# Presentation: 124142

## VA’s CPRS and Its Impact on the HIMs Department

- Rebecca A. Wirth, RHIA
- April 19, 2007

## Objectives

- Introduction
- Variance
- Three Different Sites
- EHR Advantages/Disadvantages
- HIMs Department
- Scanning
- Records Analysis
- File Room
- Release of Information
- Coding
- Transcription
- Additional HIMs Involvement

## A Quick Comparison

|   | Seattle/Tacoma, WA | Albuquerque, NM | Bedford, MA |
| --- | --- | --- | --- |
| Hospital Beds | 504/283 | 310 | 65 |
| Domiciliary | 60 |  40 | 40 |
| Residential | 30 | 50 | 52 |
| Nursing Home | 131 | 36 | 345 |
|   | Staffing | Staffing | Staffing |
| ROI |  2 | 5 | 1.5 |
| Scanning | 2 | 5 | 0 |
| Analyst | 3  | 2 | 1 |
| File room | *  | 5 | 2 |
| Transfer Clerk | *  | 1 | 0 |
| Coding | 8  | 13 | 5 |

- *Shared duties and cross trained

## Definitions

- EHR – electronic health record
- HIMS – health information management
- VISTA – Veteran’s Integrated System Technical Architecture
- CPRS – Computerized Patient Record System

## Advantage’s of EHR

- Legibility
- Multiple Access
- Document Linkage Capability
- 24 x 7 Availability
- Search Capabilities
- Portability
- Real Time System Monitoring
- Less Physical Space Needed
- Amendments

## Disadvantage’s of EHR

- Technical Issues
- Templated Documents
- Copy and Paste Functionality
- On-going Training Issues for Both Clinicians and Support Staff
- S/W Packages “Talking” to Each Other
- Just Can’t Do it All
- Information Security

## Document Scanning

## Development

- Manage, Monitor, Report
- Establishing a Committee
- Policy and Procedures
- Quality Analysis
- Reporting
- Albuquerque
- Puget Sound
- Bedford

## IMPACT

- File Clerks to Scanners
- Continuity of Care
- Availability/retrievability
- Facility to Facility Access
- Legibility
- Scanning Pertinent Information
- Tracking What Comes to Scanning
- Redundancy

## Quality Analysis-Record Review

## What is Missing From the Documentation?

- Puget Sound Record Review
- What data we are looking at
- Access database
- Data Entry
- Admit/Discharge
- 100% review of every inpatient record
- Focused Review
- Reporting

## Slide 12

**Notes:**
This is the database

## Slide 13

**Notes:**
Drilling down

## Delinquent Records

- Discharge Summaries and Operative Reports >30 days

## Numbers are up!!!  JCAHO is just around the corner.  Please review the lists and take action accordingly.

- Click on the following links for the Incomplete Record, Unsigned Notes/Addenda, and Unsigned Orders lists:
**<**_[file://g:\WORKGRPS\CVAR Reports\Incomplete Records\Incomplete Records 12-8-03.xls](file://vhaabqfpc1/vaapps/WORKGRPS/CVAR%20Reports/Incomplete%20Records/Incomplete%20Records%2012-8-03.xls)__**>,**_
**<**_[file://g:\WORKGRPS\CVAR Reports\Incomplete Notes & Orders\Unsigned TIU Documents 12-8-03.xls](file://vhaabqfpc1/vaapps/WORKGRPS/CVAR%20Reports/Incomplete%20Notes%20&%20Orders/Unsigned%20TIU%20Documents%2012-8-03.xls)__> _and
**<**_[file://g:\WORKGRPS\CVAR Reports\Incomplete Notes & Orders\Unsigned Orders 12-8-03.xls](file://vhaabqfpc1/vaapps/WORKGRPS/CVAR%20Reports/Incomplete%20Notes%20&%20Orders/Unsigned%20Orders%2012-8-03.xls)__>_
- NOTE: a + next to the patient's name in CPRS means the document is an addendum.  When viewing such documents in CPRS, select the document and enter EX to expand the entry and see the underlying addendum.
- A folder in the workgroups directory has been established to hold these weekly reports.  All members of this mail group have access to the workgroup folder and sub-directories.  This has been done in order to improve information security by restricting direct access to the patient names and SSN’s.
- If additional staff need to be able to access the documents in future, please e-mail me with their full name and whether they are to receive the e-mail reminder in addition to having access to the directory.

