Case Management Corner: Use Your EMR To Revamp UR communication
By Kelly Bilodeau
Healthcare is rapidly evolving, but utilization management (UM) still often relies on outdated communication and documentation strategies, such as emails and faxes based on unit-based assignments and static patient lists. These outmoded exchanges struggle to keep pace with the demands of the modern revenue cycle.
It’s time for a change, and luckily, the needed transformation is not one that requires high-cost new technology, just smarter use of your facility’s existing electronic medical record (EMR).
“Most hospitals already possess the technology needed to transform their UM programs; they simply need to reimagine how those tools are used,” said Sara Williams, vice president of clinical strategy at Phoenix Medical Management.
Repurposing existing tools
It’s possible to transform UR by reapplying existing EMR tools, such as reporting systems and communication platforms, to make the necessary shift toward proactive, connected workflows, she said.
Improving communication with these tools will do more than just streamline processes. It can help build bridges between bedside care, hospital operations, and the billing department. Using the EMR can also help ensure that the physician advisor’s clinical judgment, correct payer terminology, and verification of medical-necessity criteria are captured in the patient’s medical record. This is not always possible using legacy tools such as spreadsheets or anecdotal documentation, Williams said.
“Physician Advisors and UR nurses must be equipped with tools that allow their work to be visible, measurable, and aligned with organizational outcomes,” she said.
EMR systems can ensure continuity and follow-through by formalizing the documentation process using EMR-integrated UR tools and interactive dashboards. This allows UR nurses and physician advisors to easily communicate to build a clinical record that will withstand payer scrutiny and draw a straight line from patient admission to final claim resolution.
Providing support for a new model
However, like any technological leap, this change requires human support. Organizations need to ensure that UR team members are still engaged and collaborating with one another, particularly as more work is done outside the hospital.
Collaborating closely with the analysts who support your EMR is a key first step in transitioning documentation and workflows from spreadsheets and external resources into integrated EMR tools. These analysts have access to the latest available system capabilities and can help incorporate those features into your existing workflows to optimize documentation, streamline communication within the system, and enhance both reporting and overall documentation efficiency.
Working remotely has advantages, but it also carries risks, Williams said. With this in mind, organizations should develop tools and training to ensure that physician advisors and UR nurses can carry out concurrent reviews, work together effectively, and understand and meet payer-specific requirements, Williams said.
“Done right, the digital tools provided by the EMR can help Physician Advisors and UR leaders to optimize performance and advance organizational excellence.”
Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered. Whether you're looking for industry updates, practical strategies, or real-world perspectives, we bring you valuable conversations designed to enhance your knowledge and support your professional growth. Stay tuned for expert insights straight from the field! Kelly Bilodeau has been a longtime writer for HCPro’s Case Management Monthly.