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Maura Cash - Policy & Procedure Changes After Implementing an EHR
237 Plays1 year ago
When it comes to implementing an EMR, there are a lot of steps to consider. One often overlooked step is updating your Policies & Procedures. Maura Cash is the Vice President of Clinical Strategies at HST Pathways, and she is here today to walk us through which policies and procedures need to be updated, which need to be created, and why it matters.
In our news recap, we’ll cover celebrities who are joining the price transparency fight, news from the White House on COVID-19 vaccines, Walmart Health’s latest move, and of course, end the news segment with a positive story about a teenager from Maryland who is making a big difference in her community.
Just a reminder that we are taking next week off due to the ASCA Conference in Kentucky from May 17-20th. Our next episode will air Tuesday, May 23rd. If you will be at ASCA, make sure you stop by HST Pathways’ booth to say hello and join us for a quick interview so you can be on an upcoming podcast episode. We’ll be at Booth 519, it’s a big booth right in the middle of the floor, so please stop by, we'd love to see you all!
Articles Mentioned:
Fat Joe Fights for Health Care Price Transparency at Capitol Hill
Walmart Health expands into Oklahoma
How 1 teen coped with tragedy by organizing book drive for sick children
Brought to you by HST Pathways.
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Transcript
Introduction to the Podcast
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Implementing an EMR: Steps and Importance
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode. When it comes to implementing an EMR, there are a lot of steps to consider. Internal buy-in, vendor research, implementation, training, support, the list goes on. But one often overlooked step is updating your policies and procedures.
00:00:46
Speaker
Maura Cash is the Vice President of Clinical Strategies here at HSC Pathways, and she is here today to talk us through which policies and procedures need to be updated, which need to be created, and why it matters. In our news recap, we'll cover celebrities who are joining the price transparency fight, news from the White House on COVID-19 vaccines, Walmart Health's latest move,
00:01:09
Speaker
And of course, end the new segment with a positive story about a teenager from Maryland who is making a big difference in her community.
Impact of ASCA Conference Break
00:01:17
Speaker
And just a reminder, we are taking next week off due to the ASCA conference in Kentucky from May 17th to the 20th. So our next episode will air Tuesday, May 23rd. And if you will be at ASCA, make sure you stop by HST Pathways booth to say hello and join us for a quick interview so you can be on an upcoming podcast episode.
00:01:38
Speaker
We will be at booth 519. It's a big booth right in the middle of the floor. So please stop by. I would love to see you all. And that is it for me. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
Updating Policies for EHR Transition
00:01:57
Speaker
Hi, Maura. Welcome to the show. Hi. Thanks for having me.
00:02:02
Speaker
I personally am so excited to have you on today. If anybody is not watching on video, you can't see the big smile on my face. But today we have a surgery center legend, clinical expert, OR manager, celebrated nurse, my sometimes therapist.
00:02:21
Speaker
and a great friend, Maura Cash. Can you give our listeners a little bit of info about you and your experience in the ASC industry? Sure. I've been a nurse for 45 years, sometimes hard to believe, but in the ASC industry for over 20. Started out as a staff nurse, just like everybody does and worked my way up. I've always been
00:02:51
Speaker
fascinated with electronic health records and with computers in general, and was able to apply that to my progress and my leadership eventually of an ASC award. So yeah, it's been a fun ride. And one of the great things about nursing is that you can learn new skills,
00:03:17
Speaker
and then apply them to nursing to create better patient care and outcomes. Perfect. Yeah. And that's a great segue because given your background, you are no stranger to the implementation process for EHRs. And it seems like one area that is often overlooked is the process of reviewing the policies and procedures surrounding medical records.
00:03:39
Speaker
So let's pretend this is brand new information to some of our listeners. Why do existing policies and procedures need to be reviewed and updated prior to implementing an EHR? What do they currently lack that this needs to take place? Great question. So when a center switches or is thinking about switching to an electronic health record, the policies and procedures that used to apply to the manual paper world will absolutely have to change.
00:04:09
Speaker
Any of those procedures associated with the care of the medical record, they're very different when an EMR comes into view. So what to look at first? So review your current manual or have a group of staff do it, which in my opinion is even better, and have them tag every page that has to do with a chart. That's the first step. And that could be done now, even if you aren't planning on an EHR for the next year or so. Then I would look at
00:04:39
Speaker
access and permission. So you can no longer just lock up your charts in a room and say, okay, they're safe. No one can access them. But let's be honest, when you have paper charts, a lot of people could have looked at that. No one would have known that anyone was looking at that chart. But now you could truly safeguard your patient's PHI and be able to show an audit log of who accessed what, when.