**Notes:**
This is the email

## Trend for Delinquent Records (Discharge Summaries and Operative Reports only):

**Delinquent Records By Service and Action Required**					DISCHARGE SUMMARIES
- SVC/Specialty	Undictated	Unsigned	Uncosigned	Total
- Medicine	83		3		3		89
- Mental Health	10 	 ***	***9 		9	 	28
- Extended Care	9		0		3		12
- SURGERY
- Cardio Thoracic	1		0		0		1
- Dental		0		1		0		1

**Trend for Unsigned TIU Documents** (progress notes and addenda)** by Service Line:**
**Service****	****	****This Week****	****Last Week****	****2 weeks****	****3 weeks****	**
**CSS****	****	****	****0****	****5****	****3****	****4****	**
**Diagnostics****	****	****5****	****7****	****30****	****12****	**
**Extended Care****	****	****75****	****76****	****98****	****108****	**
**Health Plan Mgt****	****	****373****	****377****	****340****	****463****	**
**ISS****	****	**** ****	****5****	****8****	****6****	****6****	**
**P&SMC****	****1474****	****	****1454****	****1287****	****1333****	**
**Mental Health****	****	****339****	****322****	****1047****	****910****	**

## Delinquency Report

## IMPACT	

- Data Quality
- More Technical Job Functions
- Quantitative vs. Qualitative
- Reporting and Trending Data

## File Room

## What Do We Do Now?

- Albuquerque
- 1 year 40,000 records retired to FRC
- 13 in. Loose Filing Clinical/Administrative per week
- Puget Sound
- Occasional Loose Documents
- Bedford
- Retirement Record Project

## IMPACT

- 3,692.1 Cubic Feet
- Concerned Staff
- Change in Duties
- Pull Lists
- Transfer Clerk
- Transferring Records
- RPU

## Release of Information

## Release of Information

- Software Program
- FOIA Report

## Slide 24

## Slide 25

## What Else We Do

- Social Security Disability Web Based Database
- In Person Authentication
- Forms Management
- Burning Medical Records to a CD
- Subpoenas/Legals

## IMPACT

- Decreased Turn Around Time
- 1506 Requests per Month, TAT is 3.01
- 24 X 7 Retrievability
- Workload Management
- Reporting and Monitoring
- Decrease in Work Space Storage
- On the Spot Record Processing
- Sensitive  Data Review

## IMPACT Continued...

- Record Storage Systems
- Voice Signatures
- Records for Torts/Legal
- On the Spot Record Demand
- Education
- Provider’s and Support Staff

## Coding

## Coding/Billing/Compliance

- From Paper to Computer
- QuadraMed
- Communication Tool
- Workload Mgt
- Reporting and Monitoring

## Slide 31

## Slide 32

## Slide 33

## IMPACT

- Ease of Use
- Paper vs. EHR
- Paper Index Cards

## Remote Coding – Why?

- Retention
- Saves Money
- Workplace, commuting
- Increased Morale
- Increased productivity
- Less interruptions

## IMPACT

- Communication
- Isolation
- IT support
- Updates – Carrying Around Your PC
- Don’t Want to Come Back
- Information Security

## Transcription

## Another Way to Document

- Process
- Training
- Talking fast
- Accents
- Editing documentation before signing

## Slide 39

## IMPACT

- Decrease in Lost Dictation
- Continuity of Care
- Timeliness
- Instant Availability/Retrievability
- No Incomplete Records Room

## A Need for HIMS Input

- I Med Consent
- Standardized Note Titles
- Template/Forms Management
- Document Corrections
- My Health_***e***_Vet

## My HealtheVet

## What is My HealtheVet?

- On Line Personal Health Record
- Uses Web-based technology for health resources to enhance patient/clinician collaboration.

## What Can I find on My HealtheVet?

- Trusted Health Information
- Links to Federal and VA Benefits and Resources
- Personal Health Journal
- BP, Medications
- Online VA Prescription Refill
- Frequently Used Forms

## IMPACT

- Technical Issues
- Sensitive Data Review
- Privacy and Security
- ROI???
- IPA

## Health Information Management Challenges

- New Policies and Procedures
- New Method for Monitoring
- Re-organization of Staffing/Department
- Training HIMs, Clinical, and Support Staff
- Successfully selling “change” to HIMs, Clinical and Support staff
- Building Collaboration With Clinical and IT Staff – “talking” Their Language

## Using Information as A tool for Change

## References

- Quadra Med Corp.
- Document Storage Systems ROI Record Manager
- Health_***e***_Vet
- _[https://www.myhealth.va.gov/](https://www.myhealth.va.gov/)_

## Thank You!

- _[Rebecca.Wirth3@VA.GOV](mailto:Rebecca.Wirth3@VA.GOV)_
- 505-265-1711 x5111