Note consolidation also saves Augusta University Health each month on discharge summary transcription costs
A project to combine multiple discharge notes into one comprehensive discharge note helped Augusta University Health providers save hundreds of hours and thousands of dollars each month. At the same time, Augusta University Health reduced the number of delinquent charts and enhanced document layout.
Clinicians at the Cerner ITWorks℠ client in Augusta, Georgia, say reducing the number of notes also made the process easier to understand.
“Not having to do three notes, but one note, is phenomenal,” said David Fallaw, MD, chief medical information officer. “What’s great is we’ve been able to decrease the amount of time it takes for discharge summaries to be completed.”
Previously, Augusta University Health required up to three notes for each patient at discharge — a daily progress note, an inpatient discharge summary and a discharge progress note (if the discharge summary was transcribed).
The health system worked with Cerner’s Continuous Advancement and Cerner ITWorks teams (the Jaguar Collaborative) to figure out how to streamline discharge documentation. In addition, the project closely followed Cerner’s Model Experience, a strategy plan to help clients reach their best outcomes.
Augusta University Health switched from PowerNote® to Dynamic Documentation™ and unveiled the optimized discharge note in March 2017. Providers were encouraged to move to the electronic discharge process, however the organization continued to offer transcription.
Combining the notes saved providers a lot of time.
From December 2016 to February 2017, providers performing the discharge documentation process required nearly 13 minutes of documentation time per patient. After implementation, from June through August 2017, that time dropped to an average of a little more than nine minutes per patient. During those three months, the change saved physicians a total of 651 hours.
Before the consolidation, Augusta University Health would have spent an estimated $233,800 on discharge summary transcriptions over the course of a year. Now that Augusta University Health has a streamlined process, it estimates yearly discharge summary transcription costs at only $57,450. That is a yearly savings of more than $176,000.
Reducing the number of transcribed notes didn’t just help with cost. It also freed staff from monitoring note delinquencies which allowed the same staff to review quality of documentation.
“Now the same staff is checking all records for discharge summaries whether dictated or created via Cerner,” said Cinnamon Hood, health information management services assistant director. “They’re performing quality checks and follow up functions.”
Augusta University Health also realized process efficiencies through its discharge note optimization project. When a patient chart has an unauthenticated note the organization cannot apply a claim. From December 2016 through February 2017, the average lag time for a note to be completely authenticated was 385 hours. From June to August 2017, this same authentication lag time took only 108 hours — a drop of more than 71 percent.
The improved authentication process also helped reduce delinquent charts. A delinquent chart is a patient encounter that has not had a note signed which means a claim can’t be applied.
Working with Cerner, Augusta University Health lowered the number of delinquent charts. Reducing the number of chart delinquencies “expedites the hospital in being able to submit charges,” Fallaw said. Submitting claims quickly means Augusta University Health can also see reimbursements quicker.
From February to June 2017, chart delinquencies greater than 30 days fell 54 percent, and chart delinquencies less than 30 days fell 76 percent.
The optimized discharge note has a revamped look that allows clinicians to quickly consume important information.
“I can quickly assess why the patient came, what happened to them during the hospitalization, what they were diagnosed with, and then the discharge medications and the plan of action upon discharge,” Fallaw said.
The new discharge note included a revamped two-column format, which even caught the eye of providers from other health systems.
“We had comments from referring physicians in our community who thought we were completely revamping our electronic health record because the notes looked so much better,” Fallaw said.
Augusta University Health staff members are also working with the Continuous Advancement and Cerner ITWorks teams on new phases of optimization including physician specialties and also an ongoing managed service that leverages analytics to more effectively solve problems.
Footnote: Augusta University leveraged Cerner’s Model Experience, to assist in this project. In addition, all clients can utilize Cerner’s Light’s On Network to track information about documentation time per patient.