Coders Are Essential in EHR Implementation and Use
By Angela Jordan, CPC
The key to successful electronic health record (EHR) implementation is not only selecting the right system, but ensuring you have the right people involved in the process from day one. The team should be comprised of one member from each area of the practice to represent all who ultimately must use the system.
Which means: Don’t forget the coder.
Coding Experience Proves Valuable
In 2008, after only one year in my new position as coding and compliance manager, I was chosen to be part of a team to oversee the practice’s transition to EHRs. To fulfill my role, I attended three EHR demonstrations back to back (to back). Each sales team was set up in a conference room on a different floor of the building. It was speed dating with software vendors.
Each vendor assured the providers they could reduce or eliminate coding staff because the EHR would allow them to document and code more accurately. While watching the first demo, however, I realized that I would be able to ask questions that office managers, nurses, and physicians weren’t even aware to ask, such as:
- How are the evaluation and management (E/M) levels calculated?
- Can you disable the “All Systems Reviewed” button?
- Does the provider have the option to use the 1995 or 1997 physical exam?
- Can you make medical decision-making (MDM) one of the required elements?
- Does it keep track and authenticate who is entering the information for each visit?
- How timely is the system updated for ICD-9-CM and CPT® codes each year?
As I listened to the software vendor’s responses, I noticed the expressions on the faces of a few of the managers and physicians. It was a mixture of “Why is that important?” and “I wish we would have asked that when we selected our first EHR.”
I left the demonstration that day feeling confident about the contributions a certified coder could make during the selection and implementation of an EHR, especially one well versed in E/M, documentation guidelines, and auditing. Coders who embrace this technology and learn as much as they can about it are, and always will be, invaluable to the practice of medicine.
When It Comes to Training, One Size Does NOT Fit All
When an EHR vendor was chosen, “super users” like me were trained on how to troubleshoot the system. Anyone who has gone through the implementation of a practice management system or EHR knows vendors rarely provide enough training. Most trainers come from a front office background or are clinicians themselves. They have health care knowledge, but aren’t accustomed to documentation, coding, and billing rules. They teach you how to use their product. And in our case, although our trainers really knew the system, they trained us to use it only one way. The problem is: One size does not fit all.
As the first offices went live with the chart portion of the EHR, I shadowed our trainers (who had been trained by the vendor). I interjected correct documentation and coding practices whenever a trainer taught the providers improper coding or documentation. As the providers started to use the system on their own, I performed random reviews.
When our last and largest office was ready to go live, I trained several of the providers. It was a great opportunity because I applied what I had learned from the previous deployments done by the vendor trainers. I worked with the key staff to break down the workflows and develop step-by-step guidelines to handle every process, from taking phone messages to transferring key patient information from the paper chart into the EHR. The whole point was to make it easier for the providers receiving their training next.
From day one of provider training, I focused on all of the issues in paper charts. I explained history of present illness (HPI), review of systems (ROS), past medical, family and social history (PFSH), and exactly how the EHR calculated them. As the providers built their templates, they finally understood 1997 E/M guidelines for a bulleted exam. The diagnosis “favorites” list and look-up function was a challenge, but after providers began to use it, they understood why accurate coding is reliant on comprehensive documentation.
While working on the plan and patient instructions of provider templates, we discussed medical necessity and how MDM is typically calculated. That was another “Aha!” moment for some of the providers. As we discussed how they cared for their patients, they understood why it was important to summarize outside records they had reviewed and to document additional information obtained from other sources.
Help Out During the Process
After two days of one-on-one training, it was time for the providers to start seeing patients and apply what they had learned. I shadowed them for five days. During that time, I answered their questions, fixed templates by adding things they didn’t know were necessary, helped them customize their user settings to work more efficiently, and simply provided positive moral support. They knew I was there to support them and help them—not only to document accurately, but also to be in compliance with federal rules and payer policies. They knew that if they had a question in the future, there was someone they could call who knows the software, is well versed in coding and documentation guidelines, and could understand and answer their questions in a timely manner.
A year later, some of the providers are already back in full production. There are a few who still “click count,” and want the vendor to rewrite parts of the software. Some providers contact me regularly, wanting to know how a template change will affect coding. There are even a few who are ready to tackle quality measures without putting up a fight. The best outcome is that the providers have a better understanding of E/M, which ultimately has improved their documentation.
CPCs® Can Prove Their Worth
Upon completing the transition, I knew I had been successful in proving the value of a Certified Professional Coder (CPC®) as an EHR implementation team member. When I returned to my office, I was pleased to find among the stack of mail on my desk a card with a personal note from each physician and nurse practitioner I helped to train, thanking me for my time, patience, and understanding. To this day, that card is on my desk to remind me that EHRs will never replace coders.
Angela Jordan, CPC, is the manager of coding and compliance for EvolveMD in Lenexa, Kan. She is the trainer for Greenway PrimeSUITE, providing provider and staff education, coding and documentation reviews, and review of carrier coding/reimbursement policies. Angela is also AAPCCA Board of Directors chair, representing Region 5 – Southwest, and the Kansas City chapter president.
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- 1995 physicial exam
- 1997 physical exam
- and social history
- EHR implementation
- electronic health record
- evaluation and management
- federal rules
- history of present illness
- medical decision making
- past medical
- review of systems