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Virtual Go-Live: A New Approach To Support Health Systems

Posted by Samantha Serfass on June 30, 2020 in Blog, News

VIRTUAL GO LIVE:

A NEW APPROACH TO SUPPORT HEALTH SYSTEMS

As the HIT industry continues to change, the demand to reduce on-site presences of traveling ‘At the Elbow Resources’ for a Go-Live continues to rise. Hospital systems also need to decrease the costs for activation support.  Providing virtual support at Go-Live can tackle both of these issues.

A virtual Go-Live occurs when a health system uses technology to virtually train their end-user staff and to help support them remotely after go-live. In most cases, health systems will still need some onsite lead resources to assist with end-users communication and escalation.

Virtual Go-Live staff will act as the on-call help desk support team. Clinicians and support staff will access the end user’s desktop remotely and walk them through the trained workflows – addressing any questions they may have via virtual “command center”.

By creating a custom icon on the desktop, an end-user can quickly connect to a support team.  These team members can assist the end-user by shadowing them while communicating via message or by phone. End-users can also email and video conference with support staff but the preferred method of communication used is based on each organization and the end-users specific challenges.

Virtual Go Live staff will act as the on-call help desk support team. Clinicians and support staff will access the end user’s desktop remotely and walk them through the trained workflows – addressing any questions they may have via virtual “command center”.

The support staff can offer assistance in two ways. First by either verbally walking end-users through issues; this can be done over a simple phone call. The second way the support staff can offer assistance is by gaining access remotely to the PC to show the end-user how to resolve the issue. It is critical to provide support staff that is extremely knowledgeable about the details surrounding the workflows.

ADVANTAGES

  • Quick set-up with multiple ways to communicate with end-users
  • Onboarding and travel costs are eliminated
  • Providers have more flexibility in “attending” classes/webinars
  • Pre/post Go Live “walkthroughs” including personalization labs that can be scheduled to train on feature and functionality

There are two key factors to consider when implementing a virtual Go-Live: the people and the process. Excite Health Partners not only has the experienced professionals to assist with a virtual Go-Live, but we also have the ability to tailor our processes to best fit the unique needs of each facility.

People: Virtual ATE Support places a large emphasis on having the right talent. Resources that intimately know the EHR screens which support the workflows, understanding the job responsibilities of the end-user and having superior communication skills are vital.  Excite has conducted over 30 activations over the years and has a database of nearly 25,000 support staff who we’ve already worked with. After each Go-Live engagement, we update the profiles of our support staff so performance expectations can be set appropriately allowing everyone to be set up for success.

Process: Excite comes to the table with a set of standard processes that addresses available support staff communicating issues and initial communication to end-users.  Our resources are trained to process escalating issues, handoffs, documenting throughout the life cycle of the ticket and finally creating new tips and tricks. Many times, our client will have specific needs around documentation and processes. Excite works with each individual client to meet their unique needs while remaining flexible in our business operations.  

As the need for virtual Go-Lives continues to increase, our experienced team has the tools to tackle your next project. Excite Health Partners can help offer the right talent, resources and approach to not only reduce onsite presence but also lower activation support cost.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

Harnessing Remote Resources for Internal Coder Training

Posted by Samantha Serfass on June 23, 2020 in Blog, News

HARNESSING REMOTE RESOURCES FOR INTERNAL CODER TRAINING

In the ever-changing world of health information management, the ability to train and maintain knowledgeable and highly qualified coding specialists is a necessity.  Shrinking budgets, lack of available training staff, tools, time, and focus on keeping current workloads current are just a few of the challenges impeding a facility’s ability to train current or new incoming coders.  With the emphasis on quick turn-around to keep Discharge Non-Final Billed (DNFB) and Accounts Receivable (AR)  at a minimum,  supporting coders in learning other coding specialties takes time away from sole focus on their designated patient type.

