The mandate from the federal government regarding patient safety and quality assurance is quite clear: Capture, analyze, and report data in a “meaningful way.” This is accomplished through the use of a certified electronic health record (EHR), the Meaningful Use EHR Incentive Program, and strategic facility planning for ICD-10-CM. By capturing data in discrete, reportable fields, the options for report generation are nearly limitless. But how is data best compiled in a meticulous fashion as it relates to wound care? The answer lies in how one optimizes available technology and the creativity established in one’s data mining.
Blended Timelines: Meaningful Use & ICD-10-CM
The coming year will be a memorable one in healthcare as we implement Stage II of Meaningful Use and transition to ICD-10-CM. The path to Meaningful Use focuses on technology while ICD-10-CM focuses on billing with a clear intersection focusing on clinical documentation. 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 EHR 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.1 3. Meaningful Data Reports – develop core reports to manage wound care practice; generate quality reports and utilize the data to improve patient and facility outcomes; provide Meaningful Use reports for provider attestation. Achieve Meaningful Use Transitioning to a certified EHR is vital to meet Meaningful Use criteria set forth by the Centers for Medicare and Medicaid Services (CMS) in order to:2 • improve quality, safety, and efficiency, and reduce health disparities; • engage patients and family; • improve care coordination, population, and public health; and • maintain privacy and security of patient health information. The objectives of Meaningful Use over five years include:1 • Stage I - focus on data capture and sharing (2011-12) • Stage II - focus on advanced clinical processes (2014) • Stage III - focus on improved outcomes (2016).
Implement and Monitor ICD-10-CM
Next, let’s take a look at the mandate for the ICD-10-CM coding system, for which conversion in the US must be met by Oct. 1, 2014. According to CMS,3 the newly redefined classification system will provide much better data needed to: • measure the quality, safety, and efficacy of care; • reduce the need for attachments to explain the patient’s condition; • design payment systems and process claims for reimbursement; • conduct research, epidemiological studies, and clinical trials; • set health policy; • support operational and strategic planning; • design healthcare delivery systems; • monitor resource utilization; • improve clinical, financial, and administrative performance; • prevent and detect healthcare fraud and abuse; and • track public health and risks. Whether meeting the regulations for Meaningful Use and/or implementing changes for ICD-10-CM, remember that a successful transition and implementation requires a well-planned and well-managed process. At the heart of each process is the data.
Discrete Vs. Non-discrete Data
A patient’s episode of care is captured in a number ways: handwritten notes on paper (filed in a standalone chart), voice recognition software text reports (often standalone text in an “open notes field”), static documents scanned into an electronic filing system (ie, interfaced records, patient’s history), and/or within an EHR. Non-discrete or unstructured data can not be electronically processed nor used for clinical decision support, outcomes or benchmarking reports, or analysis to improve quality of care. Forgoing accurate data in functional and manageable formats will not allow meaningful data to be captured. Capturing discrete or structured data provides the information necessary to meet Meaningful Use and ensure the integrity of healthcare data, decision making, and quality patient care (see Figure 1). A compliant specialty wound care EHR that’s standardized to capture the work and assessment data using discrete data fields is critical to comply with regulations and reportable data. Integrating evidence-based guidelines and templates, standardized dropdown lists, and searchable tables can assure quality data is captured and reported to support a meaningful platform. And, to make the clinical data meaningful and rich with information, data must be captured in a codified way.
Managing Process With Meaningful Data
Imagine if all wound care facilities – from the single-physician practice to health organizations – documented by using a certified specialty wound care EHR to capture their work. The output would be powerful. The influence behind the data collected and analyzed could: • provide a clear roadmap for managing disease states; • improve healthcare delivery; • streamline documentation workflows to increase efficiencies; • enable compliance to enhance quality and patient safety; and • provide valuable (consistent) information to CMS for payment related to wound care services, products, supplies, and procedures. To efficiently manage a wound care practice, consider implementing these methodologies: 1. Optimal workflows: It is important to review current processes, documentation components, and data flows as well as identify gaps in best practices and guiding recommendations for improvement in the clinical and operational workflow. This critical process will maximize clinical and operational efficiencies, enhance clinical quality and patient safety, and streamline current workflow to improve care coordination. Ensure the wound care practice’s workflow is up-to-date and customization of the specialty wound care EHR is accurate. Moreover, business management will now be attainable through correct documentation (data) and reporting. 2. Capture accurate documentation: It is prudent for clinicians to document clinical and financial outcome data in a specialty wound care EHR. The data collected can be used to advance critical pathways, improve product formularies, validate contract fees with payers, improve patient and physician satisfaction, and comply with the federal mandates. 3. Robust data reporting: Utilizing a reporting module tied to a specialty wound care EHR is key. The data collected allows for observational trends across wound and patient types as well as clinical practices and operations. The data also allows for a comparison of clinical, operational, and financial outcomes through EHR storage. To effectively interpret the report, it is important to understand the report requirements as well as the data inclusion and exclusion requirements. A complete understanding of the data report will guide one’s business efficiently and effectively. For clarification, we’ll review three sample reports focused on an outpatient wound care department and discuss how each can assist practice management.
