Insights into CDI Workflow in EPIC at Pediatric Hospitals

 
CDI in Epic
 
Presented by:
Karen MacArthur, RN, BSN, CCDS
UCSF Benioff Children’s Hospital Oakland, CA
 
Marietta Morhardt, RN, BSN, CPN, CCM
Children’s Hospital & Medical Center, Omaha, NE
 
 
UCSF Benioff Children’s Hospital
Oakland
 
In the process of affiliating with University of California
San Francisco
Located in Oakland CA
190 Bed facility with 10,000 discharges/year
Around 70% MediCal population
 
BCHO CDI Workflow in EPIC:
Work Queues
 
BCHO CDI Workflow in EPIC:
Dashboard
 
Pros and Cons
 
Pros and Cons
 
Pros:
We don’t have to move from a program to EPIC/no input
of patient data
It is in the chart and care providers can go to the record
and/or reply to our queries
Easy to see who is responsible for the query
Cons:
Must cut and paste to send to other providers
Reports are difficult to build
No place to record verbal query without sending inbox
message
 
EPIC Physician Workflow
 
Hold for screen shot of physician query
 
Question to the Group
 
In Progress Notes, and other notes as well, we pull in
the problem list. How do your coders handle these
notes?
Code
NOT Code
Query if it is not documented anywhere else?
 
Actual Note
 
Assessment:
................undergoing induction chemotherapy with last chemo 9 on
admitted for febrile neutropenia. Limited exam today due to patient
discomfort and anxiety. However his fever curve is improving and his
white cell count is improved today, along with his hgb following
transfusion yesterday. Differential is most consistent with viral illness
vs mucositis. Bacteremia less likely with a negative blood culture and
stable VS. Will continue current treatment until his ANC increases.
Active Problems:
 
Speech delay
 
Obstructive sleep apnea
 
Pancytopenia due to antineoplastic chemotherapy
 
Ewing's sarcoma
 
Delay in development
 
Febrile neutropenia
 
Morbid obesity
 
Mucositis due to antineoplastic therapy
 
Children’s Hospital & Medical
Center Fast Facts
 
Children’s Hospital & Medical Center is the only full-service, pediatric
healthcare center in Nebraska, providing expertise in more than 50 pediatric
specialty services to children across a five-state region and beyond.
We are home to Nebraska’s only Level IV regional Newborn Intensive Care
Unit and the state’s only Level II Pediatric Trauma Center.
Our regional heart center offers expertise in pediatric heart transplantation.
Children’s is recognized as a 2018-19 Best Children’s Hospital by U.S. News &
World Report in five pediatric specialties: Cardiology and Heart Surgery,
Pulmonology, Gastroenterology & GI Surgery, Orthopedics, and Diabetes &
Endocrine Disorders.
In 2017:
Total Patient Visits: 623,700
Patients: 138,500
Medicaid Patients: 46,500
50+ Outpatient Specialty Services
145 Beds
11 Regional Clinics In 3 States
 
Omaha Children’s Workqueue List
 
Omaha Children’s Workflow
 
Initial List gets reviewed by CDI Reconciler
Goes to Subsequent List, which is reviewed by CDS.  Date
for re-review is determined by CDS’s
Query List keeps track of outstanding queries
CDI Manager Review list is for final coding or if case needs
special attention, i.e. SOI mismatch with encoder, coding
issues, etc.
When ready for matching up initial with final DRG, goes to
Validation
If discharged prior to coding being completed, or if awaiting
response from practitioner in relation to coding will go in
“Discharge waiting for coding” list
 
 
 
Queries
 
Pros & Cons of In Basket Queries
 
Pros:
1.  Goes directly to practitioner
2.  Able to ascertain if it has been read or not
3.  They are able to respond and ask further questions and/or clarify
if needed
4.  You can then respond in kind if additional questions
Cons:
1.  Can only send to one practitioner at a time
2.  Doesn’t directly send the reader to the problem list to amend or
the progress note to address
3.  If you need to send same query to another practitioner, and it
has been read by the original recipient, you cannot cut & paste the
query.
4.  Have to add residents/APRN’s to treatment team in Epic in order
for them to see the query. (shows up in their “to do” list)
 
Dashboard (Children’s)
 
Dashboard is still a work in process, trying to figure out
what information is the most useful at a glance
 
QUESTIONS?????
 