A 700- bed facility had talented internal coders who expressed the desire to progress into other patient types; however, the facility did not have the bandwidth to perform the training and education internally.  Through an existing relationship, they reached out to Excite Health Partners seeking support with expanding existing coders’ skill sets.   

The first step in the project was to define the Scope, Goals, Timelines, Challenges to the project with respective solutions, and outline Project Details.

THE SCOPE

The client needed the education to span multiple coding modalities:

  • training new coders to perform outpatient ancillary coding,
  • train current outpatient ancillary coders to be proficient in emergency department coding,
  • and to educate current emergency department coders on ambulatory surgery and observation coding. 

THE GOALS:

Numerous benefits drove the facility to support this investment in their coders:

  • well-rounded coder skills to support fellow coders;
  • cross-coverage during vacations and sick time;
  • reduced need to call in additional contract coding support;
  • improved marketing for new coders demonstrating the facility’s commitment to supporting expanding coders’ career path;
  • improved coder morale and coder loyalty;
  • improved coder confidence;
  • coders felt like they were a part of a team working together to achieve a common goal.

THE TIMELINES:

All education would be performed in specific timeframes, with the ancillary training set at 6 weeks, emergency coding requiring 8 weeks, and ambulatory surgery/observation coding spanning 12 weeks.

THE CHALLENGES:

There were three primary challenges we had to tackle:

  • Maintaining current workloads while the coders were training.
    • Excite Health Partners provided additional staffing to the client to cover productive hours lost during internal staff training.
  • Creating an educational program for the ambulatory surgery/observation trainees that would effectively cover all body systems and related procedures while moving at a pace that would meet the client’s 12-week training expectation.
    • Two body systems and related procedures were covered weekly with practice exercises to apply information covered.
  • Ensuring an effective remote training/education environment.
    • Remote training sessions were interactive and inclusive in nature, using 1:1 phone calls and group screen-sharing applications.
    • Following classroom and education time, the coders would then code “live” accounts for the duration of their training. 

THE PROJECT DETAILS

A total of eight coders were trained in ancillary and emergency department coding, four for each modality.  These two training sessions were performed simultaneously, with the 8-week emergency department training starting first for two weeks, then adding the ancillary training for the remaining 6 weeks.  Each training session began with review of basic outpatient coding guidelines and also review of the facility’s specific outpatient coding policies.  After the initial training sessions, ED trainees were expected to code a total of 40 charts per week, not exceeding 10 charts per day.  The ancillary coders submitted 50 charts a week.  On a daily basis, the educator would review the accounts for coding accuracy and make recommendations for any changes.  All audit results were sent back to the coder at the end of the day for review.  Once a week, the educator and coder had individual meetings scheduled to review the audit results and discuss any issues.  Once all meetings had occurred for the week, the educator would submit progress reports to the facility’s coding management team, reflecting the coder’s progression towards overall 95% coding accuracy.

The training program for the ambulatory surgery/observation coders was developed in a different manner.  Because a thorough understanding of anatomy and physiology is needed to code surgeries, it was important to include review of individual body systems and related surgeries prior to the coders moving to coding actual charts.  The educator met with the coders in a virtual classroom setting twice a week.  During each class time, the educator focused on one body system.  This focus included anatomy and physiology of the body system, review of common surgeries on the body system, and review of coding resources pertaining to those particular surgeries.  On completion of the class time, the coders would be given simulated system-specific operative reports to code.  Their coding were returned to the educator, who would audit the codes and respond with feedback.  Throughout the week, the coder and auditor would have calls to review and discuss the audit findings, and at the end of the week the coder’s weekly score would be provided to the facility’s management staff.  Once all body systems had been covered, then the coders were assigned 25 actual charts to code on a weekly basis, following the same auditing/feedback/scoring format.

THE CONCLUSION:

The current coding team is now more well-rounded, confident, and able to support the various incoming workload types of the facility.  The facility now has more flexibility in workload assignments with the multi-skilled coding team.  Within three months of the end of the training sessions, the facility had an external audit performed on all of their coders.  Particular attention was paid to those coders who had recently attended the education, with all having done well with passing scores.

