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Hiteks Solutions Inc. | 447 Broadway, 2nd Floor | New York, NY 10013 | 2129200929 | www.hiteks.com 1 Optimizing the EHR through Realtime Analysis of the PhysicianPatient Interaction one Introduction two Realtime Value Proposition three Physician Workflow Optimization four Pointofcare Alerts & CME five Revenue Enhancement six Salient Summary Introduction The healthcare industry is juggling far too many changes when it comes to the shift from paper to digital health records mixed with a myriad of regulatory changes all of which is putting serious strain on physicians’ productivity. With numerous changes taking place in healthcare today, it’s critical that physicians have tools and services that let them focus on the patient, not the technology. The Electronic Health Record (EHR) is a critical enabler in helping providers drive productivity in the new digital era of healthcare and maintain focus on what matters most: patient care.

SalientValue White Paper, March2015

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Page 1: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

1  

 

 Optimizing  the  EHR  through  Real-­‐time  Analysis  of  the  Physician-­‐Patient  Interaction                          

               one          Introduction    two          Real-­‐time  Value  Proposition    three    Physician  Workflow  Optimization    four          Point-­‐of-­‐care  Alerts  &  CME    five            Revenue  Enhancement    six                Salient  Summary

     

Introduction  

The  healthcare  industry  is  juggling  far  too  many  changes  when  it  comes  to  the  shift  from  paper  to  

digital  health  records  mixed  with  a  myriad  of  regulatory  changes  -­‐-­‐  all  of  which  is  putting  serious  

strain  on  physicians’  productivity.    With  numerous  changes  taking  place  in  healthcare  today,  it’s  

critical   that   physicians   have   tools   and   services   that   let   them   focus   on   the   patient,   not   the  

technology.  The  Electronic  Health  Record   (EHR)   is   a   critical   enabler   in  helping  providers  drive  

productivity   in   the   new   digital   era   of   healthcare   and   maintain   focus   on   what   matters   most:  

patient  care.  

 

Page 2: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

2  

 Real-­‐time  Value  Proposition  

In   collaboration   with   leading   EHR   vendors,  

Hiteks’   Salient   Scribe   service   is   designed   to  

enable   physicians   using   an   EHR   system   to  

optimize   their   productivity   and  

documentation   quality,   all  while   they   are   in  

their   native   EHR.   This   helps   physicians  

spend   more   time   with   patients,   accelerates  

physician   adoption   of   EHRs   and   facilitates  

more   complete  documentation,  which   is   the  

foundation   for  high-­‐quality  patient   care  and  

appropriate   reimbursement.     The   EHR   by  

itself  provides  the  workflow  framework  and  

the   clinical   database   repository   for   a   health  

system,   but   requires   a   sophisticated  

technology  for  reconciliation  that  is  not  built  

into   the  EHR   to  maintain   an   up-­‐to-­‐date   and  

accurate  patient  record.  

 

This   EHR   integration   makes   clinical  

documentation   easier   for   physicians,   while  

simultaneously   creating   higher   quality   and  

more  structured  data,  which  are  essential  for  

managing  healthcare  today.      This  structured  

data  is  the  building  block  of  decision  support  

rules   but   is   very   cumbersome   for   the  

physician  user.    When   tasked  with   the  need  

to   enter   data   into   structured   fields   with  

dropdown   lists,   the   typical   physician  

comment  is  “I’m  trying  to  see  how  this  could  

help  me  as  a  doctor  because  I’m  not  seeing  it  

now.”     When   shown   how   our   technology  

automatically   populates   structured   fields  

from   the   free   text   notes,   physicians  

immediately   understand   the   potential   value  

for   decision   support,   quality   of   care  

improvement,   appropriate   reimbursement,  

research  and  education.  

   

     

     

Patient / Doctor VisitNatural Language Documentationtakes place Salient Scribe

Salient extracts relevant facts and populates the EHR

Structured EHR

Problems

Rx

AllergiesClinical Note

1 2 3 4

Page 3: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

3  

Physician  Workflow  Optimization  

Physicians   play   an   integral   role   in   patient  

care   but   face   increasing   demands   on   their  

time  that  competes  for  time  with  the  patient.      

Among   these   demands   are   increased  

computer   data   entry   time,   expanding  

requests   from   the   billing/HIM   department  

for   better   documentation   and   ongoing  

continued   medical   education   requirements  

of   very   complex   scientific   data.     Any  

efficiency   in   their   workflow   results   in  

improved   patient   satisfaction   and   financial  

savings   to   the   institution   from   increased  

productivity.  

