Frequently Asked Questions
EvidenceCare Platform
Is EvidenceCare fully integrated in the EHR?
Yes, our products are fully-integrated directly in the clinician’s EHR workflows to increase the value to the clinician. We have worked hard with Epic, Cerner, and MEDITECH to have our configurations utilize standard frameworks, APIs, and FHIR (when available) to make our integrations interoperable.
Furthermore, we are included in the Epic Showroom, Cerner App Market, and Meditech Greenfield Alliance.
Is EvidenceCare available within my EHR?
All of EvidenceCare’s products deliver timely and relevant content to clinicians directly within their EHR workflow. We are constantly adding our software to more EHR systems, but currently most of our products are available within Epic, Cerner, and MEDITECH environments. The EvidenceCare team is happy to discuss your specific integration needs.
How are you different from other clinical decision support systems?
EvidenceCare’s products are embedded directly within the clinician’s EHR workflow.
Our tools give them recommendations, insights, and nudges that help them deliver better care, while also generating tangible operational and financial ROI for the health system.
This benefits patients, providers, and the health system.
I don’t like tools that force cookie-cutter treatment approaches … What about the art of medicine?
We agree! The practice of medicine is an art.
We want to support providers by giving them the best information and insights within their EHR workflow so they can deliver the best care to their patients.
We have strict security policies... Can you securely handle our data?
We are HITRUST certified and have been through the Security / IT Approval process at dozens of leading health systems. Our team is very familiar with these various processes and are ready to complete necessary forms to initiate that process, present at your Security / IT Approval committee meetings, and handle any questions that come up through that process.
Our IT infrastructure is hosted in a HIPAA/PHI secure environment. EvidenceCare’s follows the principal of “minimal exposure / surface area,” so most EvidenceCare employees do not have access to client data.
Have your products been used at hospitals with residents?
Yes, EvidenceCare’s tools have been used and shown great benefit (clinically / operationally / financially) at large Academic Medical Centers and Community Hospitals with residents.
AdmissionCare
How long does it take to use AdmissionCare?
We track the average time it takes to utilize a guideline. Across all of our clients, that is 42 seconds.
So if a provider only needs to evaluate a single guideline on a patient admission, it would take them less than a minute to utilization AdmissionCare. If they end up reviewing multiple guidelines, it may take them 2-3 minutes.
We find that in the first few weeks after go-live, providers use multiple guidelines as they become familiar with AdmissionCare and the guidelines. Their rate of single guideline utilizations then goes up as they become more facile with the tool.
How does AdmissionCare benefit physicians?
The burden of bed status determinations falls on providers!
- They are the ones required to place bed status orders in the medical record
- They are responsible for having compliant documentation of medical necessity in their notes
Most providers were never taught how to do this in medical school, residency, or their clinical practice, so there’s a knowledge gap.
As they use AdmissionCare they start to learn bed status criteria in a way they never could previously (as they currently don’t have access to this content or the time to learn it).
AdmissionCare streamlines the admission process between emergency physicians and hospitalists, as they don’t have to spend time debating what bed status may be appropriate for that patient.
AdmissionCare reduces administrative burdens for hospitalists by reducing the amount of UR queries, inbox messages, and phone calls when the UR team has to reach out to them on patients who need their bed status changed, a documentation gap to be closed, or to perform a peer-to-peer (at health systems that still have the attending physicians completing these).
Do ED doctors or hospitalists use AdmissionCare?
AdmissionCare accommodates usage by ED physicians, hospitalists, APPs, and residents.
As part of the implementation process, we would explore your current admission process to determine who is placing the initial bed status order. That provider would be the one responsible for utilizing AdmissionCare to determine the appropriate bed status for the patient and have proper documentation of medical necessity.
How does AdmissionCare benefit the Utilization Review team?
The largest gap in the UR process right now at most health systems is physician bed status determinations and documentation of medical necessity.
With the improvements AdmissionCare makes on these items, more patients will be in the appropriate bed status to begin with and have proper documentation.
This makes it so the UR team doesn’t have to spend half their day digging out of all of the admissions that came in overnight.
UR staff can spend more time on complicated admissions, concurrent reviews, and appeals letters.
Will AdmissionCare replace or remove the need for a Utilization Management team?
Not at all… UR teams are an essential function at hospitals.
We actually find that once AdmissionCare is deployed, it helps make UR teams more efficient.
- When we get more patients in the appropriate bed status initially with proper documentation, this becomes less cases the UR team reviews that they have to go back to the physicians to make changes.
