Children’s National Health System in Washington, D.C., has been serving the nation’s children since 1870. Home to the Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is one of the nation’s top NIH-funded pediatric institutions. And, with more than 300 beds, Children’s National sees more than 200,000 patients annually.

THE PROBLEM

Physician queries are vital for accurate medical coding, which factors into proper reimbursement and quality scores for the hospital and physician – but traditionally have been a manual, multi-step process. Children’s National was using Microsoft Outlook email to communicate about physician queries.

Physicians often would have multiple steps to go through to complete a request for patient record documentation clarification, and the e-mail process presented more administrative burden. Tracking responses and measuring results was cumbersome for staff and leadership.

“We needed a better way to reach physicians and communicate with them, as well as an easy and compliant way for them to answer queries, given all of their other responsibilities,” said Stephen Wood, director of revenue analytics at Children’s National Medical Center. “We just didn’t have that seamless interface we needed to physicians using technology.”

PROPOSAL

So Children’s National selected Artifact Health, a vendor of a mobile physician query platform, to help it with its communications problem. The provider organization integrated Artifact with its Cerner EHR so physicians could respond to queries quickly in one step.

“The first issue we needed to address was access to providers,” Wood said. “Now, instead of relying on email, calls and face-to-face communication, we can go directly to providers through the mobile platform and reach them right on their smartphones. We had no way to do that before.”

"Now providers can answer these queries compliantly right on their phone from wherever they’d like, making the process fast and less disruptive and time-consuming, giving them more time to focus on patient care."

Stephen Wood, Children’s National Health System

Providers were trying to review queries and then having to login to the EHR and look up information separately in the medical record to properly answer a query. It was a multi-step, time-consuming process.

The new mobile system helped the provider organization take a process that was burdensome for the CDI and coding team as well as providers and replace it with easy, compliant access to queries, Wood explained.

“And now providers can answer these queries compliantly right on their phone from wherever they’d like, making the process fast and less disruptive and time-consuming, giving them more time to focus on patient care,” he said. “The app is so intuitive and simple to use, our doctors did not need any training, so ramp-up time for them was instant.”

MEETING THE CHALLENGE

Children’s National integrated the mobile query platform with its Cerner HER. The organization had solid buy-in from the IT department and Cerner, and it was able to make sure Cerner and Artifact were well-connected with each other, Wood said.

“It was important for us to not just bring over patient visit information but also provider documentation,” he explained. “Instead of sending over a query where we reference a specific record, and then we have to retype the documentation, it is now simple for the coding and CDI team to easily attach that information from Cerner right to the query in Artifact.”

Physicians no longer have to dig through medical records; they can reference it right on their phone. Further, the physician’s query response immediately populates the patient chart in Cerner. So getting the EHR and mobile platform connected was crucial, Wood stated.

“On our end, we needed to make sure the CDI and coding teams were using it consistently for query creation and that providers on the other end of the tool were getting to review and respond to queries easily, compliantly and in a timely fashion,” he added.

Overall, Wood said that it was a straightforward implementation that was completed in approximately two months.

RESULTS

Children’s National Health System realized some immediate wins with the new mobile physician query platform.

“Since using Artifact’s mobile platform, we are seeing 99% of our queries responded to in a 14-day period,” Wood reported. “We also measured a nearly 80% rate of queries responded to within 2 days. We’ve seen average physician response time dropping to one day for concurrent queries and two days for retrospective queries. This is incredibly important as we need to turn these around quickly to ensure we don’t slow down final coding and ultimately cash.”

Further, the provider organization is showing a dramatic increase in query volume – more than 200% for the first three months. The productivity gain for the CDI team by using the new system to streamline query creation, delivery and tracking has allowed Children’s National to expand its coverage and increase its query rate.

“We also are seeing changes in physician behavior,” Wood reported. “There are some items we used to query for that providers are now proactively addressing in future documentation. This is the ultimate goal, and we’ve leaned on the Artifact tool and our CDI educator to drive this.”

Children’s National accomplished its goal of a more accurate and comprehensive chart with better access to physicians and ease of use for physicians to compliantly respond to queries, Wood stated.

ADVICE FOR OTHERS

While Wood said the Artifact Health mobile tool is very intuitive for physicians, he added that it really needs to be appropriately communicated to providers from leadership.

“At Children’s National, I think the physician leadership team did a very good job communicating the features and benefits of this mobile platform we were going to implement to our physicians,” he said. “I really feel that this initial communication process is critical because you are asking doctors who are accustomed to reviewing emails to now look at queries on their smartphones, and you want to make sure they understand these are queries they can now answer compliantly right from their phone.”

Another great lesson, Wood reported, was making sure the CDI and coding team were aligned during the implementation and beyond, for decision making, content creation and training.

“It’s important to approach and use this tool with a collaborative effort between the two teams,” he concluded. “So I would say getting buy-in from the physician leadership team, the IT team, and getting great people behind it on the CDI and coding teams is key.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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