00:05:07
Speaker
make sure each user and non-user of the chart have the access that they need, but not all permissions to all people.
Maintaining Processes and Managing Old Charts
00:05:17
Speaker
So a lot of people think, I just need my users to have access. And then you look at, well, no, because my billers will have to look at the operative report. And somebody else might have to look at in medical records, might have to look at that entire chart. So even though they're not users of the chart,
00:05:37
Speaker
they have a part in that process and therefore will need permissions and access. So it's no longer just a locked medical records room. It's how, when, and who will have access to that. Got it. So I would also look at your chart completion process. What are the consequences? So currently a lot of places say the chart hasn't completed 30 days and if it's not,
00:06:03
Speaker
They get this reminder and that reminder and then finally they can't schedule cases or whatever. But make sure you have consequences for your chart completion if it's not done. Make sure you can live with the consequences that you have and make sure that somebody is still assigned to monitor those chart completions and have everything done in accordance with your bylaws. So make a policy and procedure about chart completion
00:06:33
Speaker
that you can live with and make sure that at least two people at your center at all times know how to do that. So one person is never enough, right? And then I would look at release of records. Right now they have to sign a release, they have to go in, they have to get copies of that paper chart. Someone sometimes has to go retrieve it from somewhere to get back, to get copies of that paper chart.
00:07:01
Speaker
Those policies and procedures all completely change when you have an EMR. So what you're going to want to do for release of records, and of course the Cures Act clearly states everyone is entitled to free and immediate access to their medical records. Make sure you know how you're going to do that. Will you print it out and hand it to them? Will you send it to them electronically?
00:07:25
Speaker
via email, will it get forwarded to their physician's office? Like what is your new policy and procedure going to be? So I would definitely look at that. That's going to come up pretty quickly. And storage and retrieval of the old records. I wish I could say that problem instantly resolves itself when you go to an EHLI.
00:07:44
Speaker
It won't. So you still have to say, what are we going to do with those old charts? Are we going to scan them into our new system and keep them in storage? Who's going to be responsible for retrieving them? So even though that policy might be there, it will definitely have to be tweaked to meet the needs of your EHR. And who is responsible for this? Again, have two people with the permissions to accomplish the new procedures and policies that you set into place.
00:08:14
Speaker
And if someone leaves your employment for whatever reason, theirs or yours, make sure you replace them with somebody competent who can then have those procedures, have those permissions.
Staff Training and Buy-In Challenges
00:08:25
Speaker
So you want to make sure somebody is in charge of assigning permissions and removing permissions. Again, it's all about access, right? Sure. Thank you.
00:08:40
Speaker
a great comprehensive list. In your experience, what are some challenges that surgery centers will face? So they have their list of things, right, that you just listed, things they have to change. But what are some of the challenges they might face while trying to roll these out? Yeah. Sending out policies and procedures for staff to sign. I mean, it's a constant thing. You update a policy, you send it around. Everybody signs that they send it back. Unfortunately,
00:09:11
Speaker
This is a totally new process to everyone. And it can't just end with, here's the updated policy. Read it. Thank you. You're done now. Sign off on it. It's a really good idea to make sure that they understand how they will utilize that policy and procedure and that it will get the results that you want accomplished. So even though you wrote a great policy and procedure,
00:09:40
Speaker
that you have to show them how to follow it. So let them practice. Let them work through a training environment and run your policies, your new procedures through a training environment to make sure that they're going to work before you push them out. There'll be a lot of ruffle feathers. No one likes change, especially people who are really good at their job and they've done it for a long time. And all of a sudden you're saying all those
00:10:09
Speaker
Skills that you've used to complete this in the past aren't relevant anymore. The people are still relevant. And while their jobs will change, they don't disappear. So change is not all bad, right? I would encourage you to own the change. Let some of these experts in the field already explain to them what their new role is going to be and let them
00:10:39
Speaker
own that change and be the catalyst to teach everybody else about it.
New Policies for EHR: Remote Access and Compliance
00:10:45
Speaker
Yeah. And it's interesting because I feel like whenever we're talking about implementing anything new, we always talk about the importance of having the staff buy-in and keeping them in the loop and involved before we even get to this point. So that when we do get here and we are introducing new policies and procedures, nobody's caught off guard. Everybody to a level expected this to some degree. So yeah, that makes perfect sense.
