Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. 3.5.2 Important Systems Functionalities and Satisfaction

10/30/2005

Scheduling. The scheduling functionality of Epic was generally thought to be an improvement over the legacy practice management systems.  Our respondents were especially pleased at enhanced functions like a module that allows patients to be scheduled to a specific room and care provider at the center.  The software was also praised for its sensitivity to concerns specific to consolidated health centers, such as a mechanism that verifies that each patient has a paying agency affiliated with them (if applicable).  None of the centers we spoke with had major complaints regarding this aspect of Epic’s functionality. 

Electronic Claims Submission. Many centers using the Epic suite reported that their accounts receivable and cash flow are now more predictable due to the standardization of electronic claims submission. Respondents praised special features of the system such as built-in logic that allow identification of potential coding errors.  We were told that the Epic software permits better identification of coding inaccuracies before the claims are mailed, increases the likelihood that insurance claims are mailed at all, and improves the centers’ chances of receiving grants because grantors take the centers’ robust infrastructure as a signal that the practice is managed effectively. 

Although respondents recognized that the ability to submit claims electronically is a great improvement from the centers’ legacy systems, certain respondents desired a more streamlined billing process.  Some reported that having OCHIN as an intermediary (between health centers and claims clearinghouses/payers) tends to slow the process down and that in the past OCHIN has not always submitted claims to payers or McKesson on a standard, predictable schedule.   

Issues with custom billing. Because there are so many variations in how centers bill their patients and payers, Epic has had to customize its system to accommodate centers’ individual needs, such as adding different modules for sliding fee schedules.  This customization process presented occasional difficulties during its implementation.  For example, one consolidated health center reported problems with the sliding scale system they use to accommodate their vulnerable patient population.  Because they did not have time to adequately test the application during Epic’s implementation at their center, there were some gaps left in the system relative to their needs and the center experienced financial setbacks as a result. These issues have now reportedly been resolved.  Other clinics have experienced some problems with electronic claims submission to Aylers, which is the contractor the Oregon Public Health Department uses to distribute payments specific to the Family Planning Expansion Project (FPEP).  In these cases as well, the respondents indicated that they would have liked more time to assess the requirements of the health centers pre-implementation.

It should be noted that billing complications were not attributed solely to the Epic system.  One respondent noted that providers do not always fill out the paperwork correctly (for example, certain items are not always coded properly), which results in delayed or insufficient payment.  Also, several of the billing issues mentioned by respondents were attributed to the process of implementing a system of Epic’s capacity in health centers. In general, respondents recognized that billing problems were often not the result of poor management on OCHIN’s part or inferior quality of the software: they assumed that the difficulties the health centers had experienced would inevitably arise in the course of launching a specialized IS collaborative.

Out-of-State issues. Some OCHIN centers, especially the out-of-state IPM partner in Seattle, WA, experienced difficulties when billing claims to Medicaid programs. In customizing the system for use by the Pike Market Medical Clinic of Seattle, OCHIN was not always able to identify potential problems or differences in the Medicaid billing office requirements or processes ahead of time in order to avoid delays or complications.  For example, in Oregon, procedure codes must be bundled to be submitted to their Medicaid office for payment.  Washington’s Medicaid office, however, does not recognize bundling.  Early on this issue resulted in some payment denials for the health center.  Although this problem has largely been resolved, Pike Market still reports issues with the billing component of the practice management system, which has resulted in declining cash collections and rising accounts receivables.  Currently, Epic is customizing its system for use in the California consolidated health center and may be able to avoid some the complications it has faced in its implementation in Washington.

Networking with OCHIN.  Initially, establishing and maintaining a secure, efficient connection with OCHIN posed an important challenge, particularly for smaller health centers with little existing systems infrastructure and no in-house technical expertise.  One site reported some initial difficulty in setting up Citrix clients during Epic’s implementation in their center, but that issue has apparently been resolved.  Likewise, some sites reported initial difficulty configuring connectivity with the OCHIN WAN, but they attributed this difficulty to typical start-up difficulties with a new service initiative and did not report serious ongoing incidents.

Reporting. While many health centers indicated that ease of reporting was an important consideration in their decision to join OCHIN, health centers meet with mixed results when using Epic to report. When probed on the issue, most centers indicated that they found the software complicated to use but were able to produce more accurate and tailored reports than with their previous system. Centers that lacked a dedicated technical staff reported the most problems.  For example, one center trained three staff members to use the Clarity reporting system, but due to its complicated structure, these staff are often still not able to generate even simple reports that are used system-wide.  If the center needs to produce more complicated reports, it is completely dependent on OCHIN staff and technical support.  Additionally, the Pike Market Medical Clinic in Washington reported that the data requirements differ by state or locality and often the information that is compiled for Epic’s canned reports is not the information that is required by the State of Washington or City of Seattle. Other centers had concerns with Epic’s canned reports as well, stating that they do not cover all the necessary data requirements.

Centers that did have IS staff knowledgeable about Epic’s Crystal reporting system experienced fewer setbacks when producing reports and often saved time on presenting the data they need to get funding.  For example, the Tillamook County Health Department has a reporting group composed of members who each have experience generating a specific type of report, so that when that type of report is needed the job is assigned smoothly.  Several centers employing staff with some technical expertise observed that Epic’s reports offered more flexibility than their legacy reporting system did, so that they could choose to submit higher quality, more accurate and tailored data to the county or state.  This level of accuracy often helped centers in receiving valuable wrap-around payments designed to fill the gap between the capitated payments and the actual cost of managed care patients served by the health center.

HIPAA compliance. Although the HIPAA compliance aspect of the Epic system was not generally a driving force behind the IPM partners’ decisions to join OCHIN, it was often noted as an attractive feature.  Utilization of the McKesson Clearinghouse relieved the pressure on health centers to develop a solution around HIPAA data exchange procedures with their payers.  This relationship ensures that centers are compliant with HIPAA standards relating to transactions and codes sets.  Respondents at the Klamath Open Door Clinic also noted that many of the legacy software vendors were unable to provide documentation of HIPAA compliance to the health centers, so the Clinic felt greatly relieved to be working with OCHIN, Epic, and McKesson, who have supplied such documentation.

In-house IS resources. It should be noted that many of the health centers best satisfied with the Epic system and its technical functionality were also centers who had some internal IS staff (or at least staff who were knowledgeable about IS systems).  While the OCHIN and Epic support staff were able to help centers take full advantage of the functionality of the software, the process was greatly expedited if there was a member of the health center team who was knowledgeable and capable of manipulating the system and fixing simple problems.  While some of the smaller centers (such as Klamath Open Door Clinic) had qualified and expert individuals that facilitated their use of Epic, other smaller centers who did not have staff dedicated to working with the Epic software were less satisfied with both the technical aspects of OCHIN as well as the organizational and process aspects detailed below.

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