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March 2008 E-news Exclusive What’s in a Name or Number? Before installing an electronic medical record (EMR) system, naming and numbering standards for masterfile records should be created. In my experience, this is an often overlooked process with frustrating, costly repercussions. In a paper-process world, departments and individual physicians create their own naming and numbering conventions that have worked for them. However, with an EMR, information flows across departments and throughout the entire organization. A simple procedure with five different names creates confusion and inefficiency. Consistency across departments and sites not only reduces confusion and rework, but it also generates efficiency and quality, the level of which can set a healthcare organization apart—and ahead—of its peers. First, set up cross-functional teams to establish standards for masterfiles shared by multiple build teams and masterfiles where this architecture will enhance utilization and management. It is important to include clinical representation so that the naming conventions make sense to the clinical users. Once the conventions are agreed on, tools for documenting naming and numbering should be centrally located and easily accessible to everyone working with the build. For example, an Excel file can be created for each masterfile. The first worksheet can contain a clear definition for the name and numbering convention. Subsequent worksheets can be labeled with identifiers and numbering range, if needed. The conventions should be published to all personnel with access to make changes. Taking an Epic installation as an example, areas that are important to consider include specialized document flow sheets, custom diagnoses, SmartTools, and computerized physician order entry (CPOE) orders and medications. For specialized document flow sheets, systematic template numbering needs to carry over to the groups and rows. The naming convention should identify templates and rows from groups. There are instances (eg, allergy shots) in which multiples of the same type of information need to be documented, with each entry appearing on a chronological report. Particularly in records that allow all free text entry, organized ID numbers can help to untangle complicated document flow sheets. SmartTools should include ID ranges reflecting the site, departments, specialty, or application rather than the system-generated IDs. When each functional area has its own number range, it reduces the likelihood that someone can overwrite the production environment when additions are made without being tracked through change control. Organizations can create their own naming conventions for custom SmartTools. One client’s SmartList that contains specialty-specific information was preceded by a custom prefix for that specialty. The specialty physicians could then easily find their SmartLists when creating SmartPhrases. Since the convention was specialty specific, other users knew that the lists could not be changed without permission from the specialty. Another client, which did not limit SmartTexts by department, chose to add a prefix to all department/specialty SmartTexts so the providers would have their texts grouped together. There are many ways to establish naming and numbering conventions, and they differ between healthcare organizations. The key objective is to have them consistent within an organization. Some clients establish a smart phrase naming convention that uses a two- to four-letter prefix that is meaningful to clinicians’ workflow. Others use conventions based on current models for documentation. There are also published suggestions and guidelines such as Peter Churgin’s, MD, Red Book for SmartPhrases and Epic’s Model System Style Guide. Epic recommends naming and numbering conventions for certain masterfiles shared by multiple applications. The style guide also provides a table of suggested specialty and application abbreviations with name prefix and build number prefixes. Frequently, specialty practices will ask for the addition of custom diagnoses. When adding these diagnoses, one numbering convention involves placing letters of the alphabet behind the ICD code, progressing through the alphabet with each custom addition under the same code. If this is set up correctly, the procedure ID number will change, but the billing will continue to reflect the parent ICD code. Many organizations have elected to enhance the build by adding custom EAP records for lab, imaging, diagnostic procedures, medical equipment, and other procedures. Each worksheet in the file was labeled with the identity of the procedure type and contained a number range for each type of procedure. Each new EAP record was entered at the next available number on the spreadsheet for that type of procedure. For additional clarity, the EAP naming convention should help users distinguish between orderable, performable, and chargeable procedures. There are many other areas of build where value is added by the architecture established with naming and numbering conventions. When making decisions about which masterfile records need to be considered, look to those that have relationships in system build, departments, organizations, or specific functionality. Consistent naming and numbering conventions will have far-reaching effects on optimizing performance, utilization, and maintenance of your Epic system. Stakeholders will enjoy improved efficiency and higher satisfaction with the Epic implementation as their needs will have been addressed in this preplanning process. Overall, the time spent developing standards and documentation tools for naming and numbering conventions will be paid back many times over as the system is implemented and used. — Laura Bloemer, RN, MSN, is a senior consultant at Hayes Management Consulting in Newton Center, Mass.
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