00:11:09
Speaker
So we covered existing policies and procedures that need to be changed and updated, but what about ones that will need to be created brand new and from scratch? What does that look like? Yeah, so I mean, I can't give you a few, but every center is a little bit different and they're going to stumble upon something and go, we don't have a plan for that. So what the first one I suggest is,
00:11:39
Speaker
Remote access. Will you let your users access the system from home or from their office? Who in the physician's office will be allowed to have access? What are the exceptions to that rule? You're going to have them. You're going to have somebody who's on extended leave who has a chart that's incomplete. How are you going to get them? Even if you don't allow remote access, are you going to have exceptions to that policy, including
00:12:07
Speaker
You know, what are you going to do if somebody is let go from your center for whatever reason and may have incomplete records? How will you get those records complete? What is your process for that? And really policies and procedures are just about, you know, the policy is the main goal and the procedure is the process that you follow to accomplish your goal. So really keep that goal in mind, but make sure that you give everybody a little room to use their, um,
00:12:37
Speaker
their common sense, their use of practice, their expertise in their field. So remote access is definitely one. The other one that people don't think of, and it always kind of surprises me a little, is the device. Someone has to handle the device and the hardware. You have cleaning, you have storing, you have charging, you have setting it up, you have the firewall, you have access, you have BYOD,
00:13:07
Speaker
which kind of a new term since EHRs, bring your own device. So you're going to have doctors who want to bring in their iPad. With EHRs, nothing is stored on the device. Everything is stored in the cloud. So having them bring their own device into the center is really not a security risk, as you might think, as long as they have the same firewalls and protections up. But you need to address that because it is going to come up and you want to make sure that you have policies around it.
00:13:35
Speaker
And then the biggest new policy I think that comes out of this is downtime. Nobody likes to talk about downtime, but there are many reasons why your assistant could go down. Your wifi could go down. The building across the street could be having work done and somebody's digging up the road. You have to have a backup plan for what happens in downtime.
00:14:03
Speaker
Where are your paper charts? Who is the go-to contact person, the main person? What is your process? Who do you call first? Who do you call second? Who do you call third? Who communicates that to all of the staff? If you decide to go to paper and you've used paper charts and the crisis is now over, how much of that information gets posthumously entered into your EHR to keep your report straight and keep your information straight?
00:14:32
Speaker
So it's really important to add that section to your emergency plan, what to do, just like you would for a tornado or a hurricane, what to do with downtime on your electronic health record.
Involving Teams in Policy Creation
00:14:45
Speaker
And the last one I would suggest is around HIPAA. We've all heard HIPAA. You understand HIPAA. We understand patients' health information needs to be protected. But with an electronic health record, you can actually
00:15:02
Speaker
prove it. You can actually run audits and say, no one who shouldn't have had access to this chart has access to this chart. And you need to run those audits and you need to come up with a policy and procedure, how you're going to run those audits, how often you're going to run those audits. Are you going to run it when you have a high profile patient? Is that going to be your standard that you follow? And most importantly, what are you going to do?
00:15:33
Speaker
when someone accesses a chart that they should not have accessed. People are curious. A couple of years ago, George Clooney was in an accident and he was in a hospital and a bunch of nurses accessed his chart and it was audited and found out. George insisted that these nurses not be fired. And I think that was really nice of him.
00:16:00
Speaker
In this day and age when staffing is so hard to find and recruiting is impossible, maybe you don't have a one and done policy here. Maybe your policy, if someone accesses a chart that they shouldn't be, is that they go to a training class for HIPAA and they get another chance, right? And then you monitor them successively. But make that a policy.
00:16:30
Speaker
outline your procedure, make sure everyone knows what the consequences are because you're going to have to enforce them. Sure. Okay, so just to sum it up, it looks like we're looking at four new policies, the remote access, the devices and hardware, the downtime, and HIPAA. Yeah, and that's probably just skimming the surface, depending on how in-depth your policy procedures are now, but I would definitely create those.
00:17:00
Speaker
Yeah. Yeah. And in the process of creating the new ones and updating existing ones, which members of the team do you typically suggest bringing in to be part of this committee and process? Yeah. So honestly, in my experience, it was just me on the weekends sitting there trying to create policies. And I do not recommend at all. The more people you involve, the more ideas that you hear, the
00:17:30
Speaker
easier the process will be and the more buy-in you'll get from the staff because they assisted in creating it. So I would make sure I had an IT person, a medical records person, a representative from each of the clinical areas of care, and business office representative from the non-clinical. If you can get a physician representative, more power to you. That would be fabulous. But even if you can't, maybe a PA.
00:17:59
Speaker
maybe someone from their office who's willing to sit in, who you know is a really strong EMR player for their office system, that might be somebody of interest. You're making policies and procedures that affect both the users and the non-users of the chart.
