Achieving Breakthroughs in Care by Reducing Barriers to Regional Exchange of Health Information

Cassi Birnbaum, System-Wide Director of Health Information Management and Revenue Integrity, UC San Diego Health
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Cassi Birnbaum, System-Wide Director of Health Information Management and Revenue Integrity, UC San Diego Health

Cassi Birnbaum, System-Wide Director of Health Information Management and Revenue Integrity, UC San Diego Health

UC San Diego Health is committed to improving the consumer experience by assuring that the complete, accurate and relevant information reaches the hands of the treating provider within seconds not days, and enabling patients/consumers to have access to their complete health information/medical record (open notes) with limited exceptions through its patient portal (MyChart).

Improving the health of the regional population UC San Diego serves along with its clinically integrated network and its affiliate partners across three counties: San Diego, Riverside, Orange County, and Imperial County. The collective goal is to achieve better outcomes by delivering the right care at the right time, while reducing not only the cost of health care but improving the value of care through available and complete data where ever the patient is treated. To fuel this effort a comprehensive strategy has been deployed to improve its technology, workflow, process and outcomes alerts/ reminders, measurement, reporting as well as its investment in care management.

Last year, CMS designated UC San Diego Health as an Accountable Care Network and part of the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) national program, which includes UC San Diego Health faculty and facilities, community hospitals, and community primary care providers and specialists serving more than 30,000 beneficiaries in San Diego, Riverside and Imperial Counties.

  Delivering quality healthcare relies on the ability of providers to easily share trusted and relevant patient information​  

Patients who are identified as higher risk for chronic diseases and other conditions receive support from the ACO's Population Health Care team, which includes social workers, nurse case managers, pharmacists, and care navigators. Services offered include coordinating transitions of care, visits to the patient in skilled nursing facilities and hospitals, telephonic health care support, and patient education and self-care tools and training. Identifying and codifying each patient’s social determinants of health is critical to establishing a successful treatment plan and involving the patient and caregivers in an improvement roadmap.

This initiative aligned well with the already well established clinically integrated network and ability to successfully share information with those entities who already are on UC San Diego’s instance of its EMR, Epic and workflows which have been aligned to support its affiliate partners who utilized a non-Epic EMR. These efforts are harmonized with the mature regional Health Information Exchange (HIE) non-profit enterprise, San Diego Health Connect to exchange with all providers, and county entities as well as the ability to benefit from other health care data sharing associated with mandatory disease reporting, immunization registry, EMS information (SAFR initiative), POLST registry, Cancer registry, and sophisticated technology to facilitate patient matching across its vast network to eliminate barriers to exchange.

Although, UC San Diego Health and its Clinical Integrated partners have developed exceptional tools to integrate its clinical, financial and risk-based reporting tools and best practice alerts and reminders to address relevant health factors at the time of the visit, Clinical and HIM leadership found that there were still remaining gaps associated with the siloed nature of the separation of clinical, revenue cycle, HIM and Revenue Integrity workflow.

Also, challenging in the current healthcare environment is the reliance on the provider to select in the EMR the current underlying conditions, diagnoses and procedures at the time of the visit, while focusing on treating the patient. Oftentimes this results in incomplete, imprecise, conflicting and outdated conditions (problems) selected that are then used for supporting the ordering of tests, treatments, and procedures as well as supporting the severity of illness. Not only does this lead the potential for less reimbursement and potential edits (re-work prior to billing) or denials, this can also lead to gaps in care if conditions are left undocumented.

This is not a situation unique to UC San Diego; however, what is unique is its willingness to partner with its technology partners to bridge the gap to address documentation deficiencies and ease the disruption/burden on the provider. The extension of its computer assisted coding platform that integrates within the EMR, leveraging natural language processing (NLP), enables deep machine learning to read the provider documentation and suggest codes to enable discreet uses of the data for reimbursement, reporting, research and clinical care as well as reducing not only physician time but also coder time. Also, secondary benefits include a decrease in denials and re-work involved in preparing the encounter for billing. Decreasing the lag time from the time the patient is seen to its availability of secondary uses in support of patient care is of paramount importance.

The other major gap that the HIM is excited to lead is associated with assuring that we can support the growing enterprise and also patients seen at a non-Epic site or outside of our network/enterprise. Historically, depending on where the patient was seen any non-electronic documentation, non-interfaced documentation and past medical records were delivered to the centralized HIM department for scanning into the EMR. Through the implementation of advanced OCR with imbedded deep AI, documentation will be scanned into a high-speed multi-functional device without time consuming prepping and indexing, will be available within an hour. This coupled with advance workflow and technology deployed last year to enable the seamless availability of all patient-centric documentation within Epic.

Delivering quality healthcare relies on the ability of providers to easily share trusted and relevant patient information. But the sheer volume of data and proliferation of sources makes managing it a serious challenge. How can provider organizations guarantee their patient data is accurate, complete, and available to the right people and systems when needed? Information governance.

While definitions vary, IG essentially is a framework for managing information in a way that ensures it can be trusted through its entire lifecycle and across the organization. Done well, IG can help providers deliver better care, increase organizational efficiency, and improve both collaboration and patient engagement while controlling costs and claims denials. Information governance is more than IT’s job, successful IG requires buy-in at all levels of a healthcare organization, from the C-suite to patient-facing employees, and it is the key to UC San Diego’s continuing success in ultimately improving the health of its patient population.

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