Around the beginning of 2018, after I took my new position at our practice as Clinical Technology Manager, I took it upon myself to come up with a solution to an enormous problem in our company. Data management, billing and overall tracking of our LTM and clinical EEG studies was a complete mess. We were living in the dark ages, log books just like everyone else. But on top of that, another logbook with patient demographics, the reading doctor, number of hours recorded, pruned/cropped and archived and so on and so forth. All of this had historically been a full-time job for somebody, but as time went on and the practice grew, things needed to change to improve efficiency.
Back in 2008 we had acquired new business performing PICU and NICU EEG telemetry at another hospital and needed a way to track what we were doing there not just for the EEG department but also for billing.
I found some code online called MySqlTableAjaxEditor. These days code like this is referred to as a CRUD (Create, read, update and delete). Basically it’s code for a webpage that allows you an easy way to manipulate a database.
With this code, I was able to create a simple web-based database on our local intranet to track all of our outreach EEG studies being performed at this remote hospital. It worked great and our billing department had a way to see what had been done and check off when they had the report for the study and they had billed for it.
Back to 2018. I needed to take this code and expand it for our core business. Let me just point out that the code I was using still had not been further developed for many years but the website was still up. I searched and tried out many other CRUDs and similar scripts and none of them had all of the functionality I was looking for. Also, I was already familiar with it so I went with what I knew.
What I needed to do in a nutshell:
- Build an electronic version of our EEG logbook including patient demographics, EEG numbers, total hours recorded and more.
- Have a way for doctors to check off when they had completed the studies and then attached the reports to the database.
- Give our medical records department a way to attach reports and/or take attached reports and upload them into the EMR system.
- Have a way for our billing department to see when the EEG reports had been completed, prompting them to start the billing process.
- Have a way for the accounting department to track what’s been billed, which reports are outstanding and overdue etc.
- Give our accounting team access to a dashboard that will give them a daily glance of all EEG numbers, reporting and billing stats.
The main page:
The front page displays many icons, but I wanted to make it as simple for the end-users as possible so I thought about how IOS is laid out on an iPhone, something everyone is familiar with. For now, this is what I went with, an icon and page for each logbook and each location.
The top icons are the logbooks for each of our units/clinics. There are corresponding real-life logbooks for each of these, and they are red which is why I chose these icons. These digital logbooks contain all patient demographics, EEG numbers, total hours recorded, room number, unit, type of equipment.
After the EEG study is entered, it shows up in the doctor’s list as an unread study. They click on their respective pages and see the studies that show up. If a study is unread for greater than 21 days, for instance, the code will see that and highlight the study in yellow and shift it to the top, like a sticky, so that it gets noticed and read.
The second row of icons displays the second tier in the process, medical records. After the EEG logbook data is entered, the medical records staff looks to see when the doctors have checked a box that the study has been read. When in a read status it shows up on their respective pages as read. They will then go into the EMR and retrieve the report and attach it to the database and mark the study as being entered into EMR.
After medical records has done their part and check off the box that the study is read and in the EMR, it’s ready to be billed. These two tables equaling Yes means they will show up in the respective billing pages. Certain billers are tasked with billing different clinics and EMUs.
Once the billing department has submitted billing with the proper CPT code based on the total hours recorded and type of study it’s now marked as completed. This data is viewable in the dashboard for the administrative and accounting departments.
Here’s a quick look at part of the dashboard:
At any given moment you can pop in and see how many reports are pending and by which physician or location. I used Highcharts to create the dashboard.
Here’s a look at the doctor’s reading page:
If the ‘Days Pending’ column is ≥ 21 days the study is highlighted in yellow and shifted to the top of the list to attract the attention of the reader. Notice the ‘Report Done’ column all show ‘No.’ Start time and stop time are entered and the Study duration column is then calculated.
Stay tuned for part 2 where I will outline creating the dashboard, email notifications, SQL table structure, and ICD-10 codes.