Wound Healing Percentage Report
- Report description: Illustrates healing percentages over a given timeframe and provides a more accurate picture of healing success (see Figure 2). This report compares the number of wounds healed to the number of wounds closed and demonstrates how effectively the patient’s wounds are managed. - Report Snapshot: In looking at this sample report, all wounds within the specified date range had a positive outcome related to clinical management practices with the exception of surgical wounds. Surgical wounds had an 83% wound healing outcome. At this point, it is prudent to conduct further research to determine why 17% of wounds did not experience a successful outcome. - Query the data by reflecting on clinical practices: Was there a delay in seeking treatment or were patients’ comorbidities impeding the wound healing outcome? Or, were less-than-optimal wound management pathways implemented? Answering these questions helps improve one’s comprehensive outcomes. - Importance of data: This report can serve as a report card, allowing clinicians to compare their healing rates to the overall healing rates of the department. Also, reflecting on this report can assist in improving performance-improvement plans.
Volume Reduction Report
- Report description: Illustrates, over a given timeframe, display of (see Figure 3): 1. wounds having successfully met desired goals; and 2. wounds that didn’t meet minimum healing percentage “outliers.” - Report Snapshot: The goal of this report is to identify patients who are missing healing milestones. In looking at this sample report, only 45% of vasculitic ulcers met the healing goal during the reported timeframe. - Query data by reflecting on clinical practices: Are the current wound management pathways clinically effective? Is the clinical team following the appropriate pathways in place? Answers to these questions should allow for early interventions and a return to healing trajectory. - Importance of data: From a clinical and operational perspective, this report is a vital tool to a department’s quality assurance and performance-improvement plans.
- Report description: Illustrates the vital wound statistics of specifically targeting admission and visit-volume trends as well as critical patient discharge trends over a specified timeframe (see Figure 4). - Report Snapshot: In looking at this sample report, if new patient admissions are proportionally smaller than the total number of previously admitted patients, this may indicate a referral pattern trending downward. - Query the data by reflecting on clinical practices: Report results may prompt a review of marketing strategy and discussion of ways to increase referrals. This report sample also demonstrates increased number of wound visits with a decrease in hyperbaric oxygen therapy (HBOT) treatments. At this juncture, consider running additional clinical data reports to determine the cause of HBOT decline. - Importance of data: Use this data report to determine whether a wound care department is growing or stagnating and establish department goals accordingly.
Comparative Data Using Reports
Reports can also be cross-referenced to maximize the significance of data collected and improve overall facility trends (see Figures 3 and 4). For example, reviewing the volume reduction report in combination with the facility statistics report would demonstrate the outlier percentages are inversely proportional to the average visits per discharged patients. The outcome of this data demonstrates that patient wounds are not meeting healing goals and are likely to result in lengthier admission periods or increased visits.
Many regulations and accrediting bodies direct the way data is structured, collected, and collated. The value of quality, discrete data will evolve as Meaningful Use and other reporting measures are implemented. Understanding how to manage one’s work to produce accurate data is key. Cathy Thomas Hess is vice president and chief clinical officer at Net Health. She may be reached at firstname.lastname@example.org.
1. Hess, C. Value of a specialty wound care electronic medical record. Advances in Skin & Wound Care. 2013;26(1):48. 2. Meaningful use definitions & objectives. Accessed online at www.healthit.gov/providers-professionals/meaningful-use-definition-objectives. 3. ICD-10-CM/PCS the next generation of coding. Accessed online at www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf.