EPIC woes

[Noyac]

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We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

 

[Planktonmd]

We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

The simple answer to this problem is: Keep labor epidural billing on paper, meaning create a paper billing sheet for each OB epidural that contains the info needed for the billing people.
The reason for the confusion is because on their side they are seeing that you produced an anesthetic record where the anesthetic is the epidural for a surgical procedure not an epidural as a pain management procedure.
Those paper forms should be left in your office and updated with time of delivery and time of epidural removal which would be end of anesthesia.
The morning team should review all the existing epidurals and designate a person to update the billing sheets.

 

[Noyac]

So plank, you are not documenting in EPIC the end of the labor? Only on the paper form?

 

[Planktonmd]

So plank, you are not documenting in EPIC the end of the labor? Only on the paper form?

On both because you still have to close the electronic record... but the billing people are instructed to only take the numbers from the paper form.
I don't use epic in my new job but that's how we did it in my previous one.

 

[sevoflurane]

We are still on paper although we have epic- easy cheese.
I basically use epic to find out my birth and placenta times which we use as our end times for running epidurals. No input into the system itself.
Still love the good old paper chart system for OB.

 

[deleted171991]

We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

I haven't worked in Epic for a good while, and I have no OB experience with it, but here are a few general principles I remember:

1) Correct. The responsible attending should change with shift change, as for any OR cases. Make sure that the first attending attests to everything s/he's done before leaving, otherwise you won't be able to finish that chart. Any change in staff should be marked in the anesthesia record.
2). No. The oncoming person will just have to assume care in Epic in that specific chart, and mark the end-time for the other attending and the start time for him-/herself. The first attending does not need to be present but, again, needs to update the chart and attest to everything s/he's done, before s/he leaves.
3) That would be the duty of the person leaving. If a patient has delivered, they should finish the chart without involving the oncoming attending. If a patient hasn't, see above. This should be part of the report, I would think.
4) No idea about that. We always did face to face signouts in the OR, and also took care of all Epic stuff on the spot.

I know you probably hate it now, but you'll end up loving Epic.

 

[Ezekiel2517]

We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

It seems like the issues aren't with EPIC but more with the docs in your group being clueless. They need to create an appropriate record for "labor epidural" and choose the correct macro for it.
1. Yes, they sign on as staff in EPIC. They wanna get paid right?
2. no
3. yes, whoever is on call when delivery occurs needs to document all that and the stop time and complete the record. Who the hell else would do it?
4. are you serious?

 

[Scotty_G]

Look on epic for delivery times. We take home call so if we have an epidural running at night and patient delivers we can finish/close chart the next day. Honestly if call person went home and the ob patient delivered then the new person can finish/close chart. It takes an extra minute or two. Yes you have to put Labor Analgesia. We have a macro for Labor epidural so when you click that and open it will not confuse billing/staff. Under the procedure I would put Labor epidural for analgesia and under diagnosis I would put Intrauterine Pregnancy/Labor pain.

 

[deleted171991]

Look on epic for delivery times. We take home call so if we have an epidural running at night and patient delivers we can finish/close chart the next day. Honestly if call person went home and the ob patient delivered then the new person can finish/close chart. It takes an extra minute or two. Yes you have to put Labor Analgesia. We have a macro for Labor epidural so when you click that and open it will not confuse billing/staff. Under the procedure I would put Labor epidural for analgesia and under diagnosis I would put Intrauterine Pregnancy/Labor pain.

Actually the dear overnight person can do that, too, in the morning, from home (hint Citrix). 😉

No need for the morning attending to touch a case s/he wasn't involved in. I'm not sure it's even legal.

 

[Scotty_G]

Yes but you know some of the "older folk" don't know how to do home access 🙂

 

[jwk]

We use a McKesson EMR for OR and GI, but it's too much hassle to use it in OB so we do it on paper.

 

[pjl]

The anesthesia end time can be automatically dropped in by epic based on baby delivery time. You have to make sure they do whatever they need to so that if you go to C/S it ends it 1 minute before that record starts.

We have it set up so you click the patient off a OB list which is showing only OB patients and gives all the stuff we care about: plt, BMI, etc. When you click, it automatically brings up Labor Epidural on the pick list for procedures, or you can choose something else.
Then in the charting part we reworked that to be a little more intuitive.

All this stuff takes a little programmer time though, get it done soon rather than waiting for them to stop initial support, it goes better early on at most places.

Feel free to PM me for more info.


Sent from my iPad using SDN mobile app

 

[Mman]

if you aren't billing time for the epidural, you can simply put a procedure note in and not bother with an anesthetic record. Do the procedure, use a smart note or smart phrase or whatever it's called as a macro for the note and then you are done. I suspect if you were billing time you could also just occasionally put an additional note in later without using an anesthetic record.

 

[Scotty_G]

Why not bill the time?

 

[Noyac]

Why not bill the time?

Because some carriers don't pay for time. They just pay a flat fee. I personally prefer the flat fee. It's cleaner and simpler.

 

[jthedestroyr]

I'm on Ob so I will tell you what our academic institution does. First of all, I love epic, but dang Ob epic has so much charting none sense, specially just documenting pulling an epidural.

We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

For our Ob, all start off as "Ob consult" aka pre op. Once the patient decides what they want, or time for epidural, we select patient again, link labor analgesia with the consult. Within epic, there starts the epidural protocol documentation.

1) On shift change, staff is changed to current person covering. They assume responsibility since they're in house.

2) We do a checkout, but nobody rounds on current epidurals. Only if there is a problem or they deliver and need to be pulled does resident check on the patient.

3) epidurals are pulled promptly by person during shift unless they're slammed with stat c/s

 

[sigrhoillusion]

Another nice thing about EPIC is that if a patient gets an epidural and then has to go back for an urgent/emergent C-section, you can link the epidural and the section and have it one seamless record.

 

[Hoya11]

We just implemented EPIC. As a group we are having some difficulty with a few things and you wou,d think that after all this time the installers and super users would have run across these issues and have a solution but they don't. They just say, "we are working on that and I will get back to you."

One thing that is really driving us crazy is OB and labor epidurals. I'm hoping somebody here can help me with this. Recently, our billing has sent me this statement:
We’re seeing records where physician is selecting Anesthesia Epidural Block instead of Labor Analgesia.

To charge correctly, need to select Labor Analgesia record type in OB unit.

Any ideas?
Also (these are some questions from my group),
1) Assume epidural placed overnight by call person, when next day new call person comes in at 0700 are we making it a policy that new 0700 Call person signs into that record as "staff"?
2) If answer to above is yes, new Call person assumes staff role at 0700, then is a face time required at that time of staff change?
3) Also, when Call person comes in at 0700, if an epidural placed overnight has since delivered, is it the call persons duty to determine which epidural pts delivered, what time delivery was, and enter into each chart to document delivery time as anesthesia stop time?
4) Should we be doing a face time on every patient since some insurances seem to require this? some of our payors are a flat fee and some are paid by time units.

These are just some issues with EPIC. Any help would be appreciated.

1. Yes. Someone has to be covering/managing even if you are not billing by time. Who do the nurses call for management issues?
2. No face time required at change over for uneventful situations
3. If the delivery time is on your shift, you close the chart. You dont turn over epidurals that have delivered because you are too lazy to check.
4. No