AHLTA Teamwork, Efficiency and Coding

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AHLTA Teamwork, Efficiency and Coding

• LCDR Brian N. Bowes, MC, USN
• Or how to get the VCR to stop blinking the time.

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AHLTA What does it mean anyway?

• AHLTA (Aw Heck Lets Try Again)
• HALTA
• It is a proper name? Then why is it all
  capitalized?
• You want us to use it as a proper name? Fine
  but what does it mean anyway?
• Armed Forces Health Longitudinal Tracking
  Application
• Whose idea was this?

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AHLTA Misconceptions

• It will make us more productive.
• It is a documentation tool, not a productivity
  tool.
• It can improve healthcare, but at a cost.
• It will fix an inefficient clinic.
• We wont need coders any longer.
• Dr. Bowes designed it.
• I did not design it.
• I did not create this PowerPoint.
• Please check all sharp objects with HM1 in the
  back of the classroom.

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AHLTA Truths

• I have to use it to see patients too.
• I am currently a full-time provider.
• As a full-time provider I was forced to implement
  P-GUI and see 17 patients a day.
• AHLTA is evolving just as CHCS Legacy did.

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AHLTA

• Benefits
• Medical records availability
• Population Health (macro and micro level)
• Point of Care Decision Support

• Costs
• Time (implementation, learning curve,
  documentation)
• Effort (overcoming organizational and individual
  inertia)

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Objective

• Provide you with tools to help you use this
  system that we did not choose, but are required
  to use.
• Front desk
• Coding stuff
• Dummies Guide to AHLTA

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At first it is SCAREY!!
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Front Desk Procedures

• Both systems are needed
• CHCS Legacy Demographics and 3rd Party
  Insurance Verification, future appointment
  creation.
• AHLTA Check-in, Telcons, Walk-in appointment
  creation.
• Telcon Transition
• Telcons can only be seen and completed in the
  system that they are initiated. Each clinic must
  carefully coordinate the transition to AHLTA for
  Telcons. Forwarding Telcons between clinics also
  must be coordinated.
• Completed AHLTA Telcons are available in Previous
  Encounters.
• Communication with healthcare team via the
  Comment field

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Completed AHLTA telcons are viewable in previous
encounters.
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Default Appointment Screen
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Columns are actionable. Selecting a column will
sort by that column.
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Columns can be reordered by dragging them to the
new position. Comment Field from CHCS Legacy
appointment or AHLTA New Appointment window.
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View Comments will allow user to view and edit
comments.
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Provider must Refresh appointment screen to see
changes in comments as well as Statue.
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Everyone has a first time
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URI Template PMH elements
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URI Template PE elements
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URI AIM form
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URI AIM form
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We just did it!(if these guys can do it)
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Patient Flow in Clinic

• How to communicate without paper charts (Flags,
  Flip Cards, Comment Field)
• Minimizing trips to waiting room
• Vital Sign Area vs. Vitals in the Exam Room
• Dictated by physical spaces and support staff.
• Exam room provides support staff with the ability
  to document in AHLTA and privacy for screening
  questions.

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Junior Corps Staff

• Vitals
• S/O documentation
• CC/ROS/Past Med Hx/FHx/SHx, Developmental
  History
• AHLTA strategies
• Doctors have to do HPI

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Existing Vital Signs Module
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AIM form. Support staff should only complete
CC, PMH, Family and Social Hx, and ROS
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AIM form. Support staff should only complete
CC, PMH, Family and Social Hx, and ROS
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Edit Note Take over note retaining
documentation. The original note is move to the
change history section at the bottom of the
encounter. New Note Original note remains in
S/O section. New note may duplicate or even
contradict information in original note. Unique
elements in both notes are considered by EM
calculator. Delete Note Moves original note to
change history section with statement that it
was deleted.
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Edit Note using same AIM form. If the provider
selects a different AIM form, some data
documented on the support staff AIM form may not
be shown on the Provider AIM form.
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New Note. No elements selected by the support
staff are displayed in the new note. The
provider can use any AIM form, however some
elements may duplicated or worse contradict
documentation in the support staff note.
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New note results in both Support staff and
Provider notes being displayed in the S/O segment
of the encounter note.
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Support Staff Medcin Template with only PMH and
ROS elements
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Support Staff Medcin Template with only PMH and
ROS elements
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Support Staff note from Medcin Template
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Edit note using Provider Asthma Medcin
Template. (PMH and ROS elements are identical to
Support Staff template)
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Edit vs. New S/O Note

• Coding issues
• MHS and AMA coding rules allow support staff to
  document CC, PMH, Family Hx, Social Hx, and ROS.
• EM calculator will count elements completed by
  support staff which is appropriate if limited to
  these areas.
• Note flow
• Edit Note results in a better flow of S/O
  section, but clutters the change history section.
• Inconsistencies and Duplications
• New Note risks both
• Do not use different AIM forms with Edit Note as
  previous documentation my be masked in the S/O
  module.
• Edit, Delete and New note all retain clear
  documentation of who documented what.

