Health Management Technology

Illegible clinical documentation, inconsistent charge capture and long patient wait times that can lead to a decrease in the quality of care and in some cases, millions of dollars in lost revenues, are a few of the problems emergency departments (ED) across the nation are facing.

EDs often are considered the front doors to the healthcare industry, with many hospitals reporting that a majority of admittances for in–patient care are coming from the ED. But an ED lacking an emergency department information system (EDIS) is less likely to capture patient information accurately, and this reality leads to duplication of efforts and millions of dollars of services rendered but never billed. In recent years, the question, “Does my hospital need an EDIS?” has changed to “How soon can we go live with an EDIS?”

At Memorial Hermann Healthcare System, a 14–hospital integrated healthcare enterprise based in Houston, we recognized that in order to successfully remain the most comprehensive network of emergency services in southeast Texas, we needed a solution that would improve our clinical documentation in the ED, coding accuracy and charge capture. The Memorial Hermann–Texas Medical Center serves as a Level 1 Trauma center and our award–winning Life Flight air ambulance program flies more than 3,000 missions a year. Some 400,000 people seek emergency care from the Memorial Hermann healthcare system each year, so we needed to act quickly across all eight of our EDs to improve efficiency.

Meeting the Need

With Houston’s expanding population, much of which does not have medical insurance and seeks primary care in our emergency departments, we recognized that by automating processes, we could increase clinician and patient interaction and improve workflow. This would result not only in greater success as a hospital network, but also improve our patient care and enable us to meet growing demands.

In the past, Memorial Hermann had been outsourcing its ED billing, which meant third–party coding analysts would individually review handwritten charts, assign codes and levels, and then bill accordingly. Although our charge capture was relatively accurate, we paid a lot for this service, and the lag time to process charts and mail out bills was lengthy. We wanted to find an in–house solution that would further improve coding accuracy, eliminate user bias and outsourcing fees, and electronically document patient information and capture charges in real time.

Because of the success our organization had experienced with the patient–tracking module from Addison, Texas–based MEDHOST, we chose to pilot for 90 days the company’s electronic nurse charting module, which has an automatic, behind–the–scenes charge capture feature. We wanted to see if by switching from paper to electronic charting and automatic charge capture, we could have equally accurate coding but in real time, thus making it possible to eliminate outsourcing.

In those first 90 days, we far exceeded our goal. We not only captured charges in real time, but we also more thoroughly documented care, which improved charge capture and coding accuracy that had been lost with paper charting. We also eliminated user bias and outsourced coder fees.

These noticeable improvements drove us to implement electronic nurse charting as a permanent solution at our pilot hospital, and to install the technology within the seven other EDs among our healthcare system as quickly and efficiently as possible.

Steps to Success

To have a successful and aggressive electronic nurse charting implementation in a short period of time, I formed a multi–disciplinary team and established regular, mandatory meetings to address problems and share information. Each member of the team had the opportunity to learn from the other facilities to make each subsequent implementation an even greater success. It was important to me to gain input and approval from all levels of our organization—from the CEO, CFO, CNO, and IS team to the front–line clinicians. Although each hospital had somewhat different processes, my decision to standardize procedures across the network prevented numerous customization requests that could have delayed and complicated the multi–hospital rollout.

With this approach, we successfully executed the electronic nurse charting implementation sequentially in just eight months. Clinical staff and supervisors from each hospital worked with members of our IS department and with MEDHOST. The most beneficial practice over the course of the implementation was having a nurse from a hospital that had just rolled out the system move to the next facility in the sequence to ensure that each implementation went smoother than the last. This person shared experiences from the previous installations, thereby mitigating any potential for reoccurring problems or pitfalls and functioned to make the implementation virtually seamless.

Training, both internally with our own staff members and with MEDHOST’s team of nurses and consultants, also played a large part in our success and it allowed our clinicians and patients to realize the benefits from the EDIS much faster. We standardized the training process across all hospitals within the Memorial Hermann system to flatten the learning curve and accelerate acceptance by clinicians.

Having a vendor that was willing to be a part of the process each and every step of the way was one of the greatest values for our healthcare system. An implementation of this magnitude within a truncated timeframe of less than a year requires dedication not only on the part of hospital administrators, IS departments and clinicians, but also the vendor supplying the product, consulting and subsequent training.

Throughout all healthcare facilities within the Memorial Hermann system, we eliminated discrete projects that would distract the team and consume its time for things that didn’t benefit our system as a whole. Instead, we focused on only making changes or updates to the system that would provide positive results to all hospitals enterprisewide. This made the implementation process significantly more efficient, and when the team’s efforts benefit all hospitals involved rather than just two or three, there’s added value behind the team’s work.

Results

Electronic nurse charting is providing all the efficiencies, and patient and staff satisfaction that we anticipated. In addition, reduced wait times and our improved workflow enable clinicians to better care for patients and manage our EDs. Thanks to bedside documentation, clinicians spend more time caring for patients and less time searching for, or handwriting, charts. This not only improves patient care, but also hospital productivity.

More thorough clinical documentation has led to better accuracy in level charges because they are calculated automatically, in real time and without user bias. Coding analysts now have time to audit charts to ensure that what is captured equates to the proper level. This eliminates sifting through handwritten paper charts, assigning charges, and deciphering orders and treatments received, which is cumbersome and can lead to inaccuracies. We also eliminated all outsourced ED billing, which saved what we were spending in additional fees. We now have better charge capture than ever before.

A multi–hospital implementation of this kind requires strategic planning and careful selection, but I could not be more pleased with Memorial Hermann’s ability to successfully complete this electronic nurse charting rollout over eight EDs in only eight months. Memorial Hermann is now equipped with the tools to provide a higher level of quality care and meet growing demands in our EDs.

Tom Flanagan is COO of Memorial Hermann–Texas Medical Center and Children’s Memorial Hermann Hospital. Contact him at Tom.Flanagan@MemorialHermann.org.