“I was thrown into the External Audits and I passed with a 98%!! I couldn’t believe it! This has made my entire day.  I’m over the moon LOL!   Thank you so much for the training and the assistance that you gave us. This is why we have been so successful!”  — Ambulatory Surgery Coder

Excite Health Partners is here to partner with you on your education and training projects and support any level of coder development, education, and training needs.  We are ready with experienced coder educators that can train coders into separate service types and offer education to coders on specific coding topics.  All education and training projects are tailored to each individual client’s needs and goals.

Robyn McCoart, RHIT, Managing Auditor Excite Health Partners

FAST HEALTHCARE INTEROPERABILITY RESOURCES: DISCUSSING WORKFLOW AND INTEGRATION

Posted by Samantha Serfass on June 16, 2020 in Blog, News

FAST HEALTHCARE INTEROPERABILITY RESOURCES: DISCUSSING WORKFLOW AND INTEGRATION

The first version of FHIR was published Feb 2014, by the HL7 International organization.  FHIR was developed in part because of the lack of the HL7 standards to easily share real time data across a variety of EHRs.  FHIR is an intraoperative data integration tool/language which allows EHRs to deviate from exchanging complex Clinical Document Architectures (CDAs).

FHIR takes advantage of open API using a structured language to access and modify discrete data. Built on HL7 and HTTPS protocol, FHIR allows for real-time data gathering from multiple specific segments of data. In 2018 Apple announced its iPhone Health application. This app would allow viewing of end user’s medical record, via FHIR.  John Hopkins, Cedars- Sinai and other large hospital organizations supported the effort.  

EHRs like Epic and Cerner have supported the use of their open API’s via FHIR and SMART. Within the SMART App Gallery Store, hundreds of applications from Care Coordination, Patient Engagement Disease Management and COVID-19 use FHIR to access systems and provide specialized support for end users. By using SMART on FHIR, developers can create applications rapidly at a fraction of the cost. These new tools and technologies have helped to improve telehealth solutions.

Excite Health Partners is a partner with SnapMD. SnapMD is a top rated KLASS telehealth solution which can be utilized within the whole hospital system. By leveraging both SnapMD and the hospitals systems open APIs we can help support a smooth workflow for patients and providers.  It is paramount when integrating the systems SMART on FHIR is used to support the right clinical & patient processes. Use Cases are identified within each specialty of care and which devices are leverage throughout each type of patient interaction.  

To confirm the bills are dropped for reimbursement, it’s important to ensure the use cases and workflows are seamless and efficient while supporting proper sharing and storage of the data. SMART on FHIR is the way of the future and provides not only a reduced cost but also a rapid integration, allowing hospitals implement and utilize these systems quicker.

Whether an organization chooses to store clinical notes and discharge summaries within their EHR or in a telehealth solution, such as SnapMD, Excite Health Partners can offer the right support. Once the desired workflows are established, Excite leverages our technical expertise to provide the integration required to support efficient operations.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

Multisystem Inflammatory Syndrome in Children Associated with COVID-19

Posted by Samantha Serfass on May 28, 2020 in Blog, News

Multisystem Inflammatory Syndrome in Children Associated with COVID-19

As we have begun to see more and more cases of COVID-19, the majority of the more severe cases have been found to be in the elderly population or people with underlying chronic conditions affecting the ability of the immune system to fight illness.  We have yet to see many cases of confirmed COVID-19 in infants and children.  However, recently there have been reports of children and adolescents with a multisystem inflammatory condition with symptoms similar to those seen in Kawasaki disease and toxic shock syndrome and required admission to intensive care units.  It is thought that this multisystem inflammatory syndrome may be related to COVID-19. [1]

Kawasaki Disease

Kawasaki disease is an acute febrile illness usually occurring in children younger than 5 years of age.  The fever usually lasts at least 5 days and is associated with rash, swelling of the hands and feet, swollen lymph glands in the neck and irritation and inflammation of the mouth and throat.[2]

