salientvalue white paper, march2015
TRANSCRIPT
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Optimizing the EHR through Real-‐time Analysis of the Physician-‐Patient Interaction
one Introduction two Real-‐time Value Proposition three Physician Workflow Optimization four Point-‐of-‐care Alerts & CME five Revenue Enhancement six Salient Summary
Introduction
The healthcare industry is juggling far too many changes when it comes to the shift from paper to
digital health records mixed with a myriad of regulatory changes -‐-‐ all of which is putting serious
strain on physicians’ productivity. With numerous changes taking place in healthcare today, it’s
critical that physicians have tools and services that let them focus on the patient, not the
technology. The Electronic Health Record (EHR) is a critical enabler in helping providers drive
productivity in the new digital era of healthcare and maintain focus on what matters most:
patient care.
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Real-‐time Value Proposition
In collaboration with leading EHR vendors,
Hiteks’ Salient Scribe service is designed to
enable physicians using an EHR system to
optimize their productivity and
documentation quality, all while they are in
their native EHR. This helps physicians
spend more time with patients, accelerates
physician adoption of EHRs and facilitates
more complete documentation, which is the
foundation for high-‐quality patient care and
appropriate reimbursement. The EHR by
itself provides the workflow framework and
the clinical database repository for a health
system, but requires a sophisticated
technology for reconciliation that is not built
into the EHR to maintain an up-‐to-‐date and
accurate patient record.
This EHR integration makes clinical
documentation easier for physicians, while
simultaneously creating higher quality and
more structured data, which are essential for
managing healthcare today. This structured
data is the building block of decision support
rules but is very cumbersome for the
physician user. When tasked with the need
to enter data into structured fields with
dropdown lists, the typical physician
comment is “I’m trying to see how this could
help me as a doctor because I’m not seeing it
now.” When shown how our technology
automatically populates structured fields
from the free text notes, physicians
immediately understand the potential value
for decision support, quality of care
improvement, appropriate reimbursement,
research and education.
Patient / Doctor VisitNatural Language Documentationtakes place Salient Scribe
Salient extracts relevant facts and populates the EHR
Structured EHR
Problems
Rx
AllergiesClinical Note
1 2 3 4
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Physician Workflow Optimization
Physicians play an integral role in patient
care but face increasing demands on their
time that competes for time with the patient.
Among these demands are increased
computer data entry time, expanding
requests from the billing/HIM department
for better documentation and ongoing
continued medical education requirements
of very complex scientific data. Any
efficiency in their workflow results in
improved patient satisfaction and financial
savings to the institution from increased
productivity.
Eliminating Double-‐Entry: One of the
government's and other payors'
requirements is to report Meaningful Use
fields, namely Problems, Medications and
Allergies, which are important to ensuring
appropriate use of information systems to
achieve quality patient care. The practical
implementation of Meaningful Use is that
reconciliation is required to ensure data
between structured lists in the chart is
consistent with the data in unstructured
notes. Studies using thousands of patient
records analyzed with Salient Scribe, Hiteks'
NLP and reconciliation platform integrated
with the EHR, achieved 50% reduction of
computer time for physicians in an average
length 15-‐minute patient visit based on
clinical experience with a test set of records.
The absolute reduction in documentation
time was from 8 minutes to 4 minutes after
the 15-‐minute interview.
Cost Saving: Calculated in “physician hours”
of time, the Cardiology, Family Practice,
Pediatrics and Pulmonology specialists who
participated in the study and used Salient
Scribe saved an average of 2 hours more
time per day (10 hours per week) compared
with another cohort of the same specialists
not using the solution. Based on a 50-‐hour
workweek at an average annual salary of
$135,000 per physician, the monetary
equivalent in savings for a health system
equals $27,000 per physician employee.
These savings can be utilized for improved
productivity, higher reimbursement and
enhanced patient satisfaction scores.
Continued Medical EducationC.M.E.
Patient Care
PracticeAdministration
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Responding to ReimbursementCoding and Quality Queries
Relative Time Spent in Various Areas of Physician Workflow
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Real-‐time Documentation Alerts
Alerts and other prompts for appropriate
documentation of the clinical visit at the
point-‐of-‐care can reduce physician post-‐visit
consultation time. In a test cohort examining
the time spent responding to HIM
Department queries to a physician’s inbox or
task-‐list, the length of time required for a
physician to respond was reduced by 90%,
from an average of 24 hours prior to Salient
alerts to 2.4 hours annually. The monetized
value of the time saved per physician is
approximately $6,000 per year. This savings
does not include the impact on the higher
reimbursement from a shorter coding cycle
turnaround time.