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Break!!
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Coding

• Physician and Extended Provider Tips
• Communication with Coders/Auditors
• Tasking module (Due 28 APR)

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Coding EM Codes

• Defaults Encounter type Outpatient Established
• If you do not change it for New Patients and
  Preventive Care or Office Consult visits, you
  will loose RVUs
• EM Code Calculator
• AHLTA is a documentation tool that will count
  structured items in HPI, ROS, PEX to determine an
  EM code
• Poorly developed templates and AIM forms will
  generate low EM codes. (ROS elements)
• You must know when it under or over-codes and how
  to change it (URI visit should not get a 99214).

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EM calculator determines code based on
structured text elements
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99213 0.67 RVUs 99202 0.88 RVUs
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99213 0.67 RVUs 99391-7 1.02-1.71 RVUs
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Details displayed by pushing button
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Bored yet?
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ICD-9-CM and CPT-4 Codes

• Code Search
• Favorite Lists
• Problem list (Diagnoses only)
• Modifiers
• Extenders

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Adding Modifiers to Procedure codes.
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Coding Process

• Providers become default coders Coders become
  auditors and educators
• AHLTA writes to ADM
• Auditors can make changes to ADM but those are
  not written back to AHLTA. Auditors can not make
  changes to coding in AHLTA.

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Break
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Efficient Tips for Provider Documentation

• AutoNeg
• Copy Forward
• Dx Prompt

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AutoNeg - Responsibilities - Risks
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AutoNeg - Benefits
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AutoNeg - Benefits
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Copy Forward brings forward elements from a
previous encounter loading them for selection in
the current encounter
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Only those elements from the previous encounter
are contained in the Copy Forward Template. The
previous selection ( or -) is identified with
the yellow background. Free text is also
brought forward. The provider must select
elements to include them in the current
encounter.
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AutoEnter selects all previous elements and
associated free text but only for the tab
displayed (HPI, PMH, ROS, ..)
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Dx Prompt can be used to create a template on the
fly for a specific condition. It also provides
point of care decisions support.
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List Size will expand or contract the Dx Prompt
Template
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Break!!
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Provider A/P Documentation

• S/O template
• Diagnosis
• Templates
• Pts Problem List
• Favorite List
• Procedures (Lots of RVUs here)
• Template
• Favorite List
• Order Sets (Huge time saver)

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Select an Encounter Template then right click to
set that as your default.
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Template details for this Encounter Template.
S/O template is an AIM form
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Default S/O template will load for all patients.
Users other favorites available with drop-down.
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Default Diagnosis list.
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Default Order Set.
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Default Procedure list.
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Default Therapy list.
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Diagnosis Favorite List
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Procedures Favorite List
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Adding to your Favorite List
Tip If you had trouble finding a Dx or
Procedure, add it to your favorite list and move
it to the bottom. Move using List Management.
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Selecting a Diagnosis from the Patients Problem
List
All previous diagnoses a patient has been given
in AHLTA are added to the Patients problem
list. This list is managed in Problems in
Health History.
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Pre-positioned Encounter Templates note you must
have an encounter opened to activate the
Template Selections tab.
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Enterprise Templates Folder
Folder contains a subset of AHLTA encounter
templates. Many have been reviewed by Specialty
Leaders and Coders. Any user can select these
templates use them, add them to their favorites
or copy them. Only a few people can store
templates in this folder.
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Army Encounter Templates (about 200)
Specialty Specific Subfolders
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Example of an expanded specialty sub-folder.
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Add to favorites using tool bar or right click
drop down.
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Never move a template from the Enterprise
Folder!!! You will not be able to move it back.
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Managing Pts AHLTA Chart

• Problem List
• Med List
• Immunization History

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Productivity (impact of implementation)

• 30 reduction in available appointments for a
  provider for first 5 weeks of AHLTA training for
  that provider.
• Demand for encounters does not decrease so access
  will be impacted.
• Must balance need for providers to come up to
  speed (with trainers on hand) with access to
  care.
• All commands are facing the same implementation
  impact.

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AHLTA Enhancements(all due 28 APR)

• OB Summary
• Pediatric Growth Charts
• Telcon Redesign
• Template Management Phase 2
• Tasking Module

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Questions????
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HELP!!!

• How do I get help?
• Clinic super user.
• Command super user.
• Command Working Group
• Regional super user
• USAFP listserv / navyahlta_at_gmail.com

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Clinic Manager Course Links

• http//nshs.med.navy.mil/courses/CMC/Access
  Management.zip
• http//nshs.med.navy.mil/courses/CMC/AHLTA Master
  04 APR 06.ppt http//nshs.med.navy.mil/courses/CMC
  /AHLTA.ziphttp//nshs.med.navy.mil/courses/CMC/Cap
  turing Productivity.zip http//nshs.med.navy.mil/c
  ourses/CMC/Customer Service LTG.doc
• http//nshs.med.navy.mil/courses/CMC/Dental.zip
• http//nshs.med.navy.mil/courses/CMC/Metrics
  I.zip
• http//nshs.med.navy.mil/courses/CMC/Metrics
  II.zip
• http//nshs.med.navy.mil/courses/CMC/Optimal
  Clinic.zip
• http//nshs.med.navy.mil/courses/CMC/Overview.zip
• http//nshs.med.navy.mil/courses/CMC/PopHealth
  Improvement 2Apr06.ppt
• http//nshs.med.navy.mil/courses/CMC/Population
  Health Improvement and Tools.zip