CDI in Epic Presented by: Karen MacArthur, RN,

BCHO CDI Workflow in EPIC: Dashboard Pros and Cons<br>

Pros and Cons Pros:
We don’t have to move from a program to EPIC/no input of patient data
It is in the chart and care providers can go to the record and/or reply to our queries
Easy to see who is responsible for the query
Cons:
Must cut and paste to send to other providers
Reports are difficult to build
No place to record verbal query without sending inbox message<br>

EPIC Physician Workflow Hold for screen shot of physician query<br>

Question to the Group In Progress Notes, and other notes as well, we pull in the problem list. How do your coders handle these notes?
Code
NOT Code
Query if it is not documented anywhere else?<br>

Actual Note Assessment: ................undergoing induction chemotherapy with last chemo 9 on admitted for febrile neutropenia. Limited exam today due to patient discomfort and anxiety. However his fever curve is improving and his white cell count is improved today, along with his hgb following transfusion yesterday. Differential is most consistent with viral illness vs mucositis. Bacteremia less likely with a negative blood culture and stable VS. Will continue current treatment until his ANC increases. Active Problems: Speech delay Obstructive sleep apnea Pancytopenia due to antineoplastic chemotherapy Ewing's sarcoma Delay in development Febrile neutropenia Morbid obesity Mucositis due to antineoplastic therapy<br>

Children’s Hospital & Medical Center Fast Facts Children’s Hospital & Medical Center is the only full-service, pediatric healthcare center in Nebraska, providing expertise in more than 50 pediatric specialty services to children across a five-state region and beyond.
We are home to Nebraska’s only Level IV regional Newborn Intensive Care Unit and the state’s only Level II Pediatric Trauma Center.
Our regional heart center offers expertise in pediatric heart transplantation.
Children’s is recognized as a 2018-19 Best Children’s Hospital by U.S. News & World Report in five pediatric specialties: Cardiology and Heart Surgery, Pulmonology, Gastroenterology & GI Surgery, Orthopedics, and Diabetes & Endocrine Disorders.
In 2017:
Total Patient Visits: 623,700
Patients: 138,500
Medicaid Patients: 46,500
50+ Outpatient Specialty Services
145 Beds
11 Regional Clinics In 3 States<br>

Omaha Children’s Workqueue List<br>

Omaha Children’s Workflow Initial List gets reviewed by CDI Reconciler
Goes to Subsequent List, which is reviewed by CDS. Date for re-review is determined by CDS’s
Query List keeps track of outstanding queries
CDI Manager Review list is for final coding or if case needs special attention, i.e. SOI mismatch with encoder, coding issues, etc.
When ready for matching up initial with final DRG, goes to Validation
If discharged prior to coding being completed, or if awaiting response from practitioner in relation to coding will go in “Discharge waiting for coding” list<br>

Queries<br>

Pros & Cons of In Basket Queries Pros:
1. Goes directly to practitioner
2. Able to ascertain if it has been read or not
3. They are able to respond and ask further questions and/or clarify if needed
4. You can then respond in kind if additional questions
Cons:
1. Can only send to one practitioner at a time
2. Doesn’t directly send the reader to the problem list to amend or the progress note to address
3. If you need to send same query to another practitioner, and it has been read by the original recipient, you cannot cut & paste the query.
4. Have to add residents/APRN’s to treatment team in Epic in order for them to see the query. (shows up in their “to do” list)<br>

Dashboard (Children’s) Dashboard is still a work in process, trying to figure out what information is the most useful at a glance<br>

QUESTIONS?????<br>