Optimizing your EMR in the Cancer Registry - PowerPoint Presentation

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Optimizing your EMR in the Cancer Registry

Sanford USD Medical Center

Cancer Registry

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Objectives

Attendees

will understand the advantages of utilizing their EMR to perform electronic case finding.

Attendees

will identify potential problem areas in the use of the EMR.

Attendees

will be able to describe the role of EMR billing indicators in the import process.

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Current EMR – EPIC One Chart

Sanford has been utilizing electronic

case finding

since 2006

.

Current abstracting software – Metriq

Have imported patient data into registry since 1983.

Use NAACCR version – implementation guides are available on vendor website.

Currently abstracting for 3 facilities.

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Billing indicators

Tumor

Reg

Import

P

ut on when case is reviewed in the Case finding WQ and found to be eligible for the Registry.

Used to drive account into regular WQs.Used to drive the account into Metriq through the import process. Removed when case is abstracted.

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Billing Indicators

Approximately 188 billing indicators used across the EMR system at Sanford by multiple departments

Applied to the account level

Means of activity tracking on accounts

Means of communication between departments

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Tumor Review CompletedPut on when abstracting of case is completed.

Prevents accounts from re-entering case finding WQ.

Tumor

Reg

DO NOT CLOSE

System auto action to hold cases in the queue.

Removed when abstracting of case is completed. Tumor Registry Billing Indicators

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Tumor Registry Billing Indicators

Tumor

Reg

NA

Applied to cases not eligible for the registry during case review in Case finding WQ.

Prevents cases from re-entering work queue.

Tumor Reg PBBTum Reg Rad/Onc

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Tumor Registry FYI flags

Applied at the patient level by CTR when abstracting of case is completed in Metriq.

Have been used to drive reports through EPIC One Chart.

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FYI Flags

As a means of communication between CTRs,

FYI flags are updated during CTR follow up review.

Establishes starting point for review of records for abstract updating.

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Auto actions

Do not close billing indicator

Used to hold accounts in the WQ

Accounts entering the Case finding WQ with an FYI flag automatically have Import billing indicator applied to push them to the regular WQ.

Eliminates need for case finding review.

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Work Queues

Case finding queue

All cases with an eligible ICD-10 code enter

this work queue.

A

ll cases reviewed and disposed of daily by CTR.Tumor Reg NA – not eligible for collection

Tumor

Reg

Import – import case into Metriq and regular or PBB work queues.

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Work queue Listings

Regular queues

Contain majority of cases

Split out alphabetically

RQRS queues

Breast and colorectal specific

Allows for abstraction within 90 days.

Worked by same CTR each month.

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Work Queue Listing

PBB (Provider Based Billing)

Contains cases diagnosed / treated at physician’s offices.

Broken out alphabetically

Worked after regular work queues are completed.

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Work queue Rules/ Routing Rules

Items considered in the rules

Location of service

Discharge date

Billing indicators / FYI flags

Last name

Charges

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Work Queue View

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Workqueue Rules / Routing Rules

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Colon RQRS work queue rules

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Each facility has a duplicate set of work queues with unique rules to those facilities.Work flows for all facilities are the same.

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How to work the Queues

Work queues are sorted by admit date.

This assures staff are working the oldest accounts in the queue.

Can then R) click on patient name and bring all of the patient accounts together.

Due to having several months of patient accounts in the WQ, can work up to the current date.

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Multiple accounts for 1 patient

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Activity Tracking

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Import of Data

Sanford Cancer Registry has utilized electronic import of data since 1983.

NAACCR format

Cases come in as a suspense case

Suspense list query is run at completion of abstracting cases in WQ as a case finding check.

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Fields Imported

Demographics – name, date of birth, address, social security number, phone number,

Primary site

ICD – O – 3

Looking to bring in occupation and industry as assigned at registration.

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Electronic Import

Old way – using ICD codes

New way – using Tum

Reg

Import billing indicator.

Brings in cases that through the case finding WQ process are eligible for entry into the registry.

Eliminates cases that were brought in, but through record review, were not eligible.

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Checks and Balances

Constant evaluation of what works and what doesn’t

Suspense list

Path Review

Option to run report through EPIC using FYI flags, billing indicators and codes.

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Thumbs up!

Work queues populate automatically as accounts are coded.

Runs the disease index list for us.

Offer flexibility in case lists

Sort alphabetically

Sort by site

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Thumbs down!

Relying heavily on technology

Clitches

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Electronic Staging

Per Cancer Committee policy, all cases presented at Tumor Conference must have a staging form completed.

Send to the MD through the EMR

inbasket

.

Clinical and pathological staging forms are available.

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Added to Problem List

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Routed per EMR In basket

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In basket message

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Clinical Staging

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Pathological Staging

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Prognostic Indicators

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CollaborationRelationship with your IT department.

Outside the box thinking

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Credits

Amanda DeGroot, RHIT, CTR

Bryce Hansen, RHIT, CTR

Patty Mullen, RHIT, CTR

Lori Severson, RHIT, CTR

Karla Sorenson, RHIT, CTR

Ingrid Steen, RHIT, CTR

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Contact Information

Denise Lutkemeier, RN, CTR

Cancer Registry

Supervisor

Sanford USD Medical Center

Denise.Lutkemeier@Sanfordhealth.org

Office – 605-333-5595Home – 605-938-4716