Toxic Shock Syndrome

Toxic shock syndrome is another condition that typically presents with a high fever.  Associated symptoms include hypotension, diffuse erythematous rash, and organ dysfunction in at least two organ systems that may progress rapidly to severe shock.  Toxic shock syndrome is typically caused by staphylococcal or streptococcal bacteria.[3]

On May 14, 2020, the Centers for Disease Control and Prevention (CDC) released an official health advisory which provided background information on several cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) along with a case definition of the syndrome.  Cases have been reported in U.S. and other countries. [4]

Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C):

  • Age 21 years or younger presenting with fever
  • Laboratory evidence of inflammation
  • Evidence of clinically severe illness requiring hospitalization
  • Multisystem organ involvement (2 or more organ involvement)
  • No other plausible diagnosis
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

The CDC is recommending that healthcare providers who have treated or are currently treating patients meeting the criteria for (MIS-C) should report suspected cases to their local, state, or territorial health department.[4]

Coding Guidance:

As of April 1, 2020, there is no official coding guidance for MIS-C.  MIS-C cannot be indexed in the ICD-10-CM Alphabetic Index therefore coders must follow the guidance in ICD-10-CM Official Guidelines for Coding and Reporting, Section I.B.15:  Syndromes.  This instructs the coder to assign codes for the documented manifestations of the syndrome.  Any additional symptoms that are not an integral part of the disease process may be reported when the condition does not have a unique code.

NOTE: Changes to the official coding guidelines and rules beyond April 1, 2020 will render the Coding Guidance educational content invalid for future educational purposes.

Sandy Hall, Coding Education Auditor; CCS, COC, CPC


[1] https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

[2] https://www.cdc.gov/kawasaki/index.html

[3] https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss

[4] https://emergency.cdc.gov/han/2020/han00432.asp

HEALTHCARE: THE NEW NORMAL

Posted by Samantha Serfass on May 21, 2020 in Blog, News

HEALTHCARE: THE NEW NORMAL

As states across the US begin the process of reopening, establishing a sense of normalcy becomes a top priority. Healthcare systems are facing a significant challenge as they work to resume normal operations while still focusing efforts on decreasing the virus.

It is estimated the American healthcare system has lost $200 billion dollars resulting in the job loss of over 1.4 million healthcare workers. While healthcare systems begin to resume full services, several key factors are important to consider.

In March, the CMS first recommended limiting the non-essential care in an effort to save critical PPE supplies. As healthcare systems reopen and PPE supplies still remain limited, the CMS has updated its recommendations for facilities in order to allow health systems to safely provide nonemergent non-COVID-19 care. The CMS will continue to publish recommendations and updates to existing guidelines to help carefully phase in normal hospital operations. More information on the guidelines and regulations established by the CMS for phase one can be found here.

Healthcare IT departments have shifted gears to best assist their hospitals during COVID-19. Hospitals across the US have pressed “pause” on many projects unless considered critical – shifting their focus to support COVID-19 initiatives.

Tim Pugsley, CIO for Titus Regional Medical Center in Mount Pleasant, TX, has dispatched analytics, informatics and technical teams to support their clinical leaders across many platforms. They have created new dashboards which track PPE consumption rates, temperature tracking for staff, video visit encounters and record call center statistics for the CV-19 hotline.  In addition, they have updated their EHR to record the latest COVID-19 documentation requirements all while supporting a remote workforce.

TRMC has also expanded their telehealth presence. Prior to COVID-19, TRMC focused on telehealth equipment in the ambulances and extending specialty care to outlying communities. Since the pandemic, they have enabled video visits in TRMC operated and independent ambulatory clinics, inpatient floors and on the COVID unit. Patient’s visitors also have an option to become “virtual visitors” enabling them to interact with loved ones.

                 “We understand the importance of social interaction with family and friends. To address that need, we supply the patient with a tablet and technology to have a video interaction” added Pugsley.

