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  With more than 120 clinicians generating up to 90 care plans each day, the rehabilitation team at
Carle Foundation Hospital began searching for a solution that helped reduce errors and redundancy by
interfacing scheduling, documentation and charge entry.
  Following an evaluation of several systems, Carle purchased the Chart Links solution that is developed
specifically to address the needs of rehabilitation clinics.
  The increased efficiency facilitated by Chart Links enabled the practice to add a significant number of clinical staff without adding support
staff. In addition, Chart Links
helped decrease lost charges and reduce the redundancy of processes both key factors as patients and clinicians travel between clinic locations.

The Carle Outpatient Rehabilitation program handled more than 140,000 outpatient visits over the last fiscal year, and has 11 locations in east central Illinois. The program is affiliated with the 305-bed Carle Foundation Hospital, Urbana, Ill.

Having access to patient charts – from any of its locations – is important to Carle, since patients may visit more than one office during the course of their treatments, and clinicians float between sites. Carle's previous manual processes made it difficult to track plans of care, physician authorizations and reauthorizations, as well as capturing all charges for each encounter.

Carle implemented Chart Links in February 2006 after evaluating other systems. Chart Links' unique rehabilitation-specific design and ability to simplify workflow impressed Carle, whereas other systems appeared to be adaptations of solutions designed for hospitals or physician offices. "Chart Links was an obvious choice because it simplified the tracking of authorizations and mirrored our workflow, which is the result of it being developed specifically for rehabilitation," said Stephanie Dotson, a physical therapist at Carle. "With Chart Links, we can access information from any of our remote locations, accurately track plans of care and physician authorizations, and the system notifies us when reauthorizations are needed."

The increased access to documentation has improved the efficiency of Carle's billing processes. Previously, charts were faxed or sent via courier to different locations to be billed or to research billing issues.

"Coders can now pull up the documentation and code directly from Chart Links. In the past, they worked from stacks of papers that would occasionally get lost," said Vanetta Dean, financial manager for Carle Therapy Services. "Using Chart Links has reduced our revenue cycle days significantly. Now, coders are caught up within a couple of days after the evaluation, where in the past we were 30 days out. This includes coding for commercial payers and Medicare."

Other coding features include working lists within Chart Links, which help coders prevent lost charges, improve coding accuracy and assist with assigning ICD-9 codes. Chart Links helps office staff and patient accounting personnel catch billing errors.

The transition to electronic charting helps prevent legibility issues, which is a concern for all paper-based practices. Like other practices, Carle coders often struggled with deciphering handwritten notes during the billing process, which would occasionally result in lost charges. Legibility issues also arose when patients visited other Carle locations requiring a clinician to read another's handwriting or when a clinician filled in while another clinician was on leave.

Since introducing Chart Links, Carle Therapy Services has experienced increased revenue, which the organization partially attributes to the way Chart Links more accurately captures charges. Besides increasing revenue, Chart Links has enabled Carle to eliminate transcription costs, substantially reduce printing costs, and decrease write-offs.

"Our clinicians appreciate how Chart Links makes their jobs easier by automatically tracking plans of care. It's easy for them to pull up care plans from any location, get up to speed with the patient's condition, and determine next steps in the treatment. Everything is at their fingertips," Dotson said.

Every time a patient encounter is billed, Chart Links has a pop-up window that displays how many more visits are authorized, the expiration date, and when reauthorization is necessary. This feature helps keep Carle in compliance with commercial payer regulations, such as those that require authorization.

Chart Links' reporting capabilities enable Carle to better monitor and measure its operations and finances. "We can easily monitor the charges generated by each clinician or measure the hours they worked against the hours they billed," Dotson said. "Since using Chart Links, we've implemented stricter productivity guidelines. Staff can now utilize the system to monitor their productivity and take accountability. As a result, targets are now more meaningful to staff, rather than just an arbitrary number. We wouldn't have been able to achieve our productivity goals without Chart Links."

Chart Links features that have increased productivity include:
  • Minimizing the number of forms that must be signed by clinicians
  • Reductions in duplicate paperwork due to lost notes
  • The ability to fax documents directly from the system
  • Prompts and cues that help clinicians improve the accuracy of documentation
  • Producing legible documentation that makes it easy to hand-off patient information to other clinicians
  • Point of service documentation and charging

The increased productivity and efficiency has allowed Carle to add clinical staff without increasing support staff. In fact, since using Chart Links, Carle has reduced its support staff by 4 people through attrition, which saves Carle a substantial amount each year in salary and benefit costs. Currently 120 clinicians and 40 support staff use Chart Links to manage nearly all aspects of its operations, such as registering and scheduling patients, documenting daily notes and plans of care, charge entry and handling referrals.