As a healthcare business entity, the outpatient wound clinic operates for a patient population living with complex chronic conditions unlike any other throughout the care continuum. Associated morbidity, decreased quality of life, and, in some cases, mortality are among the many reasons significant interest has been focused on the prevention and treatment of chronic wounds. Care planning requires a multifaceted approach by specialists managing the care and integrating proven clinical practice guidelines. As a wound care provider, the very root of proving one is working within the guidelines of the clinic is found within the data captured using the specialty electronic medical record (EMR). A specialty wound care EMR will capture a granularity of information in a certain workflow that other EMRs simply cannot. This becomes high-value information that proves worth and compliance within the wound clinic. Furthermore, hospitals seek to open outpatient specialty clinics focused on wound care to support patients living with chronic wounds and to provide a setting that can manage recurring visits. This places a great responsibility on the wound clinic to have competent staff and processes in place to support documentation, patient safety, revenue cycle management, regulations, compliance, clinical therapies and workflows, operational leadership, clinical quality measures (focusing on Meaningful Use and Physician Quality Reporting System [PQRS]), reporting, and data analytics (See Figure 1). To ensure financial success within the clinic, process efficiencies must be in place to manage volume, support outcomes, and drive data/reporting. Utilizing a comprehensive, interoperable specialty EMR, supporting these process efficiencies, is key for the department’s success.1 “Numerous documentation elements are captured for specialty care, which are not always available in standard EMR solutions. Some specialty documentation forms can be template driven, but others require complex algorithms to reflect the steps that specialty clinicians take in their clinical encounters. The views, protocols and order sets are another aspect requiring special design and consideration. It is critical that the specialty content and workflow be analyzed correctly in order to effectively achieve user adoption.”2 This article will address six key components of the specialty wound care EMR that will drive clinical value and compliance in the clinic.
1) InteroperabilityInteroperability is critical to receiving and collecting data. According to www.HealthIT.gov, “A complex healthcare system requires diverse EMR products. One size does not fit all. To realize their full potential, EMR products must be able to share information seamlessly. An interoperable health information technology (IT) environment makes this possible. EMR interoperability enables better workflows and reduced ambiguity, and allows data transfer among EMR systems and healthcare stakeholders. Ultimately, an interoperable environment improves the delivery of healthcare by making the “right” data available at the “right” time to the “right” people. In creating an interoperable health IT environment, standards are particularly critical in four areas of EMR technology: • How applications interact with users (such as e-prescribing); • How systems communicate with each other (such as messaging standards); • How information is processed and managed (such as health information exchange); and • How consumer devices integrate with other systems and applications (such as tablet personal computers).”3 Integrating interoperability within the clinic is critical for capturing and sending codified data, decreasing duplicative work, and improving patient safety.
2) Patient SafetyImplementing specialty wound care EMRs with guided workflows also assists the clinic in improving patient safety, among other initiatives. Customizing the specialty EMR with clinical practice guidelines, payment, and clinical regulations (eg, Centers for Medicare & Medicaid Services [CMS], Joint Commission) provides a platform for multidisciplinary communication. Implementation of the guidelines, evidence-based clinician instructions, predefined order sets, medication management through the use of Computerized Physician Order Entry, regulations, and product formularies further supports patient safety and objectives that are necessary to provide quality clinical care.
3) Revenue Cycle Management, Regulations, & ComplianceThe documentation process begins at the time the patient’s appointment is scheduled within the specialty outpatient clinic. The workflow encounter may include verification of: • front-end collections; • coverage prior to the patient visit; • insurance information; • patient demographics; and • reason for visit. Each of these measures has additional action steps that can be built into a workflow to ensure complaint documentation and billing. Additionally, demographic and payer information is gathered, medical necessity and coverage is confirmed, and all information is entered into the documentation system. Revenue cycle processes that include patient registration, compliant billing, and denial management complement the documentation process for a fiscally successful wound clinic. These processes are also governed by policy. Medicare is required by the Social Security Act to ensure payment is made only for those medical services that are reasonable and necessary. Policies specify the circumstances under which Medicare covers specific services. Further, most payers have implemented medical necessity guidelines for wound care services. At the heart of the specialty wound care clinic is compliance. Compliance provides oversight for clinical, operation, and financial standards. Staying abreast of coding regulations and government changes is critical to maintain a compliant clinic. Managing compliance standards through a specialty wound care EMR ensures complete, compliant documentation.