 

Eliminating   Double-­‐Entry:     One   of   the  

government's   and   other   payors'  

requirements   is   to   report     Meaningful   Use  

fields,   namely   Problems,   Medications   and  

Allergies,   which   are   important   to   ensuring  

appropriate   use   of   information   systems   to  

achieve   quality   patient   care.     The   practical  

implementation   of   Meaningful   Use   is   that  

reconciliation   is   required   to   ensure   data  

between   structured   lists   in   the   chart   is  

consistent   with   the   data   in   unstructured  

notes.     Studies   using   thousands   of   patient  

records  analyzed  with  Salient  Scribe,  Hiteks'  

NLP   and   reconciliation   platform   integrated  

with   the   EHR,   achieved   50%   reduction   of  

computer   time   for   physicians   in   an   average  

length   15-­‐minute   patient   visit   based   on  

clinical  experience  with  a  test  set  of  records.    

The   absolute   reduction   in   documentation  

time  was   from  8  minutes   to  4  minutes  after  

the  15-­‐minute  interview.  

 Cost  Saving:    Calculated  in  “physician  hours”  

of   time,   the   Cardiology,   Family   Practice,  

Pediatrics   and   Pulmonology   specialists  who  

participated   in   the   study   and   used   Salient  

Scribe   saved   an   average   of   2   hours   more  

time  per  day  (10  hours  per  week)  compared  

with   another   cohort   of   the   same   specialists  

not   using   the   solution.     Based   on   a   50-­‐hour  

workweek   at   an   average   annual   salary   of  

$135,000   per   physician,   the   monetary  

equivalent   in   savings   for   a   health   system  

equals   $27,000   per   physician   employee.      

These   savings   can   be   utilized   for   improved  

productivity,   higher   reimbursement   and  

enhanced  patient  satisfaction  scores.  

Continued Medical EducationC.M.E.

Patient Care

PracticeAdministration

7

Responding to ReimbursementCoding and Quality Queries

Relative Time Spent in Various Areas of Physician Workflow

Page 4: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

4  

Real-­‐time  Documentation  Alerts  

Alerts   and   other   prompts   for   appropriate  

documentation   of   the   clinical   visit   at   the  

point-­‐of-­‐care  can  reduce  physician  post-­‐visit  

consultation  time.    In  a  test  cohort  examining  

the   time   spent   responding   to   HIM  

Department  queries  to  a  physician’s  inbox  or  

task-­‐list,   the   length   of   time   required   for   a  

physician   to   respond   was   reduced   by   90%,  

from  an  average  of  24  hours  prior  to  Salient  

alerts  to  2.4  hours  annually.    The  monetized  

value   of   the   time   saved   per   physician   is  

approximately  $6,000  per  year.    This  savings  

does   not   include   the   impact   on   the   higher  

reimbursement   from   a   shorter   coding   cycle  

turnaround  time.  

 

   Our  study  also  analyzed  the  ICD10  impact  on  

physician  time  spent  answering  HIM  queries.    

We   anticipate   that   ICD10   once   it   goes   into  

production   as   a   reporting   requirement,  will  

increase  the  amount  of  queries  from  what  is  

currently   20%   of   patient   charts   having   at  

least   1   query   to   over   60%.     This   tripling   of  

queries   means   that   a   more   efficient  

workflow-­‐based   solution   will   be   needed   to  

answer   queries   more   efficiently   and   also  

reduce   queries   by   bringing   real-­‐time  

guidance   to   the   physician   for   appropriate  

medical   necessity   documentation   to   reduce  

the  total  query  burden.  

 

 

Point-­‐of-­‐care  CME  

 Another  important  area  of  a  physician’s  time  

is  CME.    Because  of  our  ability  to  analyze  the  

patient  record  in  real-­‐time,  Salient  Scribe  

offers  point-­‐of-­‐care  educational  content  (i.e.  

literature  searches,  CME,  research  

opportunities)  keyed  to  patient  problems  

and  available  with  a  single  click  through  

their  EHR.    Accredited  CME  through  local  or  

through  3rd  party  agents  provides  each  link  

as  a  15  minute  (.25  CME)  credit.    Since  most  

states  require  15-­‐30  hours  of  CME  per  year,  

savings  in  physician  hours  per  year  amount  

to  25  hours  of  total  savings  (approximately  

$6000  per  year).  