While preparing to reopen, Telehealth initiatives are the front runners for helping to safely allow these healthcare systems to better assist, treat and safely diagnosis their patients while working to decrease the possibility for COVID-19 exposure. Titus Regional Medical Center’s clinical leaders are developing a strategy and tactical plans to safely provide care by partnering with physicians and key stakeholders. Policies and procedures are reviewed constantly to adapt to the changing landscape and processes continue to evolve to support our community, our providers, and our staff.

As elective services begin to slowly reopen, Titus has leveraged their telehealth solution to keep the community informed. Through the use of MyChart, public radio and social media platforms – like Facebook – Titus has been able to communicate with the community about the virus, guidelines, and regulations being implemented.

Telehealth will continue to play a vital role as phase one of reopening begins to occur. CMS will likely start to remove the waivers they once had in place for telehealth solutions (for example, enforcing HIPAA compliance). Ensuring your telehealth solution is effective and compliant is more crucial than ever. Demonstrated by TRMC, telehealth solutions allow healthcare systems to safely and efficiently communicate, treat, and assist patients during this pandemic.

Excite Health Partners offers the knowledge and experience to implement the right fit telehealth solution. We can develop new workflows and data integration, improve the efficiency of care and help recover revenue. As healthcare systems continue to adapt during these unprecedented times, we can help ease the burden of implementing the best telehealth solution to meet your organization’s needs.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

COVID-19 and Cytokine Storm/Cytokine Release Syndrome (CRS)

Posted by Samantha Serfass on May 6, 2020 in Blog, News

COVID-19 and Cytokine Storm/Cytokine Release Syndrome (CRS)

During this COVID-19 crisis, coders are beginning to see the providers document cytokine storm as a secondary diagnosis in patients who have been diagnosed with a primary diagnosis of COVID-19.

Some of the acutely ill COVID-19 patients are developing a cytokine storm which is a Cytokine Release Syndrome (CRS). The sickest patients are the ones who have CRS that can lead to the patient developing secondary hemophagocytic lymphistiocytosis (sHLH) which then causes the patient to develop acute respiratory distress syndrome (ARDS).1

CRS “is caused by a large, rapid release of cytokines into the blood from immune cells” “Cytokines are immune substances that have many different actions in the body.” In some patients, excessive or uncontrolled levels of cytokines are released which then activate more immune cells, resulting in hyperinflammation. It is the overreaction of the immune system.

Coders and CDI Specialists should be very careful when querying the provider for clarification of cause of the signs/symptoms and/or clinical indicators for appropriate code assignment. 1,2 The symptoms of CRS can mimic other conditions.

Cytokine storms can be seen in the below conditions which have similar pathophysiology but have very different treatment options. Therefore, it is imperative to capture the conditions correctly through coding.

  • Sepsis
  • Non-infectious SIRS
  • Macrophage activation syndrome (MAS)
  • Secondary hemophagocytic lymphohistiocytosis

Possible Signs/Symptoms of CRS:

  • Trouble breathing
  • Low blood pressure
  • Rapid heart rate
  • Fever
  • Headache
  • Nausea
  • Rash
  • Multi-organ dysfunction – in severe cases

Possible Laboratory Clinical Indicators of CRS:

  • Elevated serum ferritin2
  • Markedly increased interleukin-6 (IL-6)2
  • High levels of C-reactive protein2
  • Elevated blood nitrogen levels5
  • Elevated D-dimer5

Coding Guidance:

Currently, as of April 1, 2020, neither CRS nor cytokine storm can be indexed in the ICD-10-CM code book.

Per the AHA Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019 Pages 24-25, and First Quarter 2020 Page 37, with there not being a specific code for CRS and it cannot be indexed in the code book, coders must follow the ICD-10-CM Official Guidelines for Coding and Reporting Section I.B.15 Syndromes where there are instructions to code the manifestations of the syndrome based on physician documentation. Any additional manifestations that are not typically integral to the condition may also be assigned if the condition does not have its own unique code. 4

NOTE: Changes to the official coding guidelines and rules beyond April 1, 2020 will render the Coding Guidance educational content invalid for future educational purposes.