Ensuring Updated Policies for Accreditation
00:18:17
Speaker
So you need to make sure you incorporate those people into your committee, if you can create a committee to do that. If you can't create a committee, Erica,
00:18:29
Speaker
There are so many resources online in your associations, in blogs that abound in your community, other people you've networked with. Those are the people that you can reach out to and say, you know, we're a small center. We all wear a ton of hats and I just need some help on this input. And your vendor should be able to hook you up with some people who
00:18:56
Speaker
are using the system now, who you could gain from their experience as well. Yeah, that's a great call out. And I also feel like on Ask a Connect, I see stuff about policies and procedures all the time. People are always asking, hey, what do you guys have for this specific policy? And people are more than welcome, more than happy to share. Absolutely.
00:19:16
Speaker
Yeah, that's a great call out. And let's say somebody does not take the time. Wouldn't be any of our listeners, but let's say somebody doesn't take the time to update and create new policies and procedures. What are the implications of getting this wrong and not doing that? You're going to have some chaos. You're going to have some initial chaos that you can avoid.
00:19:44
Speaker
At the last minute, somebody's gonna say, who's setting up users? How do I get in? I don't have the right permissions. Why do I have access to that? I need access to that. I need this, I need that. Oh my gosh, this isn't working right. What do I do? If you don't have some policies and procedures, instead of coming up with this through each record, that day, day by day by day, you're gonna have
00:20:12
Speaker
another issue, another issue. So that first three weeks of your EHR go live will be much more chaotic for you as the team lead in charge of the EHR, but also for all of your people who are not only now learning a new system, but learning all the new policies that
00:20:38
Speaker
that need to be put into place on the fly to handle some of these issues. So I would, I mean, if you don't have some of these things in place beforehand, you will have a much more difficult go live. And if your next accreditation survey is coming up within three to four months of starting an EHR,
00:21:05
Speaker
You're really going to want to make sure that those policies match because they're going to read that we locked the medical records room at the end of the day, and it's always manned by this many people. They're going to say, oh, where's your medical records room? Oh yeah, we're electronic now. We don't have one. So that doesn't usually fly with surveyors, especially if you've been on an EHR for several months.
00:21:33
Speaker
So I would get certain things absolutely down. And then it's okay to say it's a work in progress. I'm working on updating a lot of our policies and procedures. We just went live a month ago, two months ago.
Aligning Policies with Practices
00:21:47
Speaker
They will understand that as long as they know that you know, you've got to update these and that you're in the process of doing it. And that's okay. They do have a real understanding that this is,
00:22:01
Speaker
a continued process. It's not a one and done kind of thing. Sure. Yeah. Yeah. Makes sense. And again, I don't think, you know, I feel like everybody probably understands they have to do a little something in this arena, but probably, you know, it's good to have a reminder of the depth of it and what you need to do. So thank you, Maura. I have one final question for you. We do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers?
00:22:34
Speaker
Well, if I'm sticking this topic, I would have to say to have policies and procedures that are not just for surveys and are not just an exercise on paper. You don't want to set yourself up and your team up for failure. So sitting down with your team and listening to them, having that heart to heart, and not just about EHR policies. If they say to you, this policy, this procedure is not what we're doing. We can't do this.
00:23:04
Speaker
the time to boost, resources to do this. We don't have the environment to do this in. Change your policies. Make sure that your policies are, yes, same for the patient, absolutely geared towards positive outcomes, but also they need to be able to be followed by the staff that are expected to deliver care to the patients and or
00:23:32
Speaker
bills to the patient and or medical records for those patients. They have to be able to follow those policies. And if you can have a heart to heart with your staff that says, hey, you guys look at these 10 policies and tell me if we're not really doing any of this stuff, because if you're not really doing it, then it's really not a policy and procedure. That's what I would recommend to everybody because
00:24:00
Speaker
We are all about keeping our staff happy, keeping them in their jobs that they're doing and what can better let these people know that they're valued than hearing them and listening to them and making the changes that make their job easier. Sure. Thank you, Maura. That is wonderful advice and I'm so appreciative of your time and expertise and thank you for coming on the show today.
00:24:29
Speaker
Thank you for having me. It's been a pleasure.
Healthcare Price Transparency Advocacy
00:24:35
Speaker
As always, it has been a busy week in healthcare, so let's jump right in. Rapper Fat Joe recently joined the transparency fight and testified before Congress about the need for healthcare price transparency. During his testimony, Fat Joe shared his own experience with skyrocketing healthcare costs and called for greater transparency in pricing.