- Some UR teams have told us that prior to AdmissionCare, they were spending most of the day “digging out” of admissions from the night prior and trying to get those bed statuses correct. They are now able to spend more of their time looking at OBS cases for potential conversions, reviewing more complicated patients, and writing appeals letters.
- With less time spent messaging and trying to connect with physicians to have them fix bed status determinations, they have more time to do other aspects of their job that add value to the health system.
Can residents use AdmissionCare?
Yes, at many hospitals (especially Academic Medical Centers) residents evaluate patients and place admission orders themselves (prior to those being co-signed by their attending).
The residents use AdmissionCare as part of their evaluation of the patient and to help assure proper bed status order placement.
Some of our clients’ best success have been at Academic Medical Centers as the residents struggle with bed status decisions and there is a “new crop” every year that have to be educated on this. The great news with AdmissionCare is that residents find it very easy to use and they learn quickly how to use it proficiently.
How does AdmissionCare help with documentation?
As a provider utilizes AdmissionCare, consults the guidelines, and selects the criteria that are present on the patient, all of those items are compiled and then sent back to the EHR.
In Epic and Cerner, a note is created with all of this documentation and then the text from that note is synchronized into the Hospitalists H&P document.
In MEDITECH Expanse, a note is created. At this time there is no mechanism to synchronize this into the providers’ notes.
How does AdmissionCare impact patient status compliance?
AdmissionCare has been reviewed by compliance departments at multiple leading health systems and has been found to be in full compliance. In fact, those health systems felt they would be more compliant with AdmissionCare as it gets patients into the most appropriate bed status with proper documentation of medical necessity.
Is AdmissionCare only used at the point of admission or can it be used for the concurrent review?
While the majority of AdmissionCare utilization is on initial bed status determinations, the tool can be used for re-evaluation of OBS patients to see if they are appropriate for conversion to INPT.
We have recently enabled automated messages in the EHR on OBS patients once the patient’s LOS is >24 hours. The provider receives that message while they are in the context of that patient’s chart (often after they’ve seen the patient and are placing orders). So they appreciate that they are getting that message at the appropriate time on that patient and not having to get a call from the UR team later that day (when they are in the middle of doing something else) to receive notification that conversion should be considered on that patient.
How long does it take to implement AdmissionCare?
Our standard implementation is 16 weeks. During the scoping process, we can supply you with details on the full implementation process.
In general this includes:
- Identification of stakeholders and engagement
- Discovery / Scoping
- EHR Configuration
- Generation / Review of Baseline Data
- User Training
- Go-Live
What is EvidenceCare's team involvement after AdmissionCare is live?
The EvidenceCare team takes a collaborative approach to support you post-live.
- Your Client Success Executive will work with executive/clinical/IT/financial stakeholders to review utilization reports, KPIs, ROI, etc.
- Our Clinical Revenue Cycle Integration (CRCI) team will review provider proficiency and give feedback to clinical stakeholders and individual providers as needed.
For the first few months after go-live, we will have scheduled meetings every other week to review utilization metrics, assure everything is working properly with the EHR configuration, and answer questions that have come up.
Your first formal presentation of KPIs and ROI will come in your Quarterly Business Report (QBR) that will be scheduled 4-5 months after go-live. This allows for 1 month of go-live/stabilization, 3 months of measurement, and then another 15-30 days for us to receive/analyze KPI data.
How do you drive adoption?
Adoption is a multi-pronged approach.
While the ease of use of AdmissionCare and the configuration in the EHR are large components of creating a new default admission process, adoption starts with executive and clinical leadership.
It will be essential that your executive and clinical leaders are out front communicating the WHY behind introducing AdmissionCare:
- That the admitting provider is responsible for proper bed status determination and documentation
- That this is essential for compliance and the financial well being of the health system
- That this is important for patients, as they have a higher out-of-pocket cost responsibility if they are in OBS status
- And that, while this may feel initially like “one more thing,” after they become comfortable using AdmissionCare, it will reduce administrative burden due to all of the rework they are currently experiencing.
After go-live, your Client Success Executive will share utilization reports and proficiency reviews, so that clinical leaders can follow-up with providers that may need encouragement or additional training.
What KPIs are tracked?
KPIs are tracked on a per Admit Diagnosis basis. This allows us to normalize data, as we know that the appropriate INPT rate for a Chest Pain is different than for a Sepsis encounter.
After normalizing all data per Admit Diagnosis, we then track KPIs around:
- Utilization
- INPT vs OBS: initially, conversions (up/down), post discharge downgrades
- OBS LOS
- Denials
We are also beginning to generate analytics looking at each of the above on a per provider basis.