4) Clinical Quality Measures (CQMs)As we continue to leverage resources for “meaningful documentation,” we also need to take a closer look at another important tool — clinical quality measures (CQMs) — and their impact on the wound care business. CQMs assist providers in measuring and tracking the quality of healthcare services provided within the healthcare system. CQMs are set in place to ensure the safety and efficacy of care delivered and to measure aspects of patient care including: • health outcomes; • clinical processes; • patient safety; • efficient use of healthcare resources; • care coordination; • patient engagements; • population and public health; and • adherence to clinical guidelines. In the past, quality measures were obtained from claims processing. Now, the focus for quality measures has transitioned to be collated and reported by the provider through EMRs. Through various measures, CMS has aligned quality-reporting programs, including the EHR Incentive Program (Meaningful Use) and PQRS. Monitoring, measuring and reporting CQMs on a regular basis assists the health care system in delivering care that’s effective, safe, efficient, patient-centered, equitable, and timely. Collecting this level of documentation for CMS from a specialty outpatient wound clinic ultimately allows CMS to review reported quality metrics, thereby improving quality of life for patients living with chronic wounds.
5) Meaningful Use & PQRS for Wound CareCMS has led the charge to implement clinical quality measures within its programs, including Meaningful Use and PQRS. Through the transmission of data, clinical quality measures assist CMS in understanding the care provided to the patient/beneficiary and, ultimately, the data collected will improve quality care for the patient population. To successfully implement and achieve both mandates, the wound care community needs to embrace three key building blocks: 1) Workflow – optimize clinical, operational, and financial processes to fully leverage technology. 2) Certified Specialty Wound Care EMR and Reporting Suite – discrete data fields focused on specific wound care elements and medical necessity requirements that support documentation standards, enhance outcomes, and optimize reimbursement.4 3) Meaningful Data Reports – develop core reports to manage the clinic; generate quality reports and utilize data to improve patient and facility outcomes; attest to Meaningful Use and report for PQRS.
6) Data & ReportingCapturing discrete, or structured, data provides the information necessary to meet Meaningful Use and PQRS while ensuring the integrity of healthcare data, decision-making, and quality patient care. A compliant specialty wound care EMR standardized to capture the work and assessment data using discrete data fields is critical to complying with regulations and reportable data. Integrating evidence-based guidelines and templates, standardized dropdown lists, and reference tables can assure quality data is captured and reported to support a meaningful platform. And, to make the clinical data meaningful and rich in information, data must be captured in a codified way. “Specialty areas have sophisticated reporting needs that are different. In many implementations the focus is on the clinical workflow and process for capturing data, and the requirements for data analytics are not considered. The EMR can bring great value to the clinicians in monitoring their practice, reviewing quality measures, understanding opportunities for improvements, and supporting their research objectives.”1
References1. http://journals.lww.com/aswcjournal/Fulltext/2013/01000/Value_of_a_Specialty_Wound_Care_Electronic_Medical.12.aspx (accessed March 30, 2014). 2. http://healthcare-executive-insight.advanceweb.com/Features/Articles/Specialty-EMR-Implementation.aspx (accessed November 23, 2012). 3. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html (accessed March 31, 2014). 4. http://journals.lww.com/aswcjournal/Fulltext/2013/01000/Value_of_a_Specialty_Wound_Care_Electronic_Medical.12.aspx (accessed September 4, 2013). Cathy Thomas Hess is a TWC board member and vice president, chief clinical officer of Net Health, Pittsburgh, PA.