How do you manage documentation when inpatient, outpatient EHRs are different?

Shawnee Mission Medical Center has different EHRs in separate care settings and that means informaticists have to accommodate varying workflows so they created a flexible system to manage it.
By Jonah Comstock
09:31 AM
clinical documentation challenges

Information technologies are rapidly changing the face of medicine. But what happens when practice changes faster than documentation can keep up?

That’s a question Andrea Hall, director of clinical informatics at Shawnee Mission Medical Center, and Christina Hiatt, the Center’s clinical informatics educator, has been working hard to answer. 

“We work at a facility that has an inpatient EMR and an outpatient EMR,” Hall said. “These clinics don’t really fit traditionally in either of those documentation systems, so we’ve had to come up with our own way to determine how to customize our existing things to make it work for them.”

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The Center’s heart failure clinic, for instance, is located in the hospital but is designed not to manage all of a patient’s care like a traditional inpatient clinic, but to prevent readmissions, like an outpatient clinic.

“The biggest difference is the workflow that it accommodates,” Hall explained. “In the clinic you’ve got a nurse or medical assistant that comes in and sees you or a provider that comes in and sees you; it’s a single encounter and you’re discharged. It’s generally customized to meet meaningful use and documentation requirements for that setting. With inpatient, we’re looking at longer lengths of stay and just a workflow of continuous documentation throughout your stay. You’ve got more consultants and more people there.”

Hiatt said there are two other big considerations besides workflow: financial considerations like billing and charging and identifying the key stakeholders. She and Hall advocate creating a flexible system, that can work for different kinds of clinics, rather than trying to create a new documentation system for each clinic.

“I think we’re limited, we can’t have 25 boutique solutions in here,” she said. “We’ve kind of committed to an inpatient EMR and an outpatient EMR. We need to keep our information easily visible, available through all of our continuums of care. So how can we tailor our existing systems to something they’re not designed to accommodate?”

Hall and Hiatt said answering that can be tricky because three different clinics might require three slightly different solutions. 

Andrea Hall and Christina Hiatt will be speaking in the session, “Navigating the Grey Areas: Outpatient/Inpatient Hybrids,” at 1 p.m. March 8 in the Venetian, Palazzo L.

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