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• W1977576499 abstract "BackgroundHealth information technology is an essential tool for improving patient safety and quality of care. Emergency department point-of-care ultrasound (POC u/s) must be documented as it comprises an integral component of physician decisionmaking. An inefficient workflow with barriers to documentation causes physician non-compliance. Incomplete documentation impedes coding, billing, and physician group compensation for ultrasound procedures and patient care provided.Study ObjectiveWe aimed to assess the effect of directed education and personal feedback through a task force-driven initiative to increase the number of POC u/s scans documented and transferred to medical coders by emergency medicine physicians.MethodsThis study was performed over a six-month period (October 2013- March 2014) at an academic medical center, with a three-year emergency medicine residency program. The study was institutional review board exempt. Three months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified, eg, time costs to performing and interpreting scans, duplicate documentation systems, lack of financial incentives and timely feedback, a subset of non-credentialed physicians, and intermittent delays in wireless transmission to the archiving system. The task force met monthly and progressively introduced methods of workflow process education. Physicians received an in-person and centralized Web site-based instructional review. Reminder signs were placed on computer workstations. Daily reports were generated noting missing POC u/s or health care record data. The chairman contacted physicians with documentation missing information. The total number and application specific POC u/s scans performed and not transferred to the health care record and medical coders was compared for the pre- and post-task force intervention. Chi-square analysis was used to determine the difference between the proportion of POC u/s reported before and after the intervention.ResultsA total of 1061 POC u/s scans were documented during the study period. The number of scans submitted for the two-three month times was similar (467 and 594). Successful reporting increased from 46% pre- to 67% post-intervention (P=0.001). All individual POC u/s examinations showed a statistically significant increase in reporting including those most critical to patient care (EFAST [41% versus 63%], vascular access [26% versus 61%], and cardiac [43% versus 65%]) and those most commonly performed (biliary [44% versus 62%] and pelvic [60% versus 72%]). Soft tissue (53% versus 82%) and renal (16% versus 60%) also increased significantly. Of the 610 POC u/s studies coded and reported for reimbursement, 15.9% were billed before intervention and 28.5% were billed after intervention (P=0.0005).ConclusionThe formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing. A limitation of our study was a relatively brief post intervention period. Further analysis should be performed to assess the long-term effect of the intervention. A future study will determine if such an initiative increases revenue. BackgroundHealth information technology is an essential tool for improving patient safety and quality of care. Emergency department point-of-care ultrasound (POC u/s) must be documented as it comprises an integral component of physician decisionmaking. An inefficient workflow with barriers to documentation causes physician non-compliance. Incomplete documentation impedes coding, billing, and physician group compensation for ultrasound procedures and patient care provided. Health information technology is an essential tool for improving patient safety and quality of care. Emergency department point-of-care ultrasound (POC u/s) must be documented as it comprises an integral component of physician decisionmaking. An inefficient workflow with barriers to documentation causes physician non-compliance. Incomplete documentation impedes coding, billing, and physician group compensation for ultrasound procedures and patient care provided. Study ObjectiveWe aimed to assess the effect of directed education and personal feedback through a task force-driven initiative to increase the number of POC u/s scans documented and transferred to medical coders by emergency medicine physicians. We aimed to assess the effect of directed education and personal feedback through a task force-driven initiative to increase the number of POC u/s scans documented and transferred to medical coders by emergency medicine physicians. MethodsThis study was performed over a six-month period (October 2013- March 2014) at an academic medical center, with a three-year emergency medicine residency program. The study was institutional review board exempt. Three months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified, eg, time costs to performing and interpreting scans, duplicate documentation systems, lack of financial incentives and timely feedback, a subset of non-credentialed physicians, and intermittent delays in wireless transmission to the archiving system. The task force met monthly and progressively introduced methods of workflow process education. Physicians received an in-person and centralized Web site-based instructional review. Reminder signs were placed on computer workstations. Daily reports were generated noting missing POC u/s or health care record data. The chairman contacted physicians with documentation missing information. The total number and application specific POC u/s scans performed and not transferred to the health care record and medical coders was compared for the pre- and post-task force intervention. Chi-square analysis was used to determine the difference between the proportion of POC u/s reported before and after the intervention. This study was performed over a six-month period (October 2013- March 2014) at an academic medical center, with a three-year emergency medicine residency program. The study was institutional review board exempt. Three months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified, eg, time costs to performing and interpreting scans, duplicate documentation systems, lack of financial incentives and timely feedback, a subset of non-credentialed physicians, and intermittent delays in wireless transmission to the archiving system. The task force met monthly and progressively introduced methods of workflow process education. Physicians received an in-person and centralized Web site-based instructional review. Reminder signs were placed on computer workstations. Daily reports were generated noting missing POC u/s or health care record data. The chairman contacted physicians with documentation missing information. The total number and application specific POC u/s scans performed and not transferred to the health care record and medical coders was compared for the pre- and post-task force intervention. Chi-square analysis was used to determine the difference between the proportion of POC u/s reported before and after the intervention. ResultsA total of 1061 POC u/s scans were documented during the study period. The number of scans submitted for the two-three month times was similar (467 and 594). Successful reporting increased from 46% pre- to 67% post-intervention (P=0.001). All individual POC u/s examinations showed a statistically significant increase in reporting including those most critical to patient care (EFAST [41% versus 63%], vascular access [26% versus 61%], and cardiac [43% versus 65%]) and those most commonly performed (biliary [44% versus 62%] and pelvic [60% versus 72%]). Soft tissue (53% versus 82%) and renal (16% versus 60%) also increased significantly. Of the 610 POC u/s studies coded and reported for reimbursement, 15.9% were billed before intervention and 28.5% were billed after intervention (P=0.0005). A total of 1061 POC u/s scans were documented during the study period. The number of scans submitted for the two-three month times was similar (467 and 594). Successful reporting increased from 46% pre- to 67% post-intervention (P=0.001). All individual POC u/s examinations showed a statistically significant increase in reporting including those most critical to patient care (EFAST [41% versus 63%], vascular access [26% versus 61%], and cardiac [43% versus 65%]) and those most commonly performed (biliary [44% versus 62%] and pelvic [60% versus 72%]). Soft tissue (53% versus 82%) and renal (16% versus 60%) also increased significantly. Of the 610 POC u/s studies coded and reported for reimbursement, 15.9% were billed before intervention and 28.5% were billed after intervention (P=0.0005). ConclusionThe formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing. A limitation of our study was a relatively brief post intervention period. Further analysis should be performed to assess the long-term effect of the intervention. A future study will determine if such an initiative increases revenue. The formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing. A limitation of our study was a relatively brief post intervention period. Further analysis should be performed to assess the long-term effect of the intervention. A future study will determine if such an initiative increases revenue." @default.
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• W1977576499 date "2014-10-01" @default.
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• W1977576499 title "9 Effect of a Workflow Solution Task Force on Emergency Physician Compliance for Point-of-Care Ultrasound Documentation and Billing" @default.
• W1977576499 doi "https://doi.org/10.1016/j.annemergmed.2014.07.034" @default.
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