Constant checking required to improve safety and outcomes

Physician challenges at the point of documentation

Double data entry required using multiple screens

Prior authorization & medical necessity queries need

additional data

Clinical Users

Salient Scribein the client EHR

Context-Sensitive CME modules available through synchronous EHR prompts and message links

Page 5: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

5  

 Revenue  Enhancement  

 The  EHR  works  closely  with  Revenue  Cycle  

management  (RCM)  systems  which  rely  on  

the  documentation  within  the  EHR  to  justify  

claims  codes  produced  and  sent  to  payers.    

The  seamless  integration  of  a  Real-­‐time  NLP  

and  Analytics  layer  (i.e.  via  Salient)  

optimizes  the  EHR’s  ability  to  document  

appropriate  terms  and  facilitates  easier  

communication  between  the  RCM  and  the  

EHR  interface  due  to  the  linking  of  queries  

directly  to  the  documentation,  in  real-­‐time.  

 

Time  savings  for  physicians  is  an  important  

source  of  monetary  savings  (approximately  

$40  thousand  per  physician  annually,  as  

described  previously  in  this  document)  for  

the  health  system  which,  since  physician  cost  

as  an  employee  is  largely  a  fixed  expense,  can  

be  directed  to  other  purposes  such  as  

improved  patient  safety,  satisfaction  and  

retention.    

 

Direct  return-­‐on-­‐investment  in  revenues  have  also  been  measured  at  a  large  health  system  using  

Salient  Scribe  and  Alerts.    The  4  areas  for  improved  revenues  are  as  follows:

Financial  Area  Measured   Description  of  the  Revenues   Revenue  Amounts  Physician  Services  Claims  Capture  

10%  reduction  in  claims  rejection,  where  average  annual  claims  value  per  physician  is  $450,000  

$45,000  per  physician  per  year  

Meaningful  Use  Compliance     Automatic  fulfillment  of  MU  requirement  for  maintenance  of  Problem  List,  Medication  and  Allergies  prevents  penalty  of  6%  in  Medicare  reimbursement  (annual  Medicare  reimbursement  of  $100,000  per  physician)  

$6,000  per  physician  per  year  

Medicare  Case  Risk  Scoring   More  accurate  data  for  risk  score  results  in  higher  Medicare  payment  of  5%  maximum  per  physician  

$5000  per  physician  per  year  

Institutional  Claims  Capture   Institutional  claims  capture  of  10%  improvement  with  an  average  institutional  inpatient  charge  of  $250,000    

$25,000  per  inpatient  stay  

Page 6: SalientValue White Paper, March2015

 

Hiteks  Solutions  Inc.    |    447  Broadway,  2nd  Floor    |    New  York,  NY  10013    |    212-­‐920-­‐0929    |    www.hiteks.com      

6  

Salient  Summary  

In   summary,   Hiteks   enables   physicians   to  

seamlessly   document   the   complete   patient  

story   in   their   own   language   and   workflow  

while   simultaneously   extracting   the   key  

clinical   data   required   to   meet   broader  

regulatory  mandates  such  as  Meaningful  Use,  

Medication  Reconciliation,  HEDIS,  HCC,  etc.      

 

To   help   health   systems   streamline  

structured   data   capture   from   the   physician  

narrative,   Salient   integration   with   the   EHR  

automatically  extracts   the   important  clinical  

terms   and   reconciles   them   with   the  

structured   fields,   which   are   often   found   in  

separate  lists  or  tabs.  

Salient  draws  attention  to  areas  that  are  the  same  or  different  between  the  new  Note  and  Active  

Lists  in  the  EHR.    Clinical  facts  are  extracted,  that  information  is  run  through  a  knowledge  base  

and  language  models,  and  the  details  are  presented  to  physicians  for  review  and  acceptance  with  

prompts   for   any   additional   clarification.     As   a   result,   the   physician   is   able   to   save   time   in   the  

extraction  of  the  data  and  keeping  discrete  data  consistent  with  their  Note.    Finally,  Salient  works  

with  the  EHR  to  safeguard  clinical  data  integrity,  which  positively  impacts  the  subsequent  coding,  

quality  reporting  processes  (e.g.  Patient  Safety  Indicators)  and  education  through  valuable  alerts  

and  prompts  obtained  through  Hiteks’  experience  tying  HIM  coding  and  Quality  rules  to  Notes.