAC as an opportunity not a threat. CAC will allow clinical coding professionals to further develop their clinical coding skills and knowledge for future career progression into new roles such as clinical coding editors and clinical coding analysts. Sound change management strategies are essential for successful restructuring of the clinical coding workflows during the implementation of CAC.

The Role of Health Information Management Professionals in the Use of Geographic Information Systems.

In recent years the use of geographic information systems (GIS) in healthcare has expanded rapidly. Although the use of GIS has increased quickly, very little consensus has been reached on which healthcare professionals are best suited to be trained in and use GIS. A moderate amount of research has addressed the use of GIS in healthcare, but very little research has addressed selecting and training healthcare professionals in the area of GIS. As the use of GIS becomes more closely tied to electronic health records (EHRs), the thought arises that those best versed in EHRs, health information management (HIM) professionals, would be best suited to take on the GIS role. This mixed-methods study explored the current status of HIM professionals' role in GIS as well as the extent to which GIS is being taught in health information educational programs. Although the findings indicate that few HIM professionals are currently using GIS in their jobs and few HIM programs are currently teaching GIS, there is interest in GIS in the future for HIM professionals and in HIM educational programs.

Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department.

BACKGROUND: Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role. OBJECTIVES: Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs). METHODS: A prospective cohort study was developed in a tertiary academic ED. Charts were coded by an external billing and coding company, then returned and mapped by International Classification of Diseases, 9th revision diagnostic codes. After training by a staff member with significant experience in implementing scribe programs, scribes provided 1-to-1 support to a provider as staffing allowed. Comparisons were made between scribed and nonscribed visits. RESULTS: There were 49,389 patient visits during the study period (39,926 adult [80.84%] and 9463 pediatric [19.16%] visits), of which 7865 (15.9%) were scribed. For adults, scribed visits produced 0.20 additional RVUs per patient (p < 0.001). Scribes generated additional RVUs in Emergency Severity Index (ESI) 2 (p < 0.001) and 3 (p < 0.001) patients. There were variable effects of scribes on RVUs by diagnostic codes. For pediatric patients, scribed encounters generated 0.08 fewer RVUs per patient (p = 0.007). ESI score had no effect on RVUs. The impact of scribes on pediatric diagnostic groupings was inconsistent. CONCLUSIONS: Scribes had a positive impact on RVUs in adult but not pediatric patients. Among adults, scribes led to higher RVUs in ESI 2 and 3 but not 4 and 5 patients, perhaps suggesting a limitation to improve revenue capture on lower-acuity patients.

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction.

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.

Rehabilitación de la alimentación por vía oral en niños con enfermedades respiratorias crónicas y nutrición enteral prolongada / Oral feeding rehabilitation in children with chronic respiratory diseases and long-term enteral nutrition

Introducción: la rehabilitación de la alimentación por vía oral (RVO) es compleja en pacientes que han recibido nutrición enteral (NE) prolongada. Objetivo: describir este proceso en niños con enfermedades respiratorias crónicas y sonda nasoenteral (SNE) o gastrostomía (GT). Pacientes y métodos: estudio retrospectivo con revisión de registros clínicos de niños con NE mayor a 2 meses, ingresados entre 2005 y 2014 al Hospital Josefina Martínez. Resultados: se incluyeron 116 pacientes, con mediana de edad 10 meses (rango: 3 a 101), 56% hombres. Diagnóstico: 34,5% daño pulmonar crónico postinfeccioso (DPC), 29,3% insufi ciencia respiratoria por enfermedad neuromuscular, 19% displasia broncopulmonar y 17,2% enfermedad de la vía aérea. Con traqueostomía: 82,8%. Eran usuarios de GT 89,7% y de SNG 10,3%, instaladas con mediana de edad 6 meses (0 a 74), por ingesta insufi ciente (11,3%) o trastorno de deglución (88,7%). Del grupo total, 36,2% (42/116) tenía indicación de RVO, los cuales habían recibido NE durante 12,2 meses (2 a 41); de estos 50% (21/42) logró alimentarse exclusivamente por vía oral (91% SNG y 35,4% GT, Chi2 p = 0,023), 14% parcialmente y 36% no lo logró. El tiempo para lograr la vía oral exclusiva fue de 9,75 meses (0,5 a 47), sin diferencia por edad, sexo, vía de acceso, duración NE ni presencia de enfermedad neurológica. Conclusión: en pacientes con enfermedades respiratorias crónicas graves y NE prolongada, la RVO es un proceso lento pero posible: 64% lo logra de modo completo o parcial (AU)

