title: A workflow task force affects emergency physician compliance for point-of-care ultrasound documentation and billing.
abstract: BACKGROUND
  Emergency point-of-care ultrasound (POC u/s) is an example of a health information technology that improves patient care and time to correct diagnosis. POC u/s examinations should be documented, as they comprise an integral component of physician decision making. Incomplete documentation prevents coding, billing and physician group compensation for ultrasound-guided procedures and patient care. We aimed to assess the effect of directed education and personal feedback through a task force driven initiative to increase the number of POC u/s examinations documented and transferred to medical coders by emergency medicine physicians.
  
  
  METHODS
  Three months before a chosen go-live date, departmental leadership, the ultrasound division, and residents formed a task force. Barriers to documentation were identified through brain storming and email solicitation. The total number and application-specific POC u/s examinations performed and transferred to the healthcare record and medical coders were compared for the pre- and post-task force intervention periods. Chi square analysis was used to determine the difference between the number of POC u/s examinations reported before and after the intervention.
  
  
  RESULTS
  A total of 1652 POC u/s examinations were reported during the study period. Successful reporting to the patient care chart and medical coders increased from 41 % pre-task force intervention to 63 % post-intervention (p value 0.000). The number of scans performed during the 3-month periods (pre-intervetion, post-intervention 0-3 months, post-intervention 3-6 months) was similar (521, 594 and 537). When analyzed by specific application, the majority showed a statistically significant increase in the percentage of examinations reported, including those most critical for patient care decision making: (EFAST (41 vs. 64 %), vascular access (26 vs. 61 %), and cardiac (43 vs. 72 %); and those most commonly performed: biliary (44 vs. 61 %) and pelvic (60 vs. 66 %). Of the POC u/s studies coded and reported for reimbursement, 15.9 % were billed before intervention and 32 % were billed after intervention (p value: 0.000).
  
  
  CONCLUSIONS
  The formation of a workflow solution task force positively affected emergency physician compliance with POC u/s documentation for coding and billing over a 6-month period. Further investigation should assess the long-term effect of the intervention and whether this translates into increased revenue to the department.
authors.affiliation: Department of emergency medicine, Department of Radiology, University of Colorado Hospital, Aurora, CO, USA. resaelewiss@gmail.com.
authors.forename: Resa E
authors.initials: RE
authors.lastname: Lewiss
authors.affiliation: Department of emergency medicine, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cook
authors.affiliation: Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Sauler
authors.affiliation: Department of emergency medicine, St. Barnabas Hospital, Bronx, NY, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Avitabile
authors.affiliation: Department of emergency medicine, Mount Sinai Beth Israel Hospital , New York, NY, USA.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Kaban
authors.affiliation: Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rabrich
authors.affiliation: Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA.
authors.forename: Turandot
authors.initials: T
authors.lastname: Saul
authors.affiliation: Department of emergency medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY, USA.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Siadecki
authors.affiliation: Bronx-Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wiener
keywords: Documentation compliance; Point-of-care ultrasound; Ultrasound workflow; Workflow