Dear Physicians

Dear Physicians:

We get it. We know why 98% of you have yet to embrace inpatient electronic documentation. It’s about your time. You are getting paid less for it, and you have more patients to see every day. You like paper because it’s fast and easy. And, you don’t like paper because you do a lot of redundant documentation. Also, you don’t like wasting time rewriting notes that were lost in the black hole that exists somewhere between the floor and the HIM department. You don’t have the time to learn a complex new system when it finally arrives, especially one that was thrust on you without forewarning or any input from you. You don’t have time to change your workflow to match a structured template that did not consider your specialty when it was designed.

There are myriad solutions that were built from legacy systems that are now being sold as Enterprise Medical Record systems, where physician documentation is merely a check mark in the agreement, and you were not given any say in the purchase. For those of you that have been forced to use these systems, you don’t have the time (or the money) to wait for these legacy system vendors to update the electronic forms every time your workflow changes, CMS requirements change, or billing requirements change.

We have developed a model that addresses these issues, and we have proven that the model works for thousands of users at a handful of prestigious customer sites that already own an EMR. You no longer have to imagine what your inpatient electronic notes are going to look like before you start using them because you will participate in the requirements gathering process and the design process. Training will not be an issue because the paper form can be used to drive the initial design of the electronic note. Almost equally important, the tools that we provide enable a rapid design-review-redesign process that continues after you go live. No more waiting months for process improvement. Like making a turn in a Formula-1 speed boat instead of the QE II.

Before you know it, you will be documenting more thoroughly, your billing will improve, and you will realize that you have only just begun to understand the full potential of electronic documentation.

How do we do it, you ask? We have a 5-step model, where we combine industry best practices with state-of-the-art tools to create an impatient documentation system that can go live within three months with notes that are tailored to your needs. The 5-step Form Development Life Cycle is:

  • Gather Requirements
  • Create Form Images
  • Create the Interactive Overaly
  • Deploy to TeamNotes
  • Collect Feedback for process improvement/design updates

WARNING: Success is contagious. Physician departments not chosen for initial implementation will begin lining up faster than you can say, ‘ARRA put to good use’.

The application updates that go along with the license purchased by your organization also includes the tools and training to take full ownership of the Forms Development Life cycle.

Sincerely Yours,
Salar, Inc.

1. Gather Requirements.

Salar provides a requirements check list that considers all the features available in the electronic system to maximize efficiency for end users (interfaced items, droplists, check boxes, etc.) , and also considers the needs of hospital coders and pro-fee billing systems. The process involves end user physicians, customer project leads, IT staff, Medical Records, and other customer subject matter experts. Steps include:

  • Review paper forms in use; use as a guide for discussion
  • Accompany physicians and document current processes/workflow
  • Demonstrate and discuss electronic forms features and options with end users, including carry forward, external data integration requirements, single or multi-signature forms, billing service and procedure (CPT) codes, diagnosis (ICD9) codes, etc.

Assumptions for success:

  • A physician champion/end user participates (this phase and all others)
  • 80/20 rule applies: the goal is not to please every single user, at least initially. If you try to please everyone, you will never get the project off the ground

2. Create Form Images.

Salar recommends Microsoft Visio because it offers a variety of design options, and you can save files as .WMF files (Windows Meta Files). This format not only stores the form information in a small file size, but it also scales very nicely on larger screens. However, notes can easily be designed using PDFs or other image types if desired.

Assumptions for success:

  • Someone in your organization knows how to use Visio
  • Someone in your organization knows how to do a ‘save-as’
  • If you don’t have someone in your organization who knows Visio AND you don’t already have form images that can be used in step 3, you are willing to pay someone else to do the Visio work

3. Create XML File.

Salar’s intuitive GUI, the Form Designer, allows you to create drag-and-drop database objects on your form image. In this step, you are building fields and their behaviors for TeamNotes to integrate clinical data and workflow into your forms.

Assumptions for success:

  • Salar will build the initial forms during the contract/implementation phase
  • Form Designer knowledge transfer will occur during the 3-month implementation phase, and the customer will be self-sufficient in this process at the time of Go-live

4. Deploy to TeamNotes.

With a few clicks and configuration updates, you will use Salar’s Deployment tool to make the forms available to users . There will be no down time for users when form updates are delivered. At one of Salar’s customer sites, more than 70 form updates were deployed in a single day, buy a single person, using the Deployment Tool. No database administrators or outside support personnel required.

Assumptions for success:

  • Forms created in steps 1-3 have been reviewed and approved by proper authorities, including the Physician Champion, HIM Director, Pro-Fee Billing Director, Quality Assurance
  • Deployment Tool knowledge transfer will occur during the 3-month implementation phase, and the customer will be self-sufficient in this process at the time of Go-live.

5. User Feedback.

Compile list of user feedback after TeamNotes has been in use for one month. Repeat steps 1-4 above, incorporating user feedback for note updates and process improvement.

Assumptions for success:

  • Physician champions and IT Department (Form Development Life Cycle tools/process owner) meet regularly
  • Deployments become a regularly-scheduled event, involving all parties in Step 1
  • ROI study is conducted after one month of use to validate value