Lorrie Strait, RHIT, CCS

Manager HIM Services, Excite Health Partners

References:

  1. https://www.icd10monitor.com/covid-19-and-secondary-hemophagocytic-lymphohistiocytosis-shlh-versus-sepsis
  2. https://www.physiciansweekly.com/cytokine-storm-the-sudden-crash-in-patients-with-covid-19/, April 8, 2020
  3. https://www.cdc.gov/nchs/data/icd/Topic-packet-Sept-2019-Part2.pdf
  4. AHA Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019 Pages 24-25, and First Quarter 2020 Page 37
  5. Merck Manual, www.merckmanuals.com

UNDERSTANDING TELEHEALTH TODAY

Posted by Samantha Serfass on April 24, 2020 in Blog, News

CMS has broadened access to coverage and payment of all telehealth services due to the COVID-19 Health Emergency.  On March 30, 2020 CMS published the 1135 IFR (Interim Final Rule) Waiver stating Medicare will reimburse for office, hospital, and other visits furnished by telehealth across the country.  The IFR is retroactive to date of service 3/1/2020 on a temporary and emergency basis for the duration of the public health emergency. 

Prior to this waiver, Medicare would only pay for telehealth on a limited basis.  The most notable exception put into place is that patients no longer must travel to a designated facility in order to initiate telehealth services; these services can now be provided from a patient’s home.  Various common communication technologies can be used in good faith, such as FaceTime or Skype for the duration of the emergency.  The HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against health care providers serving patients I good faith through these technologies.  However, communication platforms that are not private (i.e., Facebook Live, TikTok, Twitch) are still considered to be HIPAA violations.

Telemedicine visits are defined as real-time, interactive audio, and video communication between the patient and the provider.  Previously, telemedicine visits were only approved for established patients but that requirement has been relaxed and can now include Evaluation and Management services (common office visits) for new patients also. Evaluation and Management levels may be selected based on Total Time spent or MDM.  They can also perform mental health counseling and preventative screenings.  A complete list of services that qualify for telemedicine is located here.

Virtual check-ins are allowable.  These are defined as brief communication technology-based services and can be conducted with a broader range of communication methods including synchronous discussion over a telephone or exchange of information through video or image.  Virtual check-ins can be provided to both new and established patients, and the appropriate HCPCS codes are G2010 or G2012.

E-Visits are generally done through an online patient portal and is considered a non-face to face encounter that is initiated by the patient and may span over a 7-day period. Total time spent must be accurately documented. Codes for these services are 99421-99423 for physician or mid-level provider and HCPCS G2061-G2063 for Qualified Non-physician Healthcare Professional (Clinical Psychologists, Physical, Occupational, and Speech Therapists).

Telephone Visits must be initiated by the patient and cannot be related to an E/M service provided in the previous 7 days nor leading to an E/M service or procedure within the next 24 hours.  Documentation should reflect total time spent.  Report CPT codes 99441-99443.

As time progresses, there may be additional advice given or changes made to the guidelines.  Because they were initiated fairly quickly, it should be viewed as a “work in progress”.  Therefore, everyone should continue to monitor for subsequent changes as they are published.

Robyn McCoart, RHIT

Managing Auditor, Excite Health Partners

A PARTNER FOR YOUR TELEHEALTH NEEDS

Posted by Samantha Serfass on April 20, 2020 in Blog, News

A PARTNER FOR YOUR TELEHEALTH NEEDS

As telehealth continues to make significant strides during today’s pandemic, Excite Health Partners has the resources and experience to help healthcare organizations identify their telehealth needs. 

Our telehealth solution, SnapMD, was developed by an ER physician and endorsed by the American Academy of Pediatrics. SnapMD is a secure HIPAA compliant enterprise wide telehealth solution with a rich feature set, ready to be fully integrated with your health system’s EHR.

