All Children’s Hospital

Overview:

All Children's Hospital (ACH) in Tampa Bay, FL was seeking to improve its charge capture process. Their 50 physicians who do inpatient rounding were using a paper-based system for hospital charge capture. This created redundancies in data entry, potentially missing charges through misplaced paperwork, and concerns about capturing diagnosis information specific enough for ICD-10 adoption.  

Their Chief Information Officer, Cal Popovich, realized that their paper system was too cumbersome and too difficult to streamline. The physicians wrote charges on paper, their medical assistant typed this information into a spreadsheet, and then their billing staff retyped the information into their billing software, Epic Resolute.  

A potential workaround for these problems would have been to ask the physicians to enter their charges directly into Epic. However, this method would have come with its own set of challenges. Doctors would have to wait until they reached a computer to enter their charges, at which time they would need to remember what they did earlier that day and risk forgetting something; or they would continue to maintain notes on paper as they rounded, then reenter the information into Epic later. This would have reintroduced all the limitations of paper, while creating additional work for the physicians as well.  

Realizing these pitfalls early on, ACH decided that it needed an automated solution which maintained the mobility and ease of paper while moving to electronic charge capture. A mobile, electronic system with robust interfaces would eliminate paper and allow the physicians to capture and submit their charges easily and efficiently at the point of patient care. Looking for a solution like this, Cal turned to pMD.  

The Existing Paper Process

ACH selected the Infectious Disease (ID) group to run the pMD pilot. This group, consisting of four doctors and a medical assistant, was on a paper system. Physicians printed daily rounding lists and wrote notes down as they saw patients. The doctors were very good about capturing charges at the point of patient care to minimize data loss. After the doctors completed their rounds, they delivered their lists to Bridget, who manually entered the information into a shared spreadsheet. Once a week, the billing department took each entry in the spreadsheet and manually keyed the information into Epic.  

When new consults came in, an order was placed in Cerner (the hospital information system). Cerner was considered the source of truth for the group's rounding list. Doctors were then notified by phone, pager, or were sometimes grabbed in the hallway. Printed patient lists were accurate at the time of printing and allowed for quick and easy note taking for charge capture. This process was streamlined as much as possible to minimize the physicians' time spent on billing.  

In addition to charge capture, the Infectious Disease group employed a simple system for patient handoffs using the tools they previously had at their disposal. Because written patient handoff is a proven solution to improving patient care and safety, the doctor on call would type up an email to the rest of the group and the others would print them out to cross reference with the patient charts.  

Challenges

This existing process had some side effects and was open to error at multiple points in the process. Information on the printed lists typically would get stale as the day went on. New consults would not be reflected on the list unless the doctor wrote them in.  

Physical paper is not secure and is prone to getting lost or misplaced, with the highest risk involving submitting the completed sheets to the medical assistant. The doctors would sometimes leave the paper on her desk with no confirmation of receipt, so a page could get misplaced without anyone realizing it. Other methods of submission included holding onto the billing sheets and handing them to the medical assistant whenever they saw her. Sometimes the assistant would have to chase them down instead. Keeping track of these paper lists and notes was extra work for the physicians, and the submission step added an unnecessary delay in the billing process.  

Finally, everyone downstream in the billing process was burdened with the handwritten information that had to be interpreted, jeopardizing the accuracy of the billing.  

Meanwhile, the group’s email system for patient handoff was working for the physicians, but it had its own set of hindrances. Printed emails were yet another physical resource for the doctors to manage. Furthermore, one email would contain notes for multiple patients, forcing doctors to search through the entire message just to find those that pertained to their patient at hand. And when writing the next email, they would have to type in the name and room number of each new patient, since the email was outside of their rounding list in Cerner.  

The New Hospital Charge Capture Process with pMD

Since the Cerner list was the most reliable patient list for the group, pMD decided to match its mobile census to Cerner's as accurately as possible in real time. Working closely with ACH's IT department, pMD received a patient feed driven by demographics and consult orders. This interface adds every new patient automatically to the group's rounding list in pMD, showing the reason why each consult was requested and providing realtime room number updates.  

The ID doctors now have a mobile electronic system that is always up to date and allows them to capture charges immediately at the point of patient care. The doctors simply fill out short electronic forms on their mobile devices and send them quickly and securely to the medical assistant.  

To eliminate the need for manual charge keying by the billing department, pMD then sends the physicians' charges to Epic Resolute electronically via another interface. Since everything is electronic, the physicians' medical assistant no longer needs to decipher handwriting or look up diagnosis codes. Now instead of retyping all the billing information into a spreadsheet, she sends the day's charges into Epic with a single click.  

Since the doctors were already used to writing emails, it was a simple transition to typing notes into pMD. These attach to existing patients on the rounding list and are immediately and automatically shared with the entire group. This streamlined the group’s handoff process and added an extra layer of security and compliance.  

Results

The ID doctors at ACH now have an accurate realtime census paired with the consolidation of patient information, historical charges, and handoff notes in one secure place. "I really like having immediate access to my patient list on my phone rather than fumbling with papers or logging onto a computer," said Dr. Dumois.  

pMD has been recognized by the physicians to be quick and easy to use, and there has been 100% immediate adoption in this group. They have gone from an entirely handwritten process to an electronic system. Dr. Jankelevich admits, "I think pMD is a great program! It's very user friendly and simple to use. I like how it has a logical workflow, and it lets me do my work fast."  

In addition to instantaneous charge submission, there are fewer concerns about misplaced charges. Dr. Dumois agrees, "pMD is very convenient! I sometimes would take my billing home to work on and forget to bring them in the next day, which delays submission. With pMD, I don't have to worry about that anymore. My billing goes out faster with a much greater likelihood of not misplacing charges."  

The doctors easily transitioned to pMD as a patient handoff tool and were delighted with the results. Dr. Jankelevich tells us, "In addition to charge capture, we use pMD for our written sign out and to share comments on patients. This is a very helpful feature." Dr. Dumois also says, "Using pMD for our checkout system has been working very well for us."  

Adoption in this group has been so successful that they have one of the most impressive charge entry lag numbers of any physicians who do inpatient rounds in the US. Their hospital charges are now captured in pMD an average of 3.8 hours from the date of service. Others in the billing process are now more efficient as well because manual reentry of information has been eliminated by removing paper. "Our previous billing system used to take me hours to complete and often take up entire mornings. With pMD, now it just takes 5 minutes with a few clicks and I have more time to work on other things. pMD has made my life much easier!" says the medical assistant.  

The right hospital charge capture solution keeps the good aspects of paper: mobility, ease of use, speed, and offline functionality. It adds accuracy, instantaneous transfer of information, and ICD-10 adoption readiness; and it removes redundancy, risk, and delays.  

For additional information, contact the pMD team.