Structured Reporting: Boosting Patient Care, Refining Billing

Akron General Heart & Vascular Center is a leader in STEMI care in Northeast Ohio, each year besting the national average for STEMI mortality rates. At the core of swift decision-making is a well-experienced team and immediate access to patient information. State-of-the-art structured reporting and coding is an enabler, bringing together patient data, anatomical diagrams and coding and quality improvement essentials for physicians, as well as administrators looking after the center’s economic health.

Akron General Heart & Vascular Center is part of Akron General Health System, a not-for-profit healthcare organization based in Akron and founded in 1914. The health system includes Akron General Medical Center, a 532-bed teaching and research medical center, Edwin Shaw Rehabilitation Institute, Akron General Partners, the Akron General Health & Wellness Centers, Lodi Community Hospital, Community Health Centers and visiting nurse services. Together, they strive to offer the best in progressive community care.

About five years ago, the cath lab team knew it was time to get out of the world of paper, paying by the line for dictation, using templates that weren’t user friendly, and manual signing and faxing of report. Their focus was on structured reporting and coding. “We needed a system that would work for interventional cardiologists who want an easy to use system and for administration to recognize efficiencies in time and money,” recalls S. Leslie Tobias, MD, medical director of the heart catheterization labs at the Akron General Heart & Vascular Center.

Other priorities included finding a vendor partner that offered “no nonsense software and administration,” according to Tobias, the physician champion for the project, and a vendor both fluent and experienced in every aspect from planning to implementation, training and support. The Akron General team also needed confidence that the product they purchased would be intuitive, continue to expand in its capabilities and evolve over time.

Step one was a survey of the health system’s immediate and longer term needs for cath lab reporting from the clinical perspective of physicians and administrative perspective of hospital leadership. A team of physicians, nurses, cardiology administrators, IT leadership and technologists offered their opinions and looked at the technology available as well as vendor integration skills and longer term vision and plans. Akron General team members focused on uniting physician reporting, diagraming and coding, and ensuring the new solution would work well with their hospital information system, hemodynamic monitoring, echocardiography systems, and hybrid EMR system, recalls Systems Specialist Tamara May, RT (R) (CV), MCSA. May was part of the initial team and today manages and monitors servers and software, serves as the center’s liaison to the IT department, and is the coding and billing liaison to financial services for the H/V Center.

“The physicians went to administration and said ‘we need this,” May says. “That is unusual. This request was taken very seriously by administration who assessed the expenses, looked at the ROI, and studied the integration and infrastructure. ProVation MD was the only choice.”

ProVation MD is a structured reporting and coding solution that provides clinically relevant, intuitive software that can ensure hyper-accurate documentation. The system includes a medical content database, updated biannually, that offers comprehensive peripheral vascular and coronary content. “The algorithms to create a good report are excellent,” Tobias notes.

The patented DocuDiagram feature makes coronary tree documentation more efficient by allowing physicians to modify unusual anatomy, quickly document findings and interventions and navigate easily through complex cases. While the cardiologist is filling in the DocuDiagram, the medical content database is completing the procedure note in the background. The coding engine then applies the appropriate reimbursement codes based on what is documented. Reimbursement codes are updated quarterly and ICD-10 ready. 

“The reports read in the same language the physician speaks,” May notes. “It is clear that ProVation works hand in hand with physicians to make the reports as accurate and realistic as possible, and this in turn helps us provide efficient and effective patient care. We were excited to be buying a reporting system that is capable of coding the note based on the actual documentation.”

Installation of the system took about six months, with careful coordination among vendor and in-house project managers. Then it was time for training for physician and administrative champions and super-users who included nurses and technologists. The vendor offered on-site support every day for two weeks after go-live, explains Director of Invasive Services Bobbie Gross, RN, MSN.

Prior to the system going live, physicians took part in an hour of mandatory training, then they trained side by side with super-users guiding them through real reports as soon as they left the cath lab. “We felt training with real cases would allow physicians to learn more quickly than test cases. And it really did,” May says.

Reports initially took about 10 minutes to complete but with just a few days of training, reporting time was trimmed to about 5 to 6 minutes, and sometimes even 2 to 3 minutes. Simple drop-down menus guide physicians through more typical or diagnostic cases as well as securing key information for proper coding and billing.

Once the physician electronically signs off, the system sends the report to the clinicians who need it, the cardiologist’s office for billing purposes, to the physician portal and hybrid EMR. Left behind with dictation are the three-day waits for reports and added costs and inefficiencies of staff time to manually get reports to the correct physicians.

To be sure physicians were committed, Tobias gave them one month from go-live to get on-board. Dictation ended a month later—as did the associated cost. “We took a take-no-prisoners attitude. Physicians had to use it,” he says. “And we truly had no issues whatsoever. About 70 percent [of physicians] thought it was great right away. And the rest bought in pretty quickly. Within 6 months, we had no issues whatsoever.” 

The team at Akron General continues to praise structured reporting and coding five years running. “It continues to meet our needs,” Tobias says. “They are constantly upgrading software in terms of power and performance. It is phenomenal.”

Billing has benefitted as well. “When a physician signs off, we have confidence the billing is correct,” Gross adds. “It is far more efficient because the system provides documentation related to the specifics of the devices used during the procedure. We know our billing is correct. Back in the days of paper reporting, we potentially lost revenue due to a lack of accuracy in documentation.”

The vendor also has helped with the integration with their hybrid EMR. Future growth includes planned expansion into non-invasive cardiology and electrophysiology. When three major cardiology departments can ultimately utilize the same reporting and coding system, the continuity is very beneficial to our patients and organization May says.

“The continuity of care is where this system makes such a difference, for the physicians in the cath lab and physicians treating patients on the floor,” says Cath Lab Coordinator Cyndie Lowry, RN, MBA. “Once the patient leaves the cath lab, the report is placed on the chart. This allows physicians and staff to know exactly what occurred in the cath lab and what the plan of care is moving forward.”

Structured reporting also boosts an essential element to clinical care: accuracy. “We as physicians can have more confidence our reports are exactly as we want them and need them to be. They are completed immediately when our minds are fresh on the details of the procedure, anatomy and stents used. It is the only way to report.”