CMS has implemented new rules and guidelines which impact the use of telehealth for hospital systems to better respond to the COVID-19 pandemic. Below are the are three major acts approved by congress.

  • CMS-1744-IFC (Applicability date of March 1, 2020)
    • CMS 1135 Blanket Waiver for Providers (Effective Date March 1, 2020)
    • Blanket Waiver of Section 1877(g) of the Soc. Sec. Act.  (Effective Date March 1, 2020)

Although variance can occur state-by-state, these new telehealth rules and guidelines, set forth by CMS, provide flexibility within the overall health systems and specialty practices. This allows a broad range to provide services using remote communication and permits licensed practitioners to order home health services outside of the hospital.   

CMS has defined interactive telecommunication systems as equipment that can, at minimum, transmit both audio and visual displays to allow for a real time two-way interactive discussion. The HHS has waved penalties for HIPAA violations during this time to encourage telehealth communication. Platforms such as FaceTime and Skype are now accepted as appropriate applications.  

The recent CARES (Coronavirus Aid, Relief and Economic Security) Act, includes funding for the support of telehealth solutions, like Snap MD.  The Office of Inspector General (OIG) is also waiving any costs sharing obligations that federal health care program beneficiaries may owe for telehealth.  This also allows for hospitals to cover the cost of telehealth systems for affiliated physicians and to include remote patient monitoring.

Telehealth systems are now being permitted to communicate and treat both new and established patients while also allowing various types of practitioners to bill for services (social workers, psychologists, physical/occupational therapists, language pathologists, etc.) 

SnapMD’ s platform allows for up to 6 different individuals to join in a virtual meeting space. From patient and family members to supervising physicians, through SnapMD multiple participants can weigh in on the visit to help provide the best service from home.  

As healthcare systems continue to adapt during these unprecedented times, Excite Health Partners can help ease the burden of implementing the best telehealth solutions to meet your organization’s needs while driving revenue.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

PUBLIC HEALTH EMERGENCY RESPONSE: IDENTIFYING ORGANIZATIONAL AND SPECIALTY STRATEGIES

Posted by Samantha Serfass on April 8, 2020 in Blog, News

PUBLIC HEALTH EMERGENCY RESPONSE: IDENTIFYING ORGANIZATIONAL AND SPECIALTY STRATEGIES

With the growing number of COVID-19 cases arise across the nation, analytics can prove to be a vital element in helping to track the pandemic.

By leveraging data, we can monitor the COVID-19 virus using Early Detection and Rapid Response Outreach programs.  These programs operate to:

  1. Decrease costs while still generating revenue 
  2. Oversee and manage patient flow
  3. Track and manage hospital resources

Data analytics also allow us to identify potential at-risk patients and target demographics. According to the CDC, at-risk patients include:

  1. Older adults, particularly those over 65
  2. People with asthma or other chronic lung diseases
  3. Groups who are at higher risk for severe illness, such as people who are diabetic or immunocompromised
  4. People with HIV

Effective as March 1st, 2020, the CMS has created guidelines for health systems to use Telehealth solutions to assist, track and monitor these at-risk patients and receive reimbursement later. These services typically provided in-person are allowed to use Telehealth –many are still using codes that describe “face to face” services. This helps health systems in various ways. First, by using Telehealth solutions, providers are able to quickly and efficiently provide care. Second, it helps to expand care to new services which helps the population respond better to the virus. Lastly, it helps generate revenue.

An Emergency Response Plan starts by identifying the correct patient populations for specific services to be offered to. To meet the immediate needs, Data warehouses and marts can also be established rapidly. Utilizing an agile approach and integrations tools – such as FHIR – databases can be set up in days/weeks rather than months.

Call center staff can leverage patient data to identify patients who need medication refills but are in the at-risk populations, allowing for medication to be delivered to homes.

