AHLTA Provider Training

1. AHLTA Provider Training AGENDA • Sustainment Training Consultant Initiatives • User Settings • Usability Aim Form & Template Tips • New Templates to Maximize RVU’s • Dragon Naturally Speaking • Documentation & Coding in AHLTA to Maximize RVU’s • E/M Calculator In Disposition Module • E/M Report in AHLTA • Questions/Answers

2. Sustainment Training Consultant Initiatives • Maximize Effective Use of AHLTA • Templates in Favorites Folder • Using Order Sets and QA’d Codes • Improve Provider Satisfaction • Focused Training • Analyze Clinic Workflows • Recommend how support staff can document in AHLTA to save provider time • Improve RVU’s • Monitor through reports module • Analyze completed encounter s/o notes

3. Sustainment Training Consultant Initiatives(Cont’d) • Triad Concept • Coder, Consultant, Clinic Champion • Monthly Meetings • Targeted Approach to Provider Training to Improve Overall Clinic RVU’s • Available Super User Training Classes • Clinic Champion Works with Consultant on Templates • Clinic Templates (QA’d by Coders)

4. User Settings

5. User Settings

6. 3.3 ONLY

7. Documentation & Coding in AHLTA Maximizing RVU’s in the S/O

8. Warning!!!!Free Text used in AHLTA is NOT coded automaticallyAvoid using free textIf you must use it always try to associate it with a Medcin term

9. How Much Should You Do? • Obviously there will be a lot of encounters (i.e. Established Patients) where little or no physical exam occurs • However when a physical exam is done or must be done (i.e. New Patients) be sure to get credit for what you do! • Things like “Vitals” “Orientation” “Gait” and “Appearance” should be automatic on almost any exam

10. This template has been added to your clinic folder with A name that includes a “#” which, when added to your Favorites will move it to the top of your drop down list In the S/O module NOTE: THIS ENCOUNTER TEMPLATE HAS THE DOD AIM FORM ON IT AND WILL BE UPDATED AUTOMATICALLY. YOU WILL USE THIS TEMPLATE FOR S/O DOCUMENTATION ONLY AND THEN LOAD YOUR DEFAULT ENCOUNTER TEMPLATE OR DISEASE SPECIFIC TEMPLATE FOR THE A/P PORTION WITH DX, PROC CODES AND ORDERS

11. GO TO CLINIC FOLDER AND EXPAND NEW TEMPLATES SUBFOLDER AND THEN CLICK ONCE TO SELECT AND THEN ADD TO FAVS

12. NOTICE HOW THE TEMPLATE IS NOW AT THE TOP OF MY DROP DOWN LIST SINCE THERE IS NO REASON TO SAVE AN AIM FORM AS YOUR OWN

13. Use the HPI/Screening Tab for Chief Complaint and past history, family history, and social history Addressing Tobacco and/or Alcohol here gives 1 credit point to Social History…

19. Coding rules are listed at the top. 1 for Problem Pertinent. 2 -9 ROS must be covered for a 99214 (Extended level ROS) from 2 or more different organ systems, etc. Must be clinically important to get credit!

20. USE THE ‘ALL NORMAL” BUTTONS TO QUICKLY DOCUMENT NORMAL ROS AND THEN CHANGE YOUR ABNORMAL FINDINGS. NOTE HOW YOU SHOULD FLIP + ROS TO HPI SO ALL YOUR + FINDINGS IN HPI

21. Use the quick normal findings button and Change from N to Y or N to A for abnormal And then describe using the free text box

23. Use New Templates • Excellent AIM Form Templates Exist • Alternate Input Method • Usability Aim for Primary Care and Pre/Post OP • Specialty Specific Templates also exist now • Searching for Templates • S/O Templates • Encounter Templates • List of Templates

25. Templates Resources List of Templates Power point and word documents on how to’s and FAQ SEE NEXT SLIDE

29. SEARCHING FOR S/O TEMPLATE

30. ADD TO FAVORITES

31. LOAD TEMPLATE

33. ENCOUNTER TEMPLATES

34. Encounter templates contain your s/o note (list or Form), diagnoses, procedures, hcpcs, and orders. Encounter templates provide you with maximum Efficiency. Multiple templates can be loaded in a/p so no Searching for codes is needed.

35. This drop down list contains all Encounter templates and order sets

36. Select ALL your orders here by clicking Select or Modify (if need to change QTY Or if RAD to modify the impression), Then press submit and all orders Process at once.

38. THIS USABILITY AIM FORM CAN BE USED FOR ABOUT 85% OF ALL VISITS AS THE FIRST TEMPLATE

39. THIS IS PROCEDURES AIM FORM

40. NEW AIM FORMS PRODUCE CLEAN, READABLE NOTES

41. Dragon Naturally Speaking

43. Coding and RVU’s