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Understanding the CDI workflow in EPIC at UCSF Benioff Children's Hospital Oakland and Children's Hospital & Medical Center, Omaha. Pros and cons of using EPIC for CDI, challenges in reporting and communication processes, and management of progress notes in coding. Dive into the actual note assessment and the unique aspects of pediatric care delivery.


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  1. CDI in Epic Presented by: Karen MacArthur, RN, BSN, CCDS UCSF Benioff Children s Hospital Oakland, CA Marietta Morhardt, RN, BSN, CPN, CCM Children s Hospital & Medical Center, Omaha, NE

  2. UCSF Benioff Childrens Hospital Oakland In the process of affiliating with University of California San Francisco Located in Oakland CA 190 Bed facility with 10,000 discharges/year Around 70% MediCal population

  3. BCHO CDI Workflow in EPIC: Work Queues

  4. BCHO CDI Workflow in EPIC: Dashboard Pros and Cons

  5. Pros and Cons Pros: We don t have to move from a program to EPIC/no input of patient data It is in the chart and care providers can go to the record and/or reply to our queries Easy to see who is responsible for the query Cons: Must cut and paste to send to other providers Reports are difficult to build No place to record verbal query without sending inbox message

  6. EPIC Physician Workflow Hold for screen shot of physician query

  7. Question to the Group In Progress Notes, and other notes as well, we pull in the problem list. How do your coders handle these notes? Code NOT Code Query if it is not documented anywhere else?

  8. Actual Note Assessment: ................undergoing induction chemotherapy with last chemo 9 on admitted for febrile neutropenia. Limited exam today due to patient discomfort and anxiety. However his fever curve is improving and his white cell count is improved today, along with his hgb following transfusion yesterday. Differential is most consistent with viral illness vs mucositis. Bacteremia less likely with a negative blood culture and stable VS. Will continue current treatment until his ANC increases. Active Problems: Speech delay Obstructive sleep apnea Pancytopenia due to antineoplastic chemotherapy Ewing's sarcoma Delay in development Febrile neutropenia Morbid obesity Mucositis due to antineoplastic therapy

  9. Childrens Hospital & Medical Center Fast Facts Children s Hospital & Medical Center is the only full-service, pediatric healthcare center in Nebraska, providing expertise in more than 50 pediatric specialty services to children across a five-state region and beyond. We are home to Nebraska s only Level IV regional Newborn Intensive Care Unit and the state s only Level II Pediatric Trauma Center. Our regional heart center offers expertise in pediatric heart transplantation. Children s is recognized as a 2018-19 Best Children s Hospital by U.S. News & World Report in five pediatric specialties: Cardiology and Heart Surgery, Pulmonology, Gastroenterology & GI Surgery, Orthopedics, and Diabetes & Endocrine Disorders. In 2017: Total Patient Visits: 623,700 Patients: 138,500 Medicaid Patients: 46,500 50+ Outpatient Specialty Services 145 Beds 11 Regional Clinics In 3 States

  10. Omaha Childrens Workqueue List

  11. Omaha Childrens Workflow Initial List gets reviewed by CDI Reconciler Goes to Subsequent List, which is reviewed by CDS. Date for re-review is determined by CDS s Query List keeps track of outstanding queries CDI Manager Review list is for final coding or if case needs special attention, i.e. SOI mismatch with encoder, coding issues, etc. When ready for matching up initial with final DRG, goes to Validation If discharged prior to coding being completed, or if awaiting response from practitioner in relation to coding will go in Discharge waiting for coding list

  12. Queries

  13. Pros & Cons of In Basket Queries Pros: 1. Goes directly to practitioner 2. Able to ascertain if it has been read or not 3. They are able to respond and ask further questions and/or clarify if needed 4. You can then respond in kind if additional questions Cons: 1. Can only send to one practitioner at a time 2. Doesn t directly send the reader to the problem list to amend or the progress note to address 3. If you need to send same query to another practitioner, and it has been read by the original recipient, you cannot cut & paste the query. 4. Have to add residents/APRN s to treatment team in Epic in order for them to see the query. (shows up in their to do list)

  14. Dashboard (Childrens) Dashboard is still a work in process, trying to figure out what information is the most useful at a glance

  15. QUESTIONS?????

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