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Wayne Winistorfer
Wayne Winistorfer

No sleight of hand

EHR improves quality, compliance, productivity


By Wayne Winistorfer
Posted: November 7, 2011 - 12:01 am ET
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People often imagine that healthcare information technology works a bit like “The Wizard of Oz,” where a genius behind the curtain does marvelous, mysterious things. But the real benefit of healthcare IT is that it produces very down-to-earth results: better patient care, greater physician satisfaction, higher reimbursement and improved quality and compliance.

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In short, healthcare IT solves ordinary problems in extraordinary ways.

In the hospital rehabilitation setting, for example, one of the biggest problems with paper documentation has been poor legibility. Physicians constantly complained that they couldn't read the therapists' notes—or that they didn't understand therapist buzzwords and acronyms such as “IADLs not PLOF” (which means “instrumental activities of daily living not at prior level of functioning”).

Paper charts also made it easy for therapists to inadvertently violate the eight-minute rule, unintentionally billing more units of service than the total time of the treatment session. Without “red flags” to prevent this type of error, once charges are entered they flow to a bill, leaving the facility vulnerable to compliance violations.

In addition, paper charting was a productivity nightmare, forcing some staff members to spend the majority of their day entering charges into the electronic billing module, or photocopying and faxing records. At our facilities, we also used elaborate, manual processes to catch charges that therapists simply “forgot” to record.

It was highly labor-intensive, and virtually impossible, to implement thorough auditing procedures because the typical rehabilitation department handles hundreds of charges a day.

So when the time came for our rehabilitation department to go paperless, we weren't looking for a wizard, just a solution to some everyday problems.

Here are some achievements of adopting an EHR for our rehabilitation services that flows to our hospital's main system:

  • Physicians have instant access to patient data. About 75% of our rehab outpatients are referred by physicians who are employed or contracted within our integrated health system. They are now able to view a therapist's notes as soon as the session has ended. There's no time wasted photocopying or faxing notes, and they're 100% legible all the time. Plus, the EHR we use automatically converts therapist acronyms and abbreviations into full text that the physicians can understand.
  • We repurposed employees. Our department has been able to redefine the roles of employees whose primary tasks were data entry and faxing. They're now freed to do more productive, patient-focused tasks that help improve the patient experience.
  • We improved regulatory compliance. Our department is now confident we can handle any Recovery Audit Contractor audit because the EHR software automatically flags things such as eight-minute rule violations. That helps ensure that errors are caught before they flow to a bill. And we're now able to easily generate daily audit reports spanning hundreds of charges and correct the few remaining charge errors on the spot.
  • We improved the quality of care. Best of all, the rehabilitation EHR has helped us sharpen our patient focus. One of the best ways to engage with a patient is to document things electronically in the patient's presence. That way, there are no surprises when the patient visits the referring physician and together they review progress in therapy. And physicians don't have to waste valuable time deciphering sloppy handwriting or therapist lingo.

All these benefits add up to an advantage that every hospital chief financial officer can appreciate: improved charge capture and enhanced reimbursements. In our case, the reimbursement and productivity improvements were far greater than what we put in our original business plan. In contrast to most IT razzle-dazzle, our project underpromised and overdelivered.

Implementing a rehabilitation EHR may not be as glamorous as some other projects, but in our CFO's view, it's real-world wizardry.

Wayne Winistorfer is director of rehabilitation services at Affinity Health System, based in Menasha, Wis.


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