Clinical Documentation Improvement/RAC auditor
As part of the Clinical Documentation Improvement Program, a CDI specialist will review a patient’s medical records during his or her stay to look for opportunities to improve physician documentation specifically for multiple or complicating diagnoses. The CDI Specialist will communicate with patients’ physicians to assure all their conditions are accurately documented.
Additionally, the CDI Specialist will assist the hospital and outlying physician offices in the health system in managing the Medicare Audit Recovery Program (RAC, which will be mandated by the Centers for Medicare and Medicaid Services,) to ensure proper reimbursement for services.
Update September 09:
CDI specialist position has been posted and interviews are underway.
Updated January 10:
The posted CDI specialist position was filled by Pat Hurley from Frederick Memorial Healthcare System. In January, Aurora Healthcare was selected and implementation is currently in progress.
Update April 10:
Implementation was completed by the end of March, training for the software for the Coordinator occurs this month.
Inpatient Throughput
This initiative involves a redesign of the admission and discharge processes for inpatients to reduce delays for those patients in the emergency room or operating room who require hospitalization overnight or for a more extensive period of time.
Improved utilization of existing beds and process changes to decrease the timeframe for discharging inpatients who are ready to go home or to be transferred to a nursing home or rehabilitation center, will minimize the potential need for future expansion of the facility.
Update September 09:
A direct admissions process to bypass the Emergency Department has been developed with Dr. Gregory Stamnas and the hospitalist team. This will reduce some of the patients through the emergency department who need to be admitted for care and cut the hold time for those patients to be placed in a hospital room.
In late September, it was determined that holds in the emergency department – those who come in and are awaiting inpatient admission – were reduced by 55 percent from the previous year.
Update January, 10:
The team is now working on increasing the percentage of discharges before noon. In December 2009, a work group was established to look for other process improvements.
Update April 10:
Since June 2009, the team has reduced med/surg holds by 51% over last year and CCU holds have reduced by 19%. Overall discharge times from order written for discharge to actual discharge remain stable at 150 minutes. Quick orders continue to be used on approximately 80% of the patients, with most of the non-use occurring on nights, which is to be expected. There is a perception there is a greater delay on nights with admissions so the team has elected to collect some additional data. The percentage of patients being admitted within one hour is consistently over 95%. A new direct admit process is being trialed by the hospital. Time from arrival to floor to seen by hospitalist is being analyzed for team evaluation .
Kiosk/Phase I-Rite Aid
This year we will also develop an electronic system patients will use to check in at three Atlantic ImmediCare urgent care clinics that will be open year-round at Rite Aid sites in Pocomoke, Ocean Pines, and Millsboro, Delaware). Computer kiosks will be available in the Rite Aid waiting rooms for patients to enter patient demographic information, thus eliminating the paper forms and time taken to manually enter the data into the patients’ health records. This initiative includes evaluation of the use of kiosks in the family practices and specialty offices of Atlantic General Health System.
Update September 09:
A contract was signed with Medfusion to provide the computer kiosk hardware and software solutions. The installation plan is being developed.
Update January, 10:
Further discussion with vendor finds they are unable to provide all of the functions requested. Internal solutions are now being discussed.
Update April 10:
Internally developed model is underway, and is expected to be completed in June.
Laboratory Outreach-In-office draw station
Placement of phlebotomy services within selected high volume or secondary market offices throughout our service area to provide convenient patient access to AGH laboratory service without requiring the patient to travel to the hospital for these services. Services would be provided 5 days per week in each office. This plan should allow us to recapture revenue currently being lost to private laboratories that have service centers placed throughout our service area.
Update September 09:
Five Atlantic General Health System healthcare provider offices have been identified to provide blood draw services. A training schedule has been implemented for the medical office staff. Snow Hill Family Medicine will be the first office to provide laboratory services to its patients.
Update January, 10:
Snow Hill Family Medicine, Tenth Street Medical Center, Pocomoke Medical Center and Atlantic Health Center have implemented in-office lab draws. Ocean Pines Primary Care and Ocean View are preparing to perform in-office lab draws in February.
Update April 10:
Current sites where laboratory drawing is live: Snow Hill, Pocomoke, Ocean Pines, Townsend Medical Center, AHC, Ocean View DE. The Selbyville office is to go-live upon startup. Dr. Conran moves to Berlin Primary Care and Dr. Gillespie takes his full-time position within the Hospitalist Program.
Non-Atlantic General Health System Physician EMR Rollout
During the last fiscal year, Atlantic General installed an electronic medical record in its system of healthcare provider offices – more than family physicians, internists, gynecologists, pulmonologists, a pediatrician and a neurologist now participate in the computerized system. This year, Atlantic General will roll out the EMR to four independent physician practices, giving them immediate access to the electronic prescribing functionality as well as critical allergy and drug interaction information. Including additional providers will result in a more clinically complete and accurate patient record, which in turn is available to all healthcare providers as needed.
Update September 09:
Atlantic General Hospital has carefully reviewed existing Stark laws and is finalizing the contractual agreements to enable AGH to provide EMR systems to several independent physicians.
Updated January, 10:
Contracts have been submitted and letters have been sent to all the physicians requesting connectivity that is being presented in our “E” strategy to the Board of Directors on February 5th and 6th and if board approved, their request letters will be used to appropriate funding for their requests during the FY2011 budget process.
Update April 10:
Atlantic General Hospital continues to work with community physicians and the Board to develop a longer term plan for the hospital to support expanded adoption of EMR technology among the community physicians and the development of a shared patient-centric Health Information Exchange (HIE).
Skin Perfusion Pressure System
Sensilase, a limb circulatory assessment system (Sensilase)that measures something called skin perfusion pressure, allows physicians the ability to determine the amount of blood flow to a wound. This system will be implemented in the Wound Care Center and is useful in managing chronic wounds where flow in the extremities may be compromised. The plan will result in:
Update September 09:
System was implemented in late July 2009
Supply Chain electronic dashboard tool
Through this initiative, Atlantic General Hospital will purchase a software product to electronically monitor and benchmark our hospital supply costs against like hospitals in order to create: (1) significant cost savings, (2) better ongoing monitoring of supply usage and costs, and (3) shared learning and coordination across departments. This initiative will enable Atlantic General Hospital and Health System to manage supplies more efficiently, thereby maintaining our mission of fiscal responsibility to the community.
Update September 09:
Premier (MySpend) has been selected as the dashboard vendor.
Updated January 10:
Contract has been approved and signed with Premier (MySpend), AGH awaiting implementation plan from vendor. Initial data has been submitted to and accepted by Premier. Currently, scheduling training for the later part of February 2010.
Update April 10:
Training has been completed.
Wide Area High Speed Fiber Connectivity
The current design of the Atlantic General Hospital and Health System (AGH/HS) wide area network has been traditionally based on the inexpensive general commercial availability of DSL and cable modems. Another of this year’s initiatives is to install high speed fiber connectivity between the hospital and its outlying offices. Uninterrupted connectivity service within the ambulatory setting will remove several barriers to the complete ambulatory EMR, which in turn will benefit the patient during provider visits at any AGHS office, as well as, during emergency room or inpatient visits. Other strategic initiatives will require network performance that can only be delivered via fiber connectivity.
Update September 09:
The hospital is seeking funding through the Maryland Broadband Cooperative’s application for federal dollars. The grant application has been forwarded on to the federal government by the state of Maryland.
Update January 10:
Backup internet services for all offices have been approved as well as having a secondary line for the hospital. AGH is still waiting to hear on the grant application. Targeting mid to late February for secondary line to be operational.
Update April 10:
Submitted for a grant and will be considered in future planning
