Vol. 17 •Issue 44
• Page 12
Documentation & Workflow
A case for computerization
By Ann W. Kummer, PhD, CCC-SLP, ASHA-F
The last two decades have created new demands and challenges for health care providers. There have been changes in reimbursement, from a fee-for-service system to managed care and capitation.
Today's health care providers face the additional pressures of increased documentation and communication requirements, increased compliance issues, as well as business-related issues, such as obtaining insurance authorization and reauthorization—not to mention tracking all of those authorizations. At the same time, there are pressures to decrease the cost of care delivery while simultaneously improving quality, customer satisfaction and revenue.
Although the majority of clinicians entered this field to provide clinical care and treat patients, it seems as if an increasingly large portion of their limited time is spent dealing with the business issues of care delivery.
To address these challenges the Cincinnati Children's Hospital Medical Center (CCHMC), in Cincinnati, OH, embarked on a mission more than a decade ago to reduce the documentation and administrative demands within the Division of Speech Pathology. Our goal was to leverage information technology (IT) to automate our processes, streamline workflow, reduce billing errors, increase coding compliance, and improve the quality, consistency and turn-around time of our documentation.
After an extensive search of the market, we quickly discovered that speech pathology-specific software didn't exist. That left us with only two options: adapt existing solutions to fit our needs or develop our own solution.
In considering our options we realized that we had some unique needs in speech pathology that couldn't be addressed by simply adapting a generic clinical documentation or electronic medical records system. Therefore, we partnered with a software development firm to create our own document management and electronic charting system.
Within a year of launching the system, we were able to start realizing the benefits of our solution, which confirmed our decision to build versus adapting a generic solution. The results included the following:
one to two hours of increased billed time per week per full-time equivalent (FTE),
increased reimbursement resulting from consistent processes to approve and document insurance authorizations,
decreased support staff costs, and
improved net revenues.
The cost reductions in computerizing the documentation process continue to deliver a financial return to the organization each year. By way of illustration, the CCHMC Division of Speech Pathology produced the equivalent of about 25,000 pages of documentation in 2004. If this documentation had been produced using traditional paper-based methods, the division would have incurred close to $200,000 in transcription and support costs alone. Our electronic documentation system eliminates transcription costs because clinicians enter their documentation directly into the system.
The commercial viability of our software application was validated when we won the 1995 International Beacon Award by IBM/Lotus. In addition, our solution was purchased by Chart Links Inc., based in New Haven, CT, which now sells, supports, and continues to develop the system. CCHMC continues to provide feedback to Chart Links for system improvements and often tests new modules.
The business of speech pathology requires many tasks in order to receive reimbursement, such as obtaining insurance authorizations, generating charge tickets, coding correctly, and documenting care. With manual systems these tasks are difficult to track and are prone to errors. Our software solution handles these tasks for us, such as automatically tracking authorizations. Every time a patient encounter is billed, the system has a pop-up window that displays how many more visits are authorized, the expiration date, and when reauthorization is necessary. As a result of this feature, patients never are seen mistakenly without authorization or a payment agreement.
The system also reduces redundant data entry. Once patient or insurance information is entered into the system, it automatically flows into all other forms created for the patient. Prompts from within the system automatically walk clinicians and administrative staff members through processes.
For example, upon patient check-in, a charge ticket is generated automatically. If the charge is for a first treatment session, the system will create a template for a new treatment plan. If the charge is for an evaluation, an evaluation report reminder is created. Evaluation templates can be chosen, or free text can be copied and pasted into the template.
Treatment plans are created quickly with the point-and-click simplicity of drop-down menus. Goals are selected from a standard database yet can be modified. Group therapy treatment plans are created based on a single treatment plan that is applied—and modified, if necessary—to all patients in the group.
As goals are accomplished, the date appears in the goals table. When a progress or discharge report is needed, that information is already in the report. The clinician just needs to add the recommendations, usually by selecting key sentences. The report then can be signed electronically and faxed online.
Automated documentation saves a tremendous amount of time and allows us to get reports to our customers—physicians, parents and insurance companies—very quickly.
The system allows managers to track the completion of charges and reports so they are done in a timely manner. Additional reports can track productivity by comparing billed time to the employee's scheduled work time. Revenue can be monitored in real time or by date, month, location or individual clinician.
An unexpected benefit of the system is its impact on our staff. Students rotating through our program are disappointed when they have to leave to work for an employer that does not have this type of profession-driven documentation and workflow system. On more than one occasion, staff members who left our organization—due to a spouse getting relocated for a job, etc.—have moved back to the area and returned to their position partly because they wanted to return to an electronic environment.
These capabilities, along with others, have enabled our division to improve the quality and timeliness of our documentation, increase reimbursement, decrease costs, increase staff satisfaction, and manage all of our support activities (e.g., referrals, scheduling, insurance authorizations) for all locations from a centralized office. With the system in place, we have been able to manage phenomenal growth—from four to 11 sites and about 30 to more than 100 clinicians—during the past 10-plus years.
Our electronic workflow system allows us to provide better service while serving many more patients than would be possible without it.
Ann Kummer, PhD, is the senior director of the Division of Speech Pathology at CCHMC and a professor of clinical pediatrics at the University of Cincinnati Medical Center. She can be contacted at Ann.Kummer@cchmc.org.
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