How do you track INPT vs OBS, conversions, and downgrades?
All KPIs are normalized on an Admit Diagnosis basis, as we would expect a different INPT % for Chest Pain vs Sepsis encounters.
For INPT vs OBS, we track initial determinations, conversions (up/down), and (if the data is available) post discharge downgrades.
Does AdmissionCare impact OBS Length of Stay (LOS)?
We are showing at multiple health systems that AdmissionCare is reducing OBS LOS.
How are we doing this?
By increasing the INPT % on initial bed status determinations, we are getting a higher % of patients that are appropriate for INPT (and will likely have a longer LOS) into that status at the beginning.
Additionally, as your providers start to utilize AdmissionCare and learn the criteria for each condition, they start to realize patients that are appropriate for conversion from OBS to INPT themselves. They are able to utilize AdmissionCare to complete that conversion with proper documentation (and not wait for the UR team to notify them at a later time to do that).
We have also recently launched an OBS Message directly in the EHR, which is shown to the provider when they are in the context of that patient’s chart, the patient is in OBS status, and their LOS is >24 hours.
How do you provide ongoing education to providers not picking correct guidelines?
After go-live, the EvidenceCare team will review data on your providers’ proficiency utilizing AdmissionCare.
Data is tracked on which providers are utilizing the most appropriate guidelines based on the Admit Diagnosis for the patient.
Your Client Success Executive will work with clinical stakeholders at your health system to generate reports and insights that can be shared with your providers.
We also have tip sheets, videos, and an online training website that providers can use at anytime.
Again, the goal is to teach your physicians “how to fish.” With the proper feedback, we can help them get better at this over time and assure they are utilizing the best guideline to determine the appropriate bed status.
CareGauge
How does CareGauge benefit physicians?
Physicians want to be good stewards of care resources. They have been asking for the kind of data that CareGauge provides for a long time.
By having access in real-time to care utilization and costs of care data, the discerning provider can make more informed care decisions that are more mindful of capacity/throughput/costs.
At the end of the day, health system margins are essential for providers. Those margins drive the availability of resources (nurse staffing, imaging, lab, etc.) for the care of our patients.
And every provider should care about capacity and throughput, as it allows for the efficient care of today’s and tomorrow’s patients.
How do you accommodate for cost changes and inflation over time?
EvidenceCare will work with your cost accounting team to determine the best frequency for updating cost information.
Depending on how your cost accounting team manages this, we may get updated information monthly, quarterly, yearly, etc.
When EvidenceCare obtains new cost information, we consider this the Latest Cost. We then normalize the Latest Cost information through all care utilization data (baseline, control, CareGauge live), so that we extract fluctuations in cost out of the utilization patterns that the providers see within CareGauge.
Is this benchmarked data specific to our facility or others?
Yes, as part of the implementation process, we will obtain historical care utilization data from each of your hospitals. We will also work with your cost accounting team to get your cost data.
This data is married up to create your baseline prior to go-live.
Because all data is local, it has already factored in your CMI, local practice patterns, patient population, and their social determinants of health.
This has been a huge benefit of CareGauge!
Many providers are familiar with retrospective reports based on claims data that compares them to national benchmarks. This data has traditionally done very little to change behavior.
Whether consciously or subconsciously, providers tends to discredit national data under the assumption that “their patients are sicker” than patients elsewhere.
Because all data shown for comparison purposes is based off of local data, it is met with much greater acceptance from the providers.
Do you have any national data we can use for comparison?
We do not have national data on expected utilization of Imaging, Labs, Medications, etc. We are hoping that over time as we collate more data from health system partners that we will be able to start incorporating these types of insights.
We do have CMS GMLOS data incorporated into the system. So your providers will be able to see not only the ALOS for historical patients with that same DRG, but also the CMS GMLOS.
How do doctors "see" CareGauge and from where do they access it?
The CareGauge Indicator starts displaying once a Working DRG is available for a hospitalized patient. This is usually around 24 hours into the patient’s stay.
The Indicator will be configured in your EHR to show in various places within the provider’s workflow on a patient.
The goal for configuration is to identify areas where the Indicator can be displayed so the providers have easy visualization, but also so it is non-intrusive and doesn’t generate pushback in terms of being disruptive.
How does this change physician behavior?
Providers want to be good stewards of care resources. Let’s give them the opportunity.
Our traditional model of trying to change provider behavior (retrospective utilization reports) have not been very effective.
