Maximizing the Benefits of an EHR: Quality Management and Compliance
by Susan Dess, 6.12.16
If properly designed, implemented, and used, your EHR can be much more than a tool for collecting and storing health records for the individuals served by your organization.
Here Crestline Advisors describes some of the critical ways in which an EHR can support your organization’s Quality Management and Compliance programs.
Your EHR and Quality Management (QM)
The healthcare industry is shifting from a focus on payment for procedures and services (fee-for-service) to value-based payment. A common approach, pay-for-performance, includes outcomes driven contracting models. As a result, an organization’s EHR system should be designed to capture quality outcomes measures as required by payers.
Metrics such as referral to service timeframes, coordination of care events, inpatient days and readmissions, maintenance of employment, and symptom reduction (to name just a few) can be tracked in a well-designed electronic health record.
In addition to the inclusion of relevant fields to collect this data, the EMR platform can support the creation of reports to be used in the analysis of performance outcomes. Additionally, an EHR system can be designed with unique forms to capture complaints and critical incident events, as well as their resolution outcomes. Use of this data can result in the development of improved processes and clinical outcomes, and a reduction of future risk to the organization.
Your EHR and Compliance
When implemented correctly, an EHR can significantly improve provider compliance with contractual, regulatory and billing requirements. CMS has recently released a series of guidance documents related to EHR and program integrity. Using an EHR to reduce, rather than increase, risk requires a three-pronged approach addressing: system functionality, user guidance, and a monitoring and auditing program.
System Functionality encompasses a variety of internal control and security measures. Example controls include user access, author verification, use templates, and macros to auto-populate data. System functionality must also address use copy and paste notes, risk of upcoding and false documentation, and access security controls.
User/Staff Guidance, such as standards of conduct, policies and procedures, and training, are critical to appropriate use of an EHR. Policies and training must also address the consequences of improper use or access, including employee disciplinary measures, and criminal and civil penalties the government may impose against both the provider and the individual user.
Monitoring and Auditing Programs should leverage EHR capabilities to support early detection and avoidance of potential fraud, including anti-fraud and access security software, as well as ease of ad hoc data mining reports and remote auditing.
What Crestline Advisors Can Do for Your Organization
Crestline Advisors specializes in quality and compliance-oriented organizational assessment and can help your organization bolster the link between your EHR and these aspects of your operations.
Crestline Advisors can assist providers with the following to support the alignment of EHR design with quality management goals by:
- Reviewing contractual obligations related to performance outcomes and quality management plans,
- Assessing current-state data collection methods, analysis and outcomes, and
- Making recommendations for EHR development to support quality management goals.
We can also help your contract and regulatory compliance and billing requirements by:
- Assessing current-state EHR internal controls and security measures
- Reviewing and updating standards of conduct, policies and procedures, and training requirements related to EHR user guidance
- Creating a data validation tool and program for internal auditing
PIMSY behavioral health EHR meets the criteria Sue has listed above! PIMSY not only keeps your data secure and manages your entire practice in the HIPAA-compliant Cloud – it also helps you maintain compliance and quality protocols.
For more information about how PIMSY can address your agency needs, contact us: 877.334.8512, ext 1 – firstname.lastname@example.org
As an experienced health care professional, Susan (Sue) Dess brings a wide range of experiences to Crestline. Her 15 year administrative and executive management background spans the operations of both managed care and provider organizations.
Additionally, Sue spent 25 years as an Emergency Room and Intensive Care Registered Nurse, further rounding out her ability to understand the “big picture.” Sue is intimately involved with each Crestline project, collaborating closely with consultants and clients.