Optimizing the Workflow of Mobile Wound Care Providers with Technology
Dr. Lauren Neuman, DO, MBA
Overview
For mobile wound providers in the post-acute care space, documentation can be one of the biggest challenges. Recording and managing wounds currently requires multiple software systems with burdensome manual data entry. This leads to poor workflow, diminishing the ability of practitioners to effectively treat patients. Without a single automated platform, providers are faced with increased burnout, clinical errors, continuity issues, and missed care opportunities. The utilization of one single platform with wound specific documentation including measurements, photo features, & assessments would save hours charting and lead to more quality clinical care. The aim of this paper is to highlight the input of hundreds of mobile wound practitioners: provide an optimized and automated workflow within a single platform that benefits both patients and providers.
Click to watch a summary of our findings!Challenges
Amongst specialties in the post-acute care space, wound care documentation is the most unique and laborious as it requires detail oriented tracking of wound progression over time. The workflow typically involves several stages including assessment, photography, documentation, treatment, progress, and follow ups. Providers use photographs and measurements to assess wounds over time and make decisions based on the wound status. The majority of generic electronic medical record (EMR) software systems do not accommodate this workflow. Furthermore, the lack of seamless integration between the outdated systems can cause data gaps, leading to poor continuity of care as well as compliance violations. This is a risk to clinical practice guidelines.
Optimized Workflow
Many EMR systems are built without input from providers, leading to impractical processes, an increase in click count, and overall frustration. Therefore optimizing and building an EHR to accommodate an efficient wound care workflow requires substantial involvement from wound care practitioners. This starts with provider involvement in the user interface design of the EHR. With an intuitive interface, providers are happier, more efficient, and less prone to burnout. They also require less support and training. The system must streamline an efficient process for entering, managing, and retrieving medical information with meaningful smart integrations
Interoperability and Integrations
Many providers experience a high degree of manual data entry due to poor interoperability between EHR systems, often leaving out crucial facility data such as demographic information, allergies, and medications. Furthermore, over half of US physicians report at least 1 symptom of burnout. Estimates of how much provider burnout costs the healthcare system come to at least $4.6 billion annually, with the greatest burden attributed to turnover and work-hour reductions. The gains from a workflow that uses integrated patient data and decreases clerical tasks are therefore large and a must-have for providers seeking a healthier lifestyle without reducing clinical impact. Data should seamlessly flow into a note or chart in a way that enhances productivity. Once charting is complete, the updated data must also seamlessly flow back to the facility EHR, further reducing manual entry.
Smart Templating
Smart templates that utilize meaningful integrated data with assistive note generation improve note accuracy, consistency, and efficiency. Therefore, it is imperative to utilize an EHR that offers a high degree of integration and allows for bidirectional data to seamlessly pull into the notes and patient chart. To enhance productivity templates should also include ”smart phrases,” also known as shortcuts or snippets, with predefined and customizable text. These phrases streamline documentation, save time, and ensure consistency. Lastly, smart templates provide companies with guardrails for accuracy, compliance, and quality tracking. The backbone of these elements is a robust integration between the provider EHR and the facility EHR where the patient is under care. This allows for seamless sharing of information,reduces errors due to manual data entry and prevents health insurance portability and accountability act (HIPAA) violations
Photo Capture
For wound care, photo capture must be available on a mobile phone, tablet, laptop, and/or desktop.. These photos must be able to sync on all devices as providers often toggle between photo capture on a mobile device and a laptop in order to chart efficiently. Facility management also requires access to the photos, which can pose a challenge when facility EHR systems do not allow for photos sharing across platforms. Therefore, an EHR must provide access to facility staff for tracking wound progression in step with the provider.
Billing
Some wound care groups require the practitioner to submit charges for patient encounters. Many providers find billing to be cumbersome and non-intuitive. Thus it is vital that a system offers convenient and accurate charge capture for billing purposes. For example, the EHR should deliver clear searchable icd-10 codes as well as the ability to favorite commonly used codes. In this way, billing can be more efficient.
Provider Training
Training and support of providers should be offered by other providers. In this way, the two parties share a common perspective on the care of patients and provide realistic clinical workflows with the ability to answer questions based on clinical expertise and skill sets. By incorporating a user-friendly interface that is easy and efficient to navigate, photography, smart templates, customizations, interoperability, mobile accessibility, data capture, data retrieval, easy billing, and training with support led by fellow clinicians, providers can better manage patients.
Requirements for Mobile Wound Care
After gathering insights from a national population of wound care practitioners, it is evident that certain key attributes are indispensable in the effective treatment of wounds. These features encompass phone and tablet compatibility to facilitate photo capture of wounds. Once photographed, accurate assessments require customizable wound descriptors and measurement tools. In order to document these wounds beyond the photo, an EHR must provide multiple modifiable template types, progress notes, and procedure notes (encompassing activities such as debridements and grafting) to minimize click count and improve documentation compliance and consistency. EHR softwares must also provide wound progress analysis through graphs and data points, providing a visualization of the healing process. Streamlined, modern integrations with facility software, such as PointClickCare and Matrix, is essential for this type of seamless workflow. Automation of charge capture, CPT coding, and billing adds another layer of efficiency. Compliance with MIPS (Merit-based Incentive Payment System) and adherence to quality measures are imperative for delivering high quality care. Lastly, a user-friendly dashboard and visit tracking feature contribute to a comprehensive and effective wound care management system.
