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iQuery- It Was Right Under Our Nose the Whole Time!

Introduction

Do you have an EHR solution that makes it very difficult to produce and manage interdisciplinary documents that require Attending signature?  Do you want to develop a solution that does?  Do you want to not have to provision any new hardware or software?  Do you want to do it for little to no cost? If your answer to all of these questions is yes, look no further, iQuery is for you!

Sharon Hopkins
Every now and then, someone comes up with an idea that is so simple and so powerful that it makes your hair stand on end.  I had the pleasure of being in the room when my friend and colleague Sharon Hopkins, Administrator of Quality and Health Information Management at my own St. Mary Medical Center, Langhorne, PA (a member of Trinity Health) came up with such an idea.  My other friend and colleague, Barbara Lopez, Manager of Data Integrity was also in the room and soon after we all were mesmerized by the idea, she coined it's name- iQuery.  It is among the best informatics solutions I've ever heard of, and I am just proud to have facilitated it's production.

The Idea- An Example Workflow

A CDI (clinical documentation improvement) colleague reviews a chart on one of your units and identifies an issue that requires a concurrent query.  They pick up the phone, dial your EXISTING transcription system, enter the patients identifier(s), pick a preloaded CDI Query template, dictate off what should be checked, what should be filled in and who she is, and viola!  The document magically shows up in the Attending physicians eSign queue for review, edit, and signature!!!

Sharon, do you hear the applause?  Take a bow...

Impact of iQuery

The above workflow is one of dozens of applications- basically anything your hospital has on paper today that requires a physician signature can now be almost effortlessly sent to your doctors for review and signature.  The impact is now your providers will have 24x7 access (and maybe even be continuously prompted) to review these documents EVERY TIME they log in to the EHR rather than just the once per day they are at the bedside.  Higher completion rate and faster turn around time of these queries improves the infamous "discharged not finally billed" (DNFB), this metric is directly proportional to your bottom line.

Most CDI programs have at least a dozen query templates in their routine circulation, some have much more and one may wonder, why not just build this in the EHR in the first place?  Well, it's easier said than done.  First, many EHRs require that only PROVIDERS have access to clinical documents.  Next, building documents in an EHR, ESPECIALLY when you have a centralized informatics/IT division is not generally a speedy process.  Turn around time can be weeks to months for just a single document, especially in 2015 when the priorities are being continuously addended.  Finally, these documents are tweaked and prodded continuously towards perfection and therefore adding the complexity of a build process is not ideal.  Most transcription companies are fairly agile, often turning around change requests in hours.  Concerned about added expense?  Well the pennies (or even dollars) that you'll be paying for these previously non-existent documents will be WAY WAY WAY offset by a successful query adding generally thousands of dollars through your CDI program.  Don't step over thousand dollar bills to pick up pennies.


Did you know there is also a $100,000 bill?!?!


The Limitations

As great as this idea is, it's not perfect.  If you need STRUCTURED information in your EHR, this is not for you.  There is some cost involved in getting these templates through your transcription vendor and this can be an issue for initiatives that are not as lucrative as a successful CDI program.

Conclusion

I made a promise this year to contribute good ideas to this blog for mass consumption and I have a feeling this one is going to be tough to beat. It's been there the whole time and just makes me wonder what other treasures there are hidden in the corridors of our non-clinical areas in the minds of our brilliant colleagues.

The moral of this story is that you should hang out with your HIM colleagues more often...

Accepting Donations

With ICD-10 around the corner, if you don't have the $300k+ that some of the state-of-the-art query management systems are going for- tell your CFO to rest a little easier and send whatever you had budgeted as a certified check to my office address.  Sharon/Barb, I love you both but you're basically out-of-luck on this one...  well, I guess the least I can do is throw you a party with a portion of the proceeds.

Want to formally thank Sharon Hopkins and Barbara Lopez for allowing me to use their names in this article.  Any accolades of iQuery should be directed to them through feedback area below, I already get all the credit for most of their hard work as it is!!

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