Q. Consent for treatment - when charts are entirely electronic, where will signed consent to treat papers go?
A: To be determined. The HIM committee will be discussing where these types of documents will be stored in the EMR and if there is a need for them to be stored in the EMR based on current rules and regulations governing “signed consent forms”.
For additional information, please contact Mary-j Waterstraat at firstname.lastname@example.org.
Q: Why should I consider using the Logician E&M Advisor? What do I need to do to make it work for me?
A: The E&M Advisor is a powerful tool that can tally the elements of care that you document in a specific format to tell you the appropriate Evaluation and Management (E&M) code (e.g., 99213 vs. 99214) you should use for the medically necessary services that you are delivering and documenting during a patient visit. This can eliminate the headache of trying to figure out which code to use (click here for an example of the mathematical gyrations needed to tally these otherwise), and can decrease inadvertent under-billing or over-billing for services delivered.
Q: What do I need to do to make the Logician E&M Advisor work for me?
A: Use Logician “Encounter Forms”. This is the term Logician uses for what you would recognize as dialog boxes or template forms that open up and allow you to enter data using check boxes, buttons, or entering text into specific data fields (e.g., entering information on blood pressure in the box reserved for BP values). One example of an advantage to using these forms instead of simple open-ended text entry or dictation is that entering information into these “structured data fields” allows Logician to “count up” the various elements of care you are documenting so you don’t have to: chief complaint; HPI; Past, Family, Social History; Review of Systems; and Physical Examination.
Since Logician counts up the number of elements of care you have entered into these “structured data fields”, when you then use the E&M advisor, it already knows the LEVEL OF HISTORY and the LEVEL OF PHYSICAL EXAM, that will support the correct billing code, so all you need to do is check the boxes in the E&M advisor to document the other tasks you completed that determine the COMPLEXITY OF MEDICAL DECISION MAKING . Such items include
o Review/order clinical lab tests
o Review/order radiology tests
o Review/order other Dx or Tx interventions
o Discussion of test results with performing MD/DO
o Obtain records or history from another person
o Review/summarization of old records
o Independent review of data, e.g., image, specimen
Once you indicate the type of patient (new vs. established), and your estimate of the risk of complications, the E&M Advisor will indicate the LEVEL OF SERVICE that the documentation supports. If it is lower than you anticipated and ask for advice about the next higher level, it will tell you which elements are missing to support the higher billing code, which may reveal a simple documentation omission you may not have noticed (e.g., recording the chief complaint in the appropriate field).
While there are already a large number of forms that can assist you in documenting care and getting automated assistance in determining the appropriate billing code, we are working hard to develop more forms to meet your specific needs.
Q: Which of the published HCFA documentation rules (1997 or 1999) are being used in the Logician E&M advisor?
A: The E&M Advisor is based on the 1997 guidelines. CMS (formerly HCFA) came out with draft guidelines in 2000 that have not been formalized. Although the 1997 guidelines are more stringent, the GE Logician clinical team is waiting for the new guidelines to take effect before they update the E&M Advisor.
A Brief History:
The 1997 guidelines were approved in November 1997 by AMA and HCFA. At the time, compliance officers were told that they could code a given encounter based on either the 1995 guidelines or the more strict 1997 guidelines (but they could not be mixed for a given encounter).
There have not been any ratified guidelines since 1997; although, HCFA/CMS and the AMA made an abortive attempt to draft some scenario-based guidelines in 2000.
As of May 2002, Paul Rudolph, director of CMS, stated that they were still trying to work out simpler, more physician-friendly guidelines with the AMA, but there was no end in sight.
Q: If a nurse enters something incorrectly during the intake (say, the weight), then a few visits later sees that in the graph it was way off, can it somehow be changed, so that the graph looks right?
A: Yes. Information that populates data fields can be changed. The mechanism for changing documented obs values is via a clinical list update. The original value will be replaced on flow sheet views but will still be recorded as a value within the chart.
Q: In a flow sheet, can you see the actual growth of a child, AND the norm for a child at the various ages, in one graph? If so, how?
A: Yes. Selecting “Graph”, then selecting the “predefined view”, can do this.
Q: How do we handle confidential documents?
A: Confidential document types will be set up for each clinic. Viewing of Confidential documents will be restricted to those individuals identified for each clinic.
Q: Is access to charts tracked to monitor for inappropriate or unauthorized viewing or modification to patient data?
A: Yes. Logician provides mechanisms for monitoring and reporting on access to patient charts. The monitoring of chart access will be the responsibility of the MSU HealthTeam privacy officer, compliance officer or their designee. Policies for violation of access policies will reflect the same principles as with paper records, with potential disciplinary action or prosecution for violation of policies or applicable laws, respectively. If you have any questions regarding this important topic, please contact the MSU HealthTeam privacy officer, Mary-j Waterstraat at email@example.com.
Q: Can patients who are concerned about their health information being recorded and stored in an electronic medical record “opt out” of having their record in electronic format?
A: No. The "method" of record keeping is at the discretion of the entity, in this case, the MSU HealthTeam. We believe the EMR is essential to delivering the highest quality health care in a cost-conscious manner, so all patients cared for in our system must be willing to allow data to be recorded in the EMR. Patients who have questions or concerns about electronic storage of their health information are invited to discuss them with their provider or contact the MSU HealthTeam privacy officer, Mary-j Waterstraat. Patients who refuse to have their health information stored in the EMR will need to obtain their health care outside the MSU HealthTeam system.
Q: Are we required to inform patients that their health records will be stored in an electronic format?
