February 11, 2020

Deficiency Tracking Optimization and Unsigned Orders Case Study

Jenn Krebs


Delinquency rate (whether you report to Joint Commission or DNV) can be a cultural shift that’s hard to improve upon once you’ve accepted a certain level for years on end. This can be true whether you have been on the same EMR for a long time or recently switched from one EMR to another. Add in the fact that each software version has improvements to make chart completion easier for your clinicians, and if you haven’t taken a long, hard look at your workflows in a while, you may be surprised at the levels of improvement you can achieve.



A Wilshire customer came to us for two primary reasons:

  • They were seeing an extremely large volume of unsigned orders.
  • They hadn’t updated their Deficiency Tracking system meaningfully since go-live, which was becoming quite apparent due to their split roll-out (they went live on revenue cycle first and then implemented the clinical suite).



Our goal was to reduce their volume of unsigned orders and improve their delinquency rates. We knew in order to do this we would have to dramatically improve the workflows and tools used by their chart completion analysts. By leveraging workqueues and other tools that have been successfully used in the coding world, we hoped to revamp the role of their Chart Completion department.


Results at a Glance

  • Reduced the system’s volume of unsigned orders (after 48 hours) by approximately 75%.
  • Reduced the system’s largest hospital’s delinquency rate by over 50% in a single year; the smaller hospital and rehab center saw reductions of over 30% and 25% respectively.



We hit the unsigned orders from a couple different fronts.

  1. We worked with the clinical team on user security, order modes, and orders setup to make sure that we were triggering co-signatures when appropriate.
  2. We created many reports to give different audiences (HIM, nurse managers, clinic directors) access to monitor unsigned orders and corresponding dashboards to track these numbers at a high level.
  3. We improved the way we presented the unsigned orders to the clinicians in the system, making sure they were able to easily sign the orders.
  4. We spearheaded educational efforts for everyone from the nurses entering the orders, to the clinicians signing them, to the administrative users monitoring the inappropriate use of order modes to ensure everyone was up to speed.

Improving delinquency rates was also a multi-step process. With each deficiency (take a history & physical, for instance), we made sure it was configured in the system for automatic triggering, assignment & completion. We also had to educate clinicians in all departments about documentation regulations and compliance standards. Finally, we put each deficiency in its own workqueue (both for missing & quality check) to aid in both analyst workflow & historic deficiency clean-up.

A lack of appropriate attention onchart completion can cause significant delayinyourrevenue cycle throughput along with unnecessary focus from regulatory reviewers. Is it time to tackle chart completion & delinquency rate improvement at your organization? The Wilshire Group can help – contact us today!

Jenn Krebs

Senior Strategic Advisor

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