How the state, payors and patients view the quality of care provided by the DOM depends on it. Moreover, this assessment increasingly determines reimbursement. Consider Maryland Hospital Acquired Conditions (MHACs): 46 potentially preventable conditions monitored by the state. At current pace, The Johns Hopkins Hospital, including the DOM, may face a $7-10 million penalty for poor performance in preventing these conditions in 2017.

Documentation queries clarify for the hospital whether a particular condition (e.g. UTI or DVT) may have been present on admission, or if it is medically impossible to determine whether it was present on admission. In either case, the condition cannot be counted as an MHAC. For DOM services in 2016, documentation queries eliminated 400 out of 800 initially-coded MHACs. Responding to all queries through the end of 2017 will help avoid the currently-projected penalty by allowing the hospital to decrease the number of reported MHACs. Across the state, hospitals are relying on similar systems of documentation queries.

What we don’t like about queries:

Historically, queries (for MHACs and other external metrics) could be difficult to respond to, could be unclear or wrongly-assigned, could arrive months after discharge and were poorly tracked – responses were not always counted.

What’s changing?

  1. Queries are now easier to complete. They can be viewed via a mobile app (recommended, free download at https://www.artifacthealth.com/start/jh), in a webpage (https://www.artifacthealth.com/sso/jh) or through the "In Basket" in Epic. In all cases, answering the question completes the query. Artifact software automatically generates a new note in Epic, so there’s nothing else to do.
  2. Providers can now send a query back to the hospital staff who wrote it for clarification or reassignment, and all queries are well-tracked through Artifact. If a provider returns a query to its author, that query is automatically cleared from the provider’s work cue.

The hospital and department are working to improve the overall quality of queries and to front-load the reviews so that fewer queries will arrive months after discharge. Change requires time, but improvement has already occurred.

The Department of Medicine’s Expectations:

Given the importance of answering queries and the improvements in the process, the DOM will now expect providers to answer all queries within the hospital’s timeframe: 48 hours for concurrent queries (patient still in the hospital) and 7 days for post-discharge queries. Answering queries on time is part of completing timely documentation and will result in more accurate assessment of the quality of care our patients receive every day.

-Steve Berry, Associate Vice Chair for Quality, Safety and Service

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