Sarah Walker Case

The incomplete record and physician inquiry process are all done through EPIC, Lexington Medical Center’s EHR. As soon as the patient is discharged any quantitative deficiencies are automatically flagged in EPIC which then sends the notice to the physician’s inbox. Physicians are able to correct any deficiencies where ever they have internet access they do not have to be in their office or the hospital. If the deficiency is found by an analyst it must be added manually (see example 11.4). A lot of the doctors will send the deficiency back stating that it is complete, when it really is not; therefor there must be a work queue for any completed deficiencies to be reviewed. Any completed deficiencies are labeled “analysis needed”. After

The report is given to the HIM Operations Manager Wendy Johnston. The report is updated weekly and every physician on it is contacted and offered help in clearing them up if needed. Sarah Walker occasionally makes visits to the physician’s offices if she feels the delinquency is contributed to user error. EPIC trainers are also available in situations like this but Sarah is more familiar with what is needed for the completion of the record. If a physician is on the delinquent list for ten weeks straight they must have a meeting with the hospital Board. By the time that meeting arrives the physicians historically have their delinquent records taken care of. At LMC they do not suspend their physicians. If the physician leaves the medical practice with incomplete medical records there are efforts to contact the physician. If the physician was involved in a partnership the partners are allowed to complete the records. If no one can be contacted to complete the records there can be an Administrative closure justification. An administrative closure can also be done if the responsible physician has died. See example (11.2).

The Centers of Medicare and Medicaid Services requires no more than a 0.50% delinquency rate. At Lexington Medical Center the delinquency rate is around 0.06%. Before “go live” the delinquency rate was much higher. With the smooth work flow EPIC has created with checks and balances it has made it much easier to complete deficiencies before they become