Book excerpt: Measuring EHR success

By Marion Kruse, BSN, RN, MBA, and Jennifer Cavagnac, CCDS

The decision to implement electronic queries can be complex, and requires input from many deci­sion-makers. CDI should work with hospital leadership to put together a robust committee to tackle the challenge, including CDI, HIM, providers, coders, compliance officers, and IT. This committee should be in charge of evaluating query and physician response rates and processes before imple­mentation, planning implementation steps, evaluating ongoing educational needs, and analyzing data and metrics.

The electronic era has made it easier to track query outcome measures, such as the financial impact and change in severity of illness. It has also expanded how the query process can be measured. Some of these expanded measures include the following:

• Query template and diagnosis: Determines diagnoses or symptoms most frequently requiring clarification
• Discharge summary query template: Tracks cases where documentation in the discharge summary is disparate from the rest of the medical record
• Concurrent vs. post discharge query rate: Tracks the number of documentation issues not addressed while the patient was admitted
• Query response distribution: Tracks the amount of time it takes the provider to answer a query

Ideally, this data is tracked, trended, and reported monthly. This will identify problematic trends and opportunities for education. If a facility is using natural language processing within their EHR software, the metrics they use to monitor query activ­ity must be updated to take advantage of the additional data that is available. For example, if alerts are triggered when the physician is writing his notes, the CDI leadership should monitor how often the alert is triggered and how often the provider involved, as well as the outcome. The data should be used to track program compliance and return on investment. This process should include the collection of baseline data.

Although the type and number of alerts can vary greatly by facility, methods of tracking information can be somewhat standardized. Program compliance measures could include the following:

• Number of alerts
  
  • Overall, by specialty, and provider
• Ratio of alerts vs. EMR entries
  
  • Overall, by specialty, and provider

• Number of alerts that resulted in additional documentation
  
  • Overall and by alert type
• Number of ignored alerts without additional documentation
  
  • Overall and by alert type
• Number of cases with alerts that required a CDI query related to the alert
  
  • Overall and by alert type
  • By specialty and provider
• Number of cases with alerts that required a CDI query not related to the alert
  
  • Overall and by alert type
  • By specialty and provider

To measure the return on investment, consider the following:

• Alerts resulting in payment change
• Alerts resulting in severity of illness changes
• Changes in CDI-issued queries
  
  • Overall
  • By CDI specialist
  • By physician specialty
• Changes in the amount of time it takes to perform CDI initial and follow-up reviews

The biggest variable for implementing these measures is the amount of manual intervention that may be needed to produce the data. CDI mangers should work with hospital leadership to determine how often to produce more in-depth reports.

Editor’s note: This article is an excerpt from the book The Essential Guide to Provider Queries.