00:24:57
Speaker
He stressed the importance of patients having access to clear and accurate pricing information before receiving treatment so that they could make informed decisions about their care. He also spoke about the challenges faced by low income and minority communities in accessing affordable healthcare and how price transparency could help to reduce those disparities. Now, Fat Joe's testimony comes at a time when healthcare costs are a major concern for many Americans and there's a growing push for greater transparency
00:25:27
Speaker
pricing across the industry. Now, we are all very familiar with this, and we have talked extensively about the No Surprises Act and treating your patients like consumers. I always like to use the airplane analogy. Would you ever get on an airplane not knowing how much it would cost? No. You purchase it upfront. It's very clear.
00:25:48
Speaker
Imagine getting off the plane, not knowing how much it costs, or maybe having a ballpark. And then in the coming weeks, you've received separate bills from the airline, the pilot, the flight attendant. Of course, you would never accept that. But this is what we expect of our patients.
00:26:05
Speaker
So as patients continue to struggle with rising costs and lack of access to affordable care, advocates hope that increased transparency will help to level the playing field and make healthcare more equitable for all. So it's great to see someone like Fat Joe using his platform to raise awareness about such an important issue. The more voices,
Policy Changes: End of COVID-19 Vaccination Requirements
00:26:26
Speaker
the better. So we'll be keeping an eye on this story as it develops and we hope to see more progress in the fight for healthcare price transparency in the near future.
00:26:36
Speaker
Big news from the White House, the Biden administration has announced that it will be ending COVID-19 vaccination requirements for federal employees, contractors, international travelers, and CMS certified facilities at the end of the day on May 11th, 2023. So depending on when you're listening to this, the requirement might already have been lifted.
00:27:01
Speaker
The decision comes as the country continues to progress in the fight against COVID, with vaccination rates steadily increasing and case numbers declining. The administration has emphasized that vaccines remain the best tool for ending the pandemic, but that the time has come to shift focus towards encouraging vaccination versus mandating vaccination.
00:27:21
Speaker
So under the new policy, again, federal employees and contractors will be encouraged to get vaccinated, but will not be required to do so. And you know, those 6,000 or so CMS certified surgery centers will also no longer be subject to vaccination requirements. And as you can imagine, the announcement has sparked plenty of debate with some criticizing the decision as premature and risky. However, others see it as a positive step towards encouraging more people to get vaccinated voluntarily.
Walmart Health Expands in Oklahoma
00:27:54
Speaker
In our third story, Walmart Health, the retail giant's healthcare division, is expanding its services in Oklahoma. The move comes as part of Walmart's broader strategy to expand its healthcare footprint and offer affordable, convenient healthcare options to more people. Walmart Health clinics offer a range of services, including primary care, dental, behavioral health services, as well as lab and x-rays.
00:28:20
Speaker
The company aims to provide high quality care at a lower cost than traditional healthcare providers, making it an attractive option for many consumers. Now the expansion in Oklahoma will see Walmart Health opening new clinics in the cities of Tulsa and Broken Arrow and just adding to the existing clinics that are already in the state. And their goal is to open more than a hundred new clinics across the country over the next few years.
00:28:48
Speaker
As you can imagine, the expansion of Walmart Health is seen as a potential disruptor in the healthcare industry. Given their scale and resources, it really allows them to offer services at a lower cost than traditional providers. Major concern being the potential impact on small independent providers in the areas where Walmart Health does choose to operate.
00:29:11
Speaker
So this is a story that I'm particularly interested in as we talk about price transparency and rising costs of care and couple that with social determinants of health, including the transportation story that we've reported on last week. The more accessible options, the better for our overall population health. But I do understand completely the impact this might have on the smaller providers.
Inspiration from Book Donations to Cancer Patients
00:29:36
Speaker
So we'll be keeping a close eye on how these clinics go and where Walmart Health decides to go from here.
00:29:43
Speaker
And to end our new segment on a positive note, Emily Batnagar is a 19 year old from Maryland and she has donated over 15,000 books to children undergoing cancer treatment via her book drive for Love and Buttercup.
00:29:59
Speaker
Her father was diagnosed with stage four thyroid cancer in 2019. Also happy to report he is alive and well now. And she just couldn't imagine children going through the same experience. So she decided to organize a book drive for pediatric cancer patients to bring joy to their lives and to their day.
00:30:19
Speaker
Now it's been almost two years that she started her first book drive. Um, and she has been able to collect and donate over 15,000 books to local hospitals in the DC area. Um, and if you would like to support, check out her Instagram at for love and buttercup.
Episode Wrap-up and Listener Engagement
00:30:36
Speaker
And that news story officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we'll see you again in two weeks after ask.