Open Clinic Encounters

November 15, 2013

Acknowledgement:

Thanks to all physicians and providers for their attention to in-basket management and completing clinic notes more quickly. With the support of the Medical Staff, Academic Enterprise and Health System leadership and staff, physicians and providers have decreased the number of open clinic encounters from 3,823 to 35 from 10/29/12 to 11/13/13.

We are confident that this number will reach zero very soon as we continue to improve our performance of in-basket management, closing all encounters in our in-baskets daily, and addressing all related activities in a timely manner. In addition, by following the guidelines set forth by the Faculty Group Practice for 96-hour record completion, it is assured that we will always be in compliance with Health System policy.

Background:

The Medical Staff Executive Committee (MSEC), at the recommendation of the Medical Staff Health Information Management Committee, set a policy in 2012 to enforce a 30-day deficiency threshold in ambulatory visits, just as we have done over the long term in the inpatient setting. "Deficiencies" in the ambulatory clinic record also include the "closing" of the encounter record after all work has been completed.

Systems Fixes:

Over the past year, a number of changes have been made as part of the Revenue Cycle implementation in Epic to support and improve the timely completion of records as well as the efficiency of their use. As you can see in the chart that follows, the "aging" of open encounters has improved dramatically. Some of these improvements have included:

  • Elimination of most examples of "noise", including DNKA encounter notes that inadvertently required provider action.
  • Administrative closure of very old open encounters that were either too antiquated for reasonable recall or to bill for the clinic encounter.
  • Provision of additional IS support to assist providers in closing their encounters for the open encounter project.
  • Production of a shared monthly report of open encounters

Aging of Open Encounters Has Improved

Aging of Open Encounters Has Improved

If there are other systems issues that we need yet to address that we have overlooked, we will be very happy to address them.

Communications with MDs:

For communications regarding open encounters that have exceeded the 96-hour period, we have developed a tiered notification process as follows:

  1. Epic automatically issues an in-basket notification the day of the encounter.
  2. Following the MSEC meeting on the second Thursday of each month, HIM sends an email notification to individual providers with delinquent encounters (this communication occurs during the third and fourth weeks of the month—see example below):


    On [DATE], the list of providers with delinquent records will be submitted to the Medical Staff Executive Committee for review and possible corrective action. Please complete any delinquent records as soon as possible.

    If you need assistance with ambulatory open encounters call x2-5200, option #4. If for some reason they are unable to assist you, you may also contact HIM for assistance:

    Le Ochia Bonilla, Medical Records (409) 772-9275
    Lucy Moreno, HIM Management (409) 747-3346


    If you have very recently completed the records listed below, please disregard this email.

    Here are some Workflow Bulletins and a FAQ document that may be of assistance:
    Provider — In basket: My Open Charts Folder
    Faculty — In basket: Request Revision of Resident Documentation
    Resident — In basket: Message in Co-Sign Charts Folder
    FAQ's — Closing Open Encounters

  3. During the first and second weeks of the following month (typically on Monday), HIM will send a final email notification to providers with delinquent records and copy their chairs (the email will be blind copied to recipients).

Summary:

Thanks to the attention and focus of our physicians/providers and leadership, UTMB has made great progress in our note compliance in the last year. If all physicians/providers follow the Faculty Group Practice guideline of 96-hour completion of clinic encounter notes and the closure of the clinic record, both to support accurate recall of the clinical event and to allow for timely billing, all providers will be in compliance with the UTMB Health System policy.

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