For those following our blog series you should be getting the hang of streamlining your QI Program by now. This week we will tackle the dreaded clinical correlation! Wait… before you cringe and close out this blog let me share some good news! IAC recently changed the correlation requirements for many of the modalities.

• Echo: Reduced to just 4 cases annually with at least 2 cases per testing area
• Vascular: Reduced to just 4 cases annually with at least 2 cases per testing area
• Nuclear: Not mandated, but can be selected to meet one of the current QI Measures
• MRI/CT: Not mandated but suggested to correlate MRI and CT with surgical intervention or treatment to meet the Interpretive Measures

With the clinical correlation measure now having such minimal requirements, this task is not as daunting as it used to be!

Hack #1: Use Technology

It still amazes me to see how many clients are still relying on paper systems to figure out which patient has had multiple tests performed on them. Use technology to help! Every test is associated with a procedure billing code. Your billing department can run a report on all patients that have been billed any combination of billing codes. Talk to your billing department and talk to your I.T. department and see how to create a report with a list of patients that have received certain tests.

We use this method to create lists of patients that have received an Echo and a Cardiac Cath for example; or a Carotid Ultrasound and an Angiogram. Just work with the billing department to find out the billing codes for the specific tests you are looking for and see the best way to generate this list. The I.T. Departments can sometimes create these reports within your EMR (like Epic for example).

Hack #2: Don’t Double Dip

Don’t be like George on Jerry Seinfeld and double dip!!
For those of you that need to rely on a paper system; be sure to make the best use of your time by not double dipping in and out of medical records. Whenever you are reviewing a patient’s chart (while checking the order and patient history prior to performing their exam) print out ANY other recent abnormal test results that you could correlate with the study you are about to do. Just place them to the side in a tray.

Tips:

1. It’s more beneficial to correlate abnormal findings. As we mentioned last week correlating normal to normal doesn’t provide as much learning opportunity as correlating pathology size, location, severity, etc.
2. You are now just looking for any abnormal study that is already in the patients’ medical records
3. Just print the report and place it to the side (have a tray designated for clinical correlations)
4. Every week or two take 10 minutes to look through the tray and attached the final echo reports

“Great idea but I don’t have access to the patient medical records prior to scanning my patients. I work in an out-patient center and all I have access to is the prescription for the test!”

Not a problem, just tackle the task backwards! Keep records of every abnormal study you complete and then see how to hunt down any additional testing.

Hack #3: Keep track of your abnormal studies

There are a couple of different ways to keep track of your abnormal studies. The best way for you to do this is to implement the least amount of change as possible! Just find little ways to tweak your day that helps track abnormal studies. Here is a list of some ideas labs around the nation are using to keep track of their abnormal studies. Which best fits into your daily routine?

Tips:

1. Add a check column to your patient log to identify abnormal studies
2. Place something in the clinical correlation tray that will remind you of the name and date of the patient study:
   •  Copy of the order or prescription
   • Copy of the preliminary worksheet
   • Scrap piece of paper with name and test date
   • Final report
3.  Reading station Identification:
   • Create a field that you can flag. Some reading stations already have a field you can mark to identify a study. For example, to identify as a learning case, peer review case, accreditation case, etc.
   • See if you can perform an advanced search under specific fields. For example, on some reading stations there are nestled (advanced) search fields that allow you to pick a field like ‘Aortic Valve’ and then search ‘field contains….’ then enter a word to search, like “stenosis”. This allows you in one sitting to quickly search within a given time frame all reports with a set pathology criteria

Now that you have created a list of your abnormal studies, the obvious next question is how you hunt down any possible clinical correlation results. Fear not… here are some suggestions.

You are now armed with your list of abnormal findings, now what?? The good news is that by narrowing down your list of patients to just those with abnormal findings you have greatly increased the possibility of findings additional testing results. We know this is not fun or particularly easy but our goal is to focus on saving you time. Remember the clinical correlation requirements have been greatly reduced with echo and vascular now having these as annual measures so there is no rush to complete this every quarter as long as you have them by the end of the year. Start implementing these best practices into your facility and they will pay off over time.

Hack #4: Be a Proactive Hunter

How do you increase your chance of success when on the hunt for clinical correlation results? By being a proactive hunter! Here are some tips we implemented in labs across the nation that did not have the ability to use technology to make their life easier.

Tips:

1. Abnormal Reports: Review the patients’ chart 2 – 3 months after placing them in your clinical correlation tray. This will give enough time to see if any additional testing was performed. If no additional testing is identified after 4-6 months you can throw out the report.
2. Out Patient Centers: This is one of the hardest challenges but we even have tips for you! We have created template letters for our out-patient clients that they use to request abnormal clinical correlation results. How does this work?
   •  Identify which referring physicians you would like to work with. Who sends the most patients to your facility? Who has the most helpful staff? etc.
   • Notify them that you are currently accredited or seeking accreditation which mandates clinical correlation (you can brag about the benefits of accreditation at this time!) and let them know you will be requesting correlation results every month or quarter.
   • Sign any necessary HIPAA agreements if required
   • Provide the ordering physician with a list of their patients that had abnormal test results and ask for them to forward any additional follow up testing to you

1. Physician Practices: One other technique we use for physician practices is to identify the patients from their office that are being sent out for additional testing.
   • Ask the front desk to make a copy of the physician request for scheduling additional testing and just throw it in a tray up front
   • 2-3 month later you can go through the tray and see if the patient followed through on their additional testing. The results will be in their medical records as it was your practice that ordered the test.

Recap!

Again, if you can rely on technology and create a report then please make your life easy and use Hack #1 – Use Technology! For all the paper pushers; remember the best option for you is Hack #2 – Don’t Double Dip. This is the easiest and most efficient way to speed up the success rate of finding clinical correlation studies as you will identify additional testing before you have even began your test! For those of you that don’t have access to this method or would like to find additional ways to find clinical correlation we suggested Hack #3 – Keep Track of your Abnormal Studies. Narrowing down your list of patients to just those with abnormal findings greatly increases the possibility that they have received additional testing. Finally use all the tips under Hack #4 – Be a Proactive Hunter to successfully hunt down your clinical correlation results.

Need help?

Remember the staff at the Intersocietal Accreditation Commission are awesome so feel free to reach out to them with questions and check out their website for useful resources. Also, don’t be shy about reaching out to us here at CardioServ. As accreditation consultants we are here to help all labs, small and large, achieve accreditation. There is no question that is too silly to ask. Give us a call if you need help and follow us on social media to stay current with the latest accreditation news.