Because CareGauge gives providers real-time feedback and visibility, it has proven to have a dramatic impact on care behavior.
Is there a Hawthorne Effect from CareGauge? Absolutely.
- With CareGauge, providers know they are being measured and can see that measurement themselves in real-time.
- Providers have told us that once CareGauge went live they immediately had a greater sense of ownership, accountability, and empowerment in utilization decisions.
Is this used as a punitive tool for doctors?
No, the goal for CareGauge is to not be a punitive tool.
There are no alerts, no hard stops, and no telling a provider that they are “bad” for ordering a particular aspect of care.
It simply gives them real-time feedback on how that patient’s utilization across different care categories compares to historical patients with that same condition.
The status of the CareGauge indicator is always visible – like the gas gauge in your care – and all of the specific category gauges can be accessed if the provider selects them.
We’ve found this approach makes providers very receptive to CareGauge, as they don’t feel like it’s something being forced on them or weaponized against them.
What are the thresholds for the green/yellow/red indicators?
Green: <85% of expected utilization for a particular category or the total utilization indicator
Yellow: 85 – 115% of expected
Red: >115% of expected
How can CareGauge improve final DRG accuracy?
Proper physician documentation is essential to accurately code a patient encounter and assure the optimal Final DRG is determined.
Right now there is very little feedback to providers while the patient is in the hospital on the Working DRG or reason for the providers to question whether that is accurate.
When providers start seeing the Green/Yellow/Red indicator for CareGauge, they start to feel a great sense of ownership and accountability over that patient encounter.
Many times a patient who goes into the Yellow/Red is not because of over utilization of care, but that the Working DRG on that patient isn’t a good comparison for that patient’s expected utilization.
When CareGauge goes Yellow/Red, providers get curious and start exploring the details on that patient. If the Working DRG is not accurate, it may prompt them to add the patient’s current condition to the Problem List or update their Progress Note documentation.
This has become particularly important at the time of discharge, where a provider may notice that the patient is in the Red, and will take those extra few moments to properly document that patient’s conditions at discharge to assure the Final DRG can be maximized.
Does CareGauge help with CDI?
We believe CareGauge has a positive impact on CDI and optimization of Final DRG.
Because CareGauge gives providers real-time feedback on expected utilization compared for a particular DRG, sometimes when CareGauge goes into the Yellow/Red, it may be because the Working DRG needs to be updated.
By getting this feedback in real-time, it prompts providers to add the patient’s current condition to the Problem List and make sure the patient’s severity of illness is properly documented in the medical record. All of this leads to the best opportunity for optimal Final DRG capture.
What if our historical care patterns aren't very good... Aren't we just going to reinforce that bad behavior?
We don’t know a single health system that is happy with their historical performance. They all wish to do better and have particular hospitals / service lines where they wished that performance was better.
Because we start from local data, we are able to get an accurate picture of historical utilization and costs at your hospitals. As part of the implementation process, we’ll review this data and be able to look at discrepencies between your hospitals, service lines, and particular DRGs.
If an adjustment in the baseline data needs to be made, we can discuss this and see if it makes sense for particular DRGs or if we use the baseline data from your best performing hospitals as the “best practice standard” for your system.
What we’ve seen in the data on CareGauge is not that it just reinforces the previous practice pattern. What we see is:
- A reduction in outlier cases to the right of the utilization / cost curve
- An overall move of the mean and mode to the left
How long does training take?
CareGauge is a very simple tool to use.
Most providers understand green / yellow / red and the details that are shown within CareGauge. So actual “training” of an individual provider only takes about 10 minutes.
The biggest aspect of training is engagement with the various service lines, messaging, and explanation of the WHY. We usually start working 1-2 months prior to go-live with service line leaders to attend their monthly meetings so we can do a brief presentation of CareGauge and build awareness.
We then have EvidenceCare members come onsite during go-live for “at the elbow” support as well as engagement with providers.
We have tip sheets, videos, and an online training website that providers can use at anytime.
How do you drive adoption?
CareGauge is a very interesting tool from an adoption perspective. There is no forced utilization.
Providers start to see the Green / Yellow / Red indicator within their EHR workflow and start to get curious about why a particular patient is in the Yellow or Red.
Once enabled, the CareGauge indicator will start showing on every patient with a Working DRG and providers realize that they are being measured and can see that measurement themselves in real-time.
Will every provider click on the indicator to see the details? No, but, like the gas gauge in your car, CareGauge is omnipresent and is giving them that subconscious feedback around their patients’ utilization and costs of care.