Different services lines or specialties can respond to the pandemic in different ways.   Mental and Behavioral Health can reach out to patients to schedule their (now) virtual Telehealth session, or the call center can identify patients that weren’t using the service before.

Diabetes is one of the underlining conditions that increase a patient’s risk for the virus. CMS 1744 allows the Medicare Diabetes Prevention Program (MDPP) to extend allowing beneficiaries to obtain MDPP services more than once per lifetime. This provides patients with virtual educational sessions.  It’s also important for the call center to look for diabetes patients who aren’t performing well and see if they need medication, would like to schedule a virtual visit with their endocrinologists (or psychiatrist) and/or offer them additional virtual educational sessions.  

Every hospital needs to make changes rapidly across the organization, such as expanding beds, increase supplies, setup new triage workflows, etc.  However, each specialty should have a strategy to continue to provide patient care while maintaining revenue and decreasing the impact of COVID-19. 

Excite Health Partners can help. We can help health organizations identify proper COVID-19 pandemic preparation and address additional operational support needed to help patient populations during emergencies. For more information on implementing an Emergency Response Plan, check out our webinar on Emergency Response Management Planning.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

Utilizing the Latest Best Practices for Better Patient Outcomes

Posted by Samantha Serfass on March 18, 2020 in Blog, News

Utilizing the Latest Best Practices for Better Patient Outcomes

The amount of time it takes to perform research and clinical trials to putting new best medicines and best practices into use is considered to be called the time from “bench to bedside”. The average time from bench to bedside is 17 years.  

During these years, two major phases occur.  The first phases consist of the conversion of knowledge from basic science research into a potential clinical product/process for testing, while the second phases consist of clinical trials (testing new products and process with patients) and putting new practices and products within a health system.  

There are, however, many delays along the way which contribute to the 17 years average. 

  • Grant awards
  • Ethical approval
  • Clinical trial execution
  • Drug approvals
  • Publication of test results and absorption

Although clinical trials are a lengthy endeavor, you can see from the latest efforts to fight the coronavirus steps can be taken to dramatically shorten the delay.  The first phase of the coronavirus took only a few short months, as it was declared an Emergency. However, there are more than 20,000 clinical trials registered every year at 16 national & regional registries. 

Historically less than half of all the trial results are published, and there is concern about the quality of the trail and the effectiveness of drugs. Companies like Good Pharma Scorecard ranks new drugs on a range of criteria. This includes the quality of the testing during clinical trials.  However, once test results are published, the new best practices are not always put into use.

There are approximately 49 different major specialties in North America (with hundreds of sub-specialties).  If a physician were to just read the publications within their specialty, they would need to on average read 4 publications each week in order to keep up. To effectively put the publication results into practice would require physicians to remember the symptoms, comorbidities and the test group for each of the studies published. They then would need to recall and act on the recommended best practice.  This provides to be a challenging course of action. 

A number of different initiatives could be implemented in order to help the physician’s stay informed.

  1. Governance focused on clinical quality outcomes
  2. Evidence-Based Medicine (EBM)Tools
  3. Effectively Leveraging the EHR

Governance should be focused on the health system’s specific performance and their patient population.  By effectively leveraging evidence-based medicine (EBM) tools and utilizing the EHR system, health systems will be able to reach and accomplish their goals. Companies like Elsevier and ProVation can be integrated with EHRs to bring best practices (based on EBM) to the healthcare providers. Coordinating Governance goals and optimizing and configuring the EHR to leverage the latest tools is key.

Earlier in 2020, Epic implemented updates to help screen and identify patients with the coronavirus. While this is an important step in better identifying the patients, workflows must be able to support initiatives and new updates to an EHR.  

Knowing the latest feature and functionality of your EHR, coordinating workflows changes, identifying governance goals, and leveraging EBM are all important factors that need to be addressed.   By leveraging the latest EBM and EHR functionality, our team has the experience and expertise to help configure your system to meet the organizational goals.

Todd Klein, CIO, VP of EHR Services & Digital Solutions