A: No. There is no law, regulation, or rule that states patients must be informed that their medical record is stored in an electronic format. However, HIPAA Privacy rules require that we give our patients a copy of our "privacy practices" – which means we must inform patients of all of the uses and disclosures of their protected health information. The notice will be distributed to our patients when the rules go into effect in April 2003.
Q: Can Logician be set up to fax information directly to pharmacies, providers, hospitals and other authorized recipients?
A: Yes. However, the current mechanism is not user friendly. We are working on an improved process and will attempt to implement the faxing option by March 2003.
Q: What other organizations currently use Logician?
Below is a sample of clinics throughout the US that use Logician
MeritCare Health Systems – Fargo, North Dakota
Heart Institute of Spokane Washington
Memorial Hermann Healthcare Systems – Houston TX
Asheville Cardiology Associates, P.A. - Asheville, NC 28803
Allergy and Clinical Immunology
- Fairfax, VA
Eastern Maine Healthcare
Allina Health System
The Orthopaedic and Sports Medicine Center of Brevard, Inc.
d/b/a Greenspoon Orthopaedics - Melbourne, FL 32901
Saint Vincent Health Center - Erie, Pennsylvania
Texas Children’s Hospital
PATIENT EDUCATION HANDOUTS
Q: Can existing paper handouts that the clinics have be uploaded into Logician so that they can be printed from inside the system?
A: Yes. In Phase 2D (clinical content) we will begin to review patient education materials, that have been developed by each clinic. Copyrighted materials can only be uploaded to Logician with permission of the publisher. While locally developed patient education materials can be uploaded, quality control and periodic updating will be important for documents that are made available throughout the HealthTeam. The EMR Steering Committee will be establishing a set of guidelines to facilitate this process.
Q: What is the source of the patient education handouts that are contained in Logician?
A: Clinical Reference System (CRS) is Logician’s source for patient education handouts, with over 7,000 reports in every-day language describing symptoms, treatments, risks and after-effects of a vast array of medical topics and conditions. English and Spanish versions are available and many diagrams are included. The “advisors” span the areas of adult health, behavioral health, cardiology, medications, pediatrics, senior health, sports medicine, and women's health.
Q: If I enter a prescription into Logician for a controlled substance that requires a “triplicate” prescription form, do I still need to write out the prescription on paper using the State of Michigan “Official Prescription Program” form? Is this likely to change in the future?
A: Yes. State laws determine whether and how controlled substances can be prescribed, including the use of electronic prescriptions. Current Michigan law does not allow for electronic prescribing of medications that currently require “triplicate” forms (actually, the single sheet official prescription forms which replaced triplicate forms in 1995). So for now they will need to be handwritten on the “Official Prescription Program” form and documented in Logician using the “handwritten” option for the item “How prescribed”. The State of Michigan Consumers and Industry Services (CIS) web site has information on and officially supports current pending legislation that if passed will permit electronic prescribing in the future.
Q: When I need to reprint a prescription due to a paper jam or other issue, how do I do this without creating a separate document?
A: You can reprint your script by
· Reopening the original unsigned document where you wrote the script
· Click on the REFILL button
· Check the REFILL script box next to the script(s) that needs to be reprinted
· Change the PRESCRIBING METHOD to REPRINT.
Note: You will create a new document if you do not reopen the original unsigned document but simply click on the REFILL button.
Q: Can Logician directly route a transcription done by a resident physician to the attending physician for signature instead of routing it first to the resident? (Some attending physicians do not want transcriptions to go to the resident first because the resident may be no longer be available by the time the transcription appears in Logician.)
A: No. Our policy is to route transcriptions to the individual who dictated the document. Logician does not determine which physician should receive a transcribed document. Outside transcriptions come through an electronic interface and are manually attached to a patient’s electronic medical record in Logician by a Health Information Management (previously Medical Records) Department employee, using a program called “DocuTrak”. Unless the resident who dictates the note indicates that the transcription should go to someone else, the document will go first to the resident, who should review, edit, sign and then route to the attending physician for his/her review and signature. Faculty physicians who want particular resident dictations to come directly to the faculty physician should instruct residents to indicate this specifically during any relevant dictation.
Q: Are paper documents going to be scanned into Logician? If so, which documents will be scanned and how will this be decided?
A: Yes. Scanning of paper documents into Logician so they can be viewed at a future date is an important part of converting to an EMR. However, studies have shown that only 5% of the information entered into a paper chart is ever referred to again at a future date. This is important given the mountains of paper that constitute our existing paper charts, and the fact that scanning, indexing and attaching each scanned document to the correct patient’s record can be complicated, expensive and time-consuming. As such, Mary-j Waterstraat has convened and chairs the Health Information Management Committee, which is comprised of medical records and clinic representatives from off-campus clinics, Olin Health Center and the MSU Clinical Center to specifically discuss "medical record management" issues. The committee will make recommendations to the EMR Steering Committee regarding which existing paper documents should be scanned into the EMR, how paper documents coming into our system in the future should be entered into the EMR, and what to do with the paper once it has been scanned.
Any additional questions from a clinic regarding scanning that are not addressed with this response should be directed to Mary-j at firstname.lastname@example.org.
Q: I tried to login to Logician but I received a message saying that my account had been “locked out”. Why does this happen?
A: Please see the EMR update of 12/8/2002 for details on this problem.
Q: How often is Logician backed up?
A: Logician is backed up on a daily basis. Backups start each night around 2:00 a.m. Providers will be unable to access Logician during the daily backup.
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