Wound Care DocNow (DN)
DocNow (DN) has focused on the development of features designed to facilitate comprehensive assessment and documentation, based on provider feedback. Specialized templates tailored for debridement and grafting procedures ensure precision in wound treatment. The inclusion of trend analysis and progress tracking with graphs further elevates the effectiveness of wound care management, allowing practitioners to monitor and visualize wound progress. A noteworthy aspect of this advanced system is its compatibility with both phones and tablets enabling practitioners to capture essential data, including photos and wound measurements, through convenient and portable devices. This comprehensive suite of advanced wound care features underscores a commitment to thorough and efficient patient care in the management of wounds.
Streamlined Integration
DocNow’s streamlined integration represents a significant advancement in the efficiency of healthcare operations, particularly in the realm of electronic health records. This focus on integration maximizes the usefulness of seamless and robust connections with PointClickCare and Matrix, surpassing the current integration capabilities of other systems. DN incorporates Dragon dictation, embedding it alongside templates and shortcuts designed to expedite the charting process. This integration not only enhances the speed of documentation but also ensures accuracy and ease of use for healthcare professionals. Additionally, the inclusion of electronic prescribing can help to decrease medical errors and improve efficiency as patients transition within post-acute care settings.
Census Creation
Numerous healthcare providers encounter frustration when compiling their patient lists, also known as a census. This can be a cumbersome task in their daily routine as they navigate identifying new patients within the facility who will need an initial visit and those who require a subsequent follow-up visit. Building and maintaining a patient census becomes efficient in DocNow. For example, users have the flexibility to make a census by importing patients from the facility patient list. They can easily see who is new by sorting by admission date as well. There is also the ability to see who “last saw” the patient within their company if another provider. Further, adding or removing patients from the census is quick and easy, with minimal clicks. Additionally, the software offers a convenient"copy forward"function, ensuring that patients are not inadvertently omitted during regular rounds by carrying over census lists and chart information from the previous week. DocNow also surfaces a comprehensive overview of patients' admission status, allowing users to ascertain whether a patient has recently been admitted, readmitted, or discharged from the PointClickCare facility. This robust set of features simplifies the management of a patient census, minimizing missed encounters and ensuring continuity of care.
MIPS & Quality Measures
DN’s MIPS (Merit-based Incentive Payment System) and Quality Measures functionality offers a user-friendly and intuitive approach to recording MIPS measures while ensuring ease of use for healthcare practitioners. The system features automatic prompting if the patient meets MIPS criteria, streamlining the process of compliance. The activation of MIPS is initiated by diagnosis codes, and practitioners can then easily select from various MIPS codes. Furthermore, the system facilitates the seamless transmission of data to a MIPS Registry, enhancing the accuracy and efficiency of reporting. This comprehensive approach not only ensures compliance with quality measures but also allows for the optimization of reimbursement revenue, providing a valuable tool for healthcare organizations seeking to navigate and succeed in the evolving landscape of healthcare incentives.
Charge Capture and Billing
Through API or HL7, DocNow is able to provide compatibility with various billing platforms. From the providers’ perspective, charge capture is simple with an intuitive interface, complete with pre-populated diagnosis codes and the ability to “favorite” commonly used codes. This feature not only expedites the billing process but also enhances accuracy of claims. Codes are also up to date so that providers are not using non-billable coding. When available, codes can also be imported from and exported to the facility EHR, allowing for transparent PDPM code sharing This benefits the provider groups as well as the facilities they service as both parties are able to comprehensively use these codes for higher reimbursement. To further streamline the billing workflow, the system includes dedicated biller logins, providing a secure and organized interface for managing claims and auditing efficiently.
Dashboard & Visit Tracking
The DN dashboard feature offers a centralized view for tracking and monitoring provider coding as well as delays in submitting charges. Users can clearly see which charges are pending vs. submitted. This helps to decrease missed charge opportunities. The dashboard also allows users to see if they are missing patient face sheets which include demographic information such as name, date of birth, and insurance information required for claim submission.
Conclusion: Optimizing Mobile Wound Care with Technology
The current challenges faced in mobile wound care, characterized by inefficient workflows and burdensome documentation, impede the delivery of quality patient care and negatively impact practitioner well-being. This paper presents a comprehensive roadmap to address these issues through the implementation DocNow, a single, automated EHR platform designed with insights from hundreds of wound care practitioners. DN’s prioritization of essential features such as phone/tablet compatibility, streamlined wound assessment and documentation, robust templates, progress notes, procedure notes, wound progress analysis, seamless integration with facility software, automated charge capture, MIPS & quality measures, and dashboard & visit tracking. The anticipated benefits encompass a reduction in burnout, improved clinical accuracy, enhanced continuity of care, minimized compliance risks, increased productivity, and optimized billing processes. Elements integral to the success of the workflow involve DN’s user-friendly interface, mobile photo capture with seamless syncing across devices, accessibility for facility staff, smart templates with assistive note generation, high interoperability, pre-defined "smart phrases," robust integration with facility EHRs, convenient charge capture, and comprehensive provider-led training and support. It is advisable to mention the impact of this optimized workflow on patient outcomes and highlight the cost-saving benefits for healthcare facilities. The significance of this impact stems from prioritizing mobile wound care technology as a transformative solution, emphasizing its potential to revolutionize the landscape of wound care practices and ultimately enhance the overall healthcare experience for both practitioners and patients alike.