Introduction: The rehabilitation of the oral feeding (ROF) is complex in patients who have received prolonged enteral nutrition (EN). Objective: To describe this process in children with chronic respiratory diseases and nasoenteral tube (NET) or gastrostomy (GT). Patients and methods: Retrospective review of clinical records from children with EN at least for two months, admitted between 2005 and 2014 at the Josefi na Martínez Hospital. Results: 116 patients were included, with median age 10 months (range: 3 to 101), 56% male. Diagnosis: 34.5% Post-infectious chronic lung disease, 29,3% respiratory failure secondary to neuromuscular diseases, 19% bronchopulmonary dysplasia and 17,2% airway diseases, 82.8% of them had tracheostomy. Access: 89.7% gastrostomy and 10.3% NET, installed at median age of 6 months (0 a 74), due to low intake (11.3%) or swallow disorders (88.7%). From the total group, 36.2% (42/116) had ROF indication, whose EN length was 12.2 months (2 to 41). Fifty% (21/42) of them achieved total oral feeding (91% SNE and 35.4% GT, Chi2 p = 0.023), 14% partially and 36% failed. The time to achieve total oral feeding was 9.75 months (0.5 to 47), with no difference by age, sex, feeding route, EN duration or presence of neurological disease. Conclusion: In patients with chronic respiratory diseases and long-term enteral nutrition, ROF is possible but slow: 64% achieved it total or partially (AU)

Desarrollo de una base de datos interrrelacionada para la toma de decisiones clínicas en un servicio de cirugía general / Development of an interrelated datebase for clinical decisión making in a general surgery department

Introducción: Con el fin de obtener datos estructurados para la monitorización y evaluación de indicadores clínicos y de gestión que sirviesen de apoyo en la toma de decisiones clínicas elaboramos una base de datos interrelacionada (BDI) a partir de registros hospitalarios existentes. Material y Métodos: Diseño prospectivo de una cohorte de intervenciones quirúrgicas programadas realizadas en el Servicio de Cirugía General de un hospital universitario de tercer nivel. Se obtuvieron un total de 4.572 registros entre el 1 de enero de 2011 y el 31 de marzo de 2013. A cada registro se le asoció información proporcionada por diferentes bases hospitalarias: Conjunto Mínimo Básico de Datos (CMBD), el sistema de gestión de pacientes (HP-HIS) e información aportada por un cirujano experto como auditor, que estableció el procedimiento principal depurado, deducido del informe quirúrgico y de alta del paciente. Los procedimientos se agruparon en 9 áreas quirúrgicas, y se clasificó su complejidad en tres grados. Resultados y Conclusiones: La BDI permite monitorizar la actividad de un servicio quirúrgico con un elevado volumen de actividad, alta complejidad técnica, gran número de cirujanos, y pacientes con variadas comorbilidades, etc. En un futuro inmediato se pretende evaluar la fiabilidad de los datos analizando el registro del procedimiento principal en HP-HIS y CMBD frente a la Historia Clínica. En una segunda etapa, se realizará la evaluación de diversos indicadores validados, que sirvan, mediante la comparación con los estándares, de apoyo en la toma de decisiones clínicas: eventos adversos, gravedad de estos, evitabilidad, desviaciones de la tendencia, etc

Introduction: In order to obtain structured monitoring and evaluation of clinical and management indicators that would serve to support clinical decision making, we have created an interrelated database (BDI) from existing hospital records. Methods: Prospective cohort of scheduled surgeries performed in the Department of General Surgery of a university hospital. A total of 4,572 records were recorded between January 1, 2011 and March 31, 2013. Each record was linked to information provided by different hospital databases: Minimum Basic Data Set (CMBD), the patient management system (HP-HIS) and information provided by a skilled surgeon as auditor, who established the main refined procedures obtained from the surgical and discharge reports. The procedures were grouped into nine surgical areas and classified into three complexity grades. Results and Conclusions: The BDI allows monitoring the activity of a surgical Department with a high volume of activity, high technical complexity, many surgeons and patients with several comorbidities, etc. In the immediate future, we intend to assess the reliability of the BDI data comparing the record of the main procedure in HP-HIS and CMBD to the medical record. In a second stage, we intend to assess several validated indicators that may serve, through a comparison with the standards, as support in the making of clinical decisions: adverse events, their severity and preventability, deviations from the trend, etc

A cost-consequences analysis of a primary care librarian question and answering service.

BACKGROUND: Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). METHODS: We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. RESULTS: The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. CONCLUSIONS: The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

Standardized testing. HIT pro exams test competencies in health IT roles.

Healthcare needs more than EHRs, it needs people who can implement and maintain them. New federally sponsored health IT exams set workforce competencies, helping job seekers demonstrate knowledge and employers benchmark qualifications.

Strategies for dealing with the national coding shortage.

Steps providers should consider to deal with a national coding shortage and implementation of ICD-10 include the following: Concentrate on employee retention (consider retention bonuses; upgrade pay scales; and offer flex-time and flexible work schedules). Begin a training program for ICD-10. Target other healthcare professionals and current employees to transition into coding positions. Collaborate with colleges, high schools, and middle schools to draw prospective students to this career path and your organization.