Epic's Enterprise System is quickly becoming the nation's most popular. Epic's innately integrated system is extremely appealing to healthcare systems both big and small.
One patient one record is clearly beneficial for patients and clinicians, but what about for a system's Revenue Cycle? If correctly implemented, Revenue Cycle and Finance can flourish with the new technology. The difficulty is, the more integrated the system, the more complicated and vast the install. To add insult to injury, it is extremely difficult to find a seasoned professional with cross application knowledge. These people are very few and far between. The following recommendations have been compiled from multiple installs, from both the clinical and revenue cycle angles. These integrated areas have been part of a pattern; either overlooked or misrepresented during the implementation process. These points will help achieve an immediately successful financial result after an Epic go-live.
Encounter Types are at the center of all instances of patient care and also a huge point of confusion for most institutions. Each install is different, but encounter types can drive the clinical tools seen on the screen, charging mechanisms available, ability to complete or "close" visits, reporting and workqueues. An "encounter" is described as any interaction with a patient. This could be over the phone, in an ambulatory clinic, in the hospital, with a physician or with support staff. Many times, each of these will be a different type of Epic Encounter. The impact to revenue cycle here can be tremendous for the following reasons.
First, the largest impact is because revenue can be held up unnecessarily. Generally, if an Ambulatory encounter is not "closed", then charges do not drop. There are a few reasons why encounters may be left open. Since encounter type can drive the clinical workspace, there is a possibility that clinicians simply are not able to "close." Another reason may simply be that no one is monitoring behavior. It is easy to feel overwhelmed at go-live and lose track of a step in a new workflow in a new system. This is why managerial oversight is so critical during and after go-live. Lastly, there could be a system issue. It is possible that the previous system had different encounter type equivalents. It is common to mis-map these, because often there is not enough collaboration during the technical evaluation of this particular system work. To get the full picture, the system analysts should be supplemented with a clinical operations lead.
Workqueues are also a focus at most go-lives. The common mistake from initial A&D stages is attempting to make a specific WQ for everything right from go-live. Inevitably, there are too many and they become mismanaged, ignored, or dormant. When beginning with highly specialized WQs, this will often lead to the accidental exclusion of important claims. It is near impossible to have every edit and DNB from day one. Start broad and inclusive, knowing that there will be constant adjustments needed during the first couple months after go-live. Workflows, staffing and workload in most areas change, sometimes drastically, after an Epic Implementation. It's important not to get ahead of the process.
Reporting and operational oversight go hand in hand during a successful Epic implementation. Epic supplies some excellent 'out of the box' reporting, but there are generally two issues. First, they are siloed to each application. There are very few reports that cross from Patient Access to Revenue Cycle or include any clinical impactors (there are many). This is where the reporting A&D should be focused prior to go-live. Leverage the most competent IT analysts (not necessarily report writers) to design reports that aggregate data, rather than compartmentalize. Secondly, reports are not helpful unless they are being monitored. Making sure operational leaders are trained in Epic reporting, feel comfortable interpreting reports and monitor reports as part of their daily duties will make a huge impact. Also, emphasize the proper interpretation of report data points. Many times the output data is not intuitive and means something dissimilar than it did in previous systems, or on paper.
Most Revenue Officer's agree that Patient Access is a critical component of Revenue Cycle. However, the integration points don't always get the appropriate amount of attention when implementing Epic. If the registration process allows for poor/incomplete data, then you should expect WQs to build up quickly with registration claim edits. Recommend adding hard stops upon check-in for all pieces of information required for a clean claim. Does your staff understand what each field means? Reiterate the impacts of good data and allow for questions. It may also help to look into the financial clearance process. Pre-registration is a just as important, and contributes to expeditious care. This may assist with physician productivity.
All of the above contributing factors still require excellent leadership and a superior Project Manager. Making use of tools like Microsoft Project will also help to create transparency, when it is easy to get lost in the mass of details. Most providers implementing EHRs rely on the EHR vendor to manage and provide periodic overall progress. In essence, these vendors are managing and providing progress on themselves and tend to not reflect reality, but political agendas. Creating a neutral and unbiased position to oversee the EHR Governance, and will specialize in managing and reporting on large IT and Government projects. This could make all the difference. The key here is to reduce risk of Project delays and over-runs.
Bio: Adrienne Epstein is currently overseeing all Healthcare Projects handled through ClearPlan. She has held a wide range of leadership positions in many aspects of healthcare, including Revenue Cycle, Patient Access, Clinical Operations and Information Systems. Adrienne has a Master's degree in Healthcare Administration from George Washington University, is pursuing PMP certification, and holds certifications in five different Epic Applications
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