Our study also analyzed the ICD10 impact on
physician time spent answering HIM queries.
We anticipate that ICD10 once it goes into
production as a reporting requirement, will
increase the amount of queries from what is
currently 20% of patient charts having at
least 1 query to over 60%. This tripling of
queries means that a more efficient
workflow-‐based solution will be needed to
answer queries more efficiently and also
reduce queries by bringing real-‐time
guidance to the physician for appropriate
medical necessity documentation to reduce
the total query burden.
Point-‐of-‐care CME
Another important area of a physician’s time
is CME. Because of our ability to analyze the
patient record in real-‐time, Salient Scribe
offers point-‐of-‐care educational content (i.e.
literature searches, CME, research
opportunities) keyed to patient problems
and available with a single click through
their EHR. Accredited CME through local or
through 3rd party agents provides each link
as a 15 minute (.25 CME) credit. Since most
states require 15-‐30 hours of CME per year,
savings in physician hours per year amount
to 25 hours of total savings (approximately
$6000 per year).
Constant checking required to improve safety and outcomes
Physician challenges at the point of documentation
Double data entry required using multiple screens
Prior authorization & medical necessity queries need
additional data
Clinical Users
Salient Scribein the client EHR
Context-Sensitive CME modules available through synchronous EHR prompts and message links
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Revenue Enhancement
The EHR works closely with Revenue Cycle
management (RCM) systems which rely on
the documentation within the EHR to justify
claims codes produced and sent to payers.
The seamless integration of a Real-‐time NLP
and Analytics layer (i.e. via Salient)
optimizes the EHR’s ability to document
appropriate terms and facilitates easier
communication between the RCM and the
EHR interface due to the linking of queries
directly to the documentation, in real-‐time.
Time savings for physicians is an important
source of monetary savings (approximately
$40 thousand per physician annually, as
described previously in this document) for
the health system which, since physician cost
as an employee is largely a fixed expense, can
be directed to other purposes such as
improved patient safety, satisfaction and
retention.
Direct return-‐on-‐investment in revenues have also been measured at a large health system using
Salient Scribe and Alerts. The 4 areas for improved revenues are as follows:
Financial Area Measured Description of the Revenues Revenue Amounts Physician Services Claims Capture
10% reduction in claims rejection, where average annual claims value per physician is $450,000
$45,000 per physician per year
Meaningful Use Compliance Automatic fulfillment of MU requirement for maintenance of Problem List, Medication and Allergies prevents penalty of 6% in Medicare reimbursement (annual Medicare reimbursement of $100,000 per physician)
$6,000 per physician per year
Medicare Case Risk Scoring More accurate data for risk score results in higher Medicare payment of 5% maximum per physician
$5000 per physician per year
Institutional Claims Capture Institutional claims capture of 10% improvement with an average institutional inpatient charge of $250,000
$25,000 per inpatient stay
Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 212-‐920-‐0929 | www.hiteks.com
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Salient Summary
In summary, Hiteks enables physicians to
seamlessly document the complete patient
story in their own language and workflow
while simultaneously extracting the key
clinical data required to meet broader
regulatory mandates such as Meaningful Use,
Medication Reconciliation, HEDIS, HCC, etc.
To help health systems streamline
structured data capture from the physician
narrative, Salient integration with the EHR
automatically extracts the important clinical
terms and reconciles them with the
structured fields, which are often found in
separate lists or tabs.
Salient draws attention to areas that are the same or different between the new Note and Active
Lists in the EHR. Clinical facts are extracted, that information is run through a knowledge base
and language models, and the details are presented to physicians for review and acceptance with
prompts for any additional clarification. As a result, the physician is able to save time in the
extraction of the data and keeping discrete data consistent with their Note. Finally, Salient works
with the EHR to safeguard clinical data integrity, which positively impacts the subsequent coding,
quality reporting processes (e.g. Patient Safety Indicators) and education through valuable alerts
and prompts obtained through Hiteks’ experience tying HIM coding and Quality rules to Notes.