The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

CLINICAL INTELLIGENCE IN RESPIRATORY CARE: BENEFITS OF USING AUTOMATED TOOLS FOR IMPROVING REVENUE CAPTURE AND MONITORING CLINICAL DOCUMENTATION COMPLIANCE

Dexter D'Costa, MBBS, MHA, Dan Murphy, MS, RRT-NPS, St.Louis Children's Hospital, St.Louis, MO.

Background: The adoption of clinical documentation systems is increasing in healthcare organizations. Electronic charting is now becoming an integral component of a majority of respiratory care departments. There is an urgent need to develop tools that provide respiratory care managers with the ability to effectively monitor clinical documentation compliance. The project evaluated the use of automated tools for improving revenue capture and monitoring clinical documentation compliance in respiratory care.

Methods: The project utilized an integrated querying, reporting and analysis tool called 'Business Objects Desktop Intelligence'. The automated tool performed queries on clinical documentation done by respiratory care staff. Existing audit methods included manual chart audits that were very time-consuming and ineffective for monitoring compliance. The primary objective of the project was to improve the accurate capture of revenue charges associated with respiratory documentation. The project began in November 2005 and was evaluated over a six-month period. Respiratory care coordinators had access to automated reports at the end of every shift to monitor compliance. Numerous change management processes were introduced to enhance the role of automated reports. A monthly Respiratory Care Scorecard was developed to provide feedback on revenue capture compliance. Staff meetings were held periodically to educate respiratory care staff on their performance. Mobile wireless computers were provided to staff to address the issue of device availability and promote point-of-care documentation.

Results: Automated reports provided the respiratory care coordinators with a real-time monitoring tool to ensure accurate capture of revenue charges associated with respiratory documentation. The number of missed respiratory treatment charges decreased significantly from 265 in November 2005 to 13 in April 2006 (a 95% improvement). This amounted to additional monthly revenue capture of approximately 10,000 dollars for the respiratory care department. Automated reports helped provide respiratory care staff with feedback/education on their documentation practices. It also provided the impetus for implementing a major re-design of the respiratory care documentation module in May 2006 to improve revenue capture and enhance respiratory workflow. The following table shows the improvement in revenue capture:

Month/Year No. of Missed RT Txs Dollar Equivalent
November 2005 265 $10,390
December 2005 92 $4,050
January 2006 23 $1,010
February 2006 32 $1,341
March 2006 33 $1,355
April 2006 13 $468



Conclusions: Automated tools have a significant role to play as respiratory care departments adopt clinical documentation systems. This needs to be coupled with change management processes that facilitate staff buy-in as well as support respiratory workflow. Respiratory care departments need to invest in 'Clinical Intelligence' to facilitate the effective monitoring of clinical documentation compliance in real-time and thus improve revenue capture.

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