Lake Health (University Hospitals)

Tinu Tadese

As a pediatrics physician, how did you find yourself in the world of clinical informatics, and how has it changed since you became a part of it?

It was around the time when the Obama administration passed the High Tech Act in 2009, was when I first got into health informatics. The act provided funds for hospitals to adopt health information technology through EMR technology. At the time, the Office of the National Coordinator (ONC) was looking to raise a new generation of clinical and medical professionals who were also trained in IT, so I opted for the 6-month training program to get certified.

When I started this work, everything was very rudimentary at the time, and we were traveling across the country, implementing EMRs in as many hospitals as possible. The focus was for hospitals to adopt information technology, and the most significant challenge then was getting physicians and clinicians to accept using information technologies.

Fast forward ten years later, and things are much different now. These days most hospitals and clinics have fully adopted the health information and technology approach and employ electronic medical records for daily use. Now the challenge is not about adopting the technology; it’s about implementing it so that EMR benefits the institutes utilizing them.

In my work with the health industry’s revenue cycle, I asked, “Can we make the EMR pay for itself?” EMR costs can go up to half a billion, or sometimes even a billion dollars, but if we can get the EMR to pay for itself, it can help subsidize the heavy investment. By making sure that our patients are well, we can actually get a return on investments in the technology, which is essential for the revenue of any hospital or clinic.

What does the revenue cycle look like from a Healthcare perspective?

The revenue cycle starts from the time a patient reaches out to the health system and places a request. It continues through their treatment process, medications, and procedures all the way to when they finally get discharged, and the health system or practice gets paid.As EMR is more readily used in hospitals, we noticed that it affected the revenue cycle significantly. Physicians were putting in patient notes as they had done when they were still using paper, writing in shorthand, and using a couple of phrases instead of well-structured sentences.

This created a problem as healthcare payers were unwilling to pay for a few lines of writing as it didn’t convey the severity of the patient’s conditions to them. They required comprehensive documentation of the patient’s condition along with treatment and procedures implemented, which justified the money being spent. It became clear that, as physicians, we didn’t really know how this area functioned.

CMS uses the case mix index, or CMI, to determine how much they pay your hospital, and it has a nearly direct correlation to the quality of a physician’s documentation. To raise the CMI, we needed to optimize how a physician puts down notes on the EMR, which is one of the fastest ways to improve the reimbursement from the payers.

To tackle the problem, I got certified, started learning the business side of healthcare, and began translating it into informatics. I started training my colleagues to bridge the gap between physicians, the revenue cycle department, and IT, as all three have to work together to sustain any healthcare organization. We do this through the clever use of the EMR and getting our money’s worth from it, how I like to say, by making the EMR sing.

Is there any particular story you’d like to share wherein EMR improved the health care system and benefitted the institute?

We had this particular disease condition that our physician had trouble documenting. So we utilized a tool on the EMR to change the CMI and deployed it accordingly to come up with a better way to document the condition. This more clinically robust documentation was ultimately beneficial for the care team, the nurses, and other physicians and surgeons to better handle the care of that patient. It was also helpful for us as our CMI went up within two months, and we saw a significant ROI as we started getting paid more.

What are some of the advancements in the field of health informatics that you’re excited to see come to fruition?

In the last couple of years, the field of medicine has grown exponentially when it comes to implementing technology in healthcare. Most patients no longer wish to write on paper and want all their options on their phones. From scheduling an appointment to paying for the services to ordering hospital food, the patients prefer to do all of this through an app on the phone. This is what we call the digital front door in healthcare, one of the industry's biggest advancements.

"As EMR is more readily used in hospitals, we noticed that it affected the revenue cycle significantly"

Patients want to access their charts and hospital records once they leave the premises, so we’re now moving to a time when the EMRs exchange information over a region and talk to each other. Artificial Intelligence is also vital in this and is being increasingly implemented in health informatics. It is used to comb through copious amounts of patient data and develop intelligent solutions that guide medical practices.

For example, if I have a five year coming into my operating room, how can I tell if they will be allergic to the anesthesia given to them? AI can comb through their patient history and reveal that they have never had a reaction to it before. Even if they’ve never had a portfolio done before, there can be instances from their brief life history that could predict ahead and tell me if the patient will do well in this procedure.

With the challenges we face in the revenue cycle side of things in healthcare, my question was, “Can AI help with this?” A few companies have employed artificial intelligence to enhance the EMRs being developed for a patient. Their algorithm reads through a patient’s electronic medical history and can advise the physician while they are taking notes on the patient during an examination and say to them, “I noticed that you said the patient has a cough and a fever. It looks like you did a chest exam. Did you find such and such and such?"

When we deployed this, I noticed that it drastically changed the documentation of our physicians and directly affected how much the payers were willing to pay the institute. So deploying artificial intelligence in the revenue cycle on physician documentation has become a real passion of mine because I can see the return on investment within weeks, and it positively affects the CMI within one or two months. 

What does the future look like for you? Could you give us an insight into which direction you’ll be turning your attention next?

I am still going to continue in the artificial intelligence area, but I’m looking for ways to improve the digital front door experience for our patients. Patient access or access of the community to healthcare is so essential, and you want them to be able to access healthcare regardless of race, creed, or location. To do this, we need to address things that are beyond EMR. 

For example, telehealth is a straightforward yet helpful feature many hospitals offered during the pandemic. But now those services have been suspended, making it impossible for many patients to access healthcare again, simply because they couldn’t afford to travel to the hospital.

The social determinant of health is a passion of mine. I'm looking to find out how I can use health IT to further the advancement of the field, and I’m positive the electronic medical record and health IT can help give patients access to healthcare right where they are.