Cardiovascular Computer-Assisted Physician Documentation (CV CAPD) from Nuance

1. CV CAPD Workflow

CV CAPD offers a single place for providers to enter and document cases performed in the cardiac catheterization lab. Providers electronically sign completed cases and submit them to the Compliance Module for review. Upon approval, completed cases are transmitted to the hospital EHR and billing systems. 

CV CAPD Workflow diagram

1.1 Case Information Exported to CV CAPD

Cases assigned to the provider are entered into the hospital EHR system and imported into CV CAPD by designated hospital staff member(s) or by automatic message. Upon login, all active cases for a provider are displayed.

1.2 Complete Forms

Forms can be added by the provider or other Forms user. Forms are then associated with a specific case by the provider in the Documentation tab.

1.3 Select a Case

An automatically updated Case List shows which cases need to be documented or revised, as well as those that are currently being reviewed through the Compliance Module.

1.4 Document the Case

Document and dictate the procedures performed in the cardiac catheterization lab.

  • Add Patient Info: Add the indication, informed consent, and moderate sedation details.
  • Customize Anatomy: Customize the patient’s coronary dominance, add or remove coronary vessels including the Ramus Intermedius, add coronary or peripheral bypass grafts, and add arch or renal variations to the Body Map. These changes will automatically populate for the patient the next time their case documented in CV CAPD. 
  • Enter Prior Studies: Document any relevant prior diagnostic studies not already in the system. Diagnostic findings entered using CV CAPD will automatically populate the Body Map if the patient returns for future care.
  • Enter Procedure Entry: Using simple form fields and the interactive Body Map, document procedures performed during the case.  See item 2 for a full list of procedures.
  • Review Documentation & Submit Case: Review the completed case documentation and submit to the Compliance Module for review.

1.5 Compliance Workflow

The Compliance Module for CV CAPD provides a single place for all cases performed in the cardiac catheterization lab to be reviewed, checked for accuracy, and approved for transmission to the hospital’s EHR and billing systems.

The following items describe the main features and functionality of CV CAPD as experienced by the compliance user.

CV CAPD Compliance Workflow Diagram

1.6 Case Submitted by Provider

After a case has been documented by the provider, he/she submits it to a compliance user for review.

1.7 Select a Case

The Case List updates automatically, showing which cases need to be reviewed by the compliance user, which cases are still being documented, and which cases need to be revised by the provider. 

1.8 Review Documentation

Once a case is selected for review by a compliance user, a single screen opens showing everything needed to ensure the documentation and CPT coding is accurate. The following items are presented for review:

  • Flags: Notifications of inconsistencies between the hemodynamic system and provider documentation.
  • Billing Codes: CPT codes with modifiers and corresponding facility-specific chargemaster codes are generated automatically.
  • Documentation: Case documentation entered by the provider through CV CAPD.

1.9 Require Provider Review

If a case needs additional information or changes, it can be routed back to the provider with a query.

1.10 Approve Case

Once a case is approved by a compliance user, the final record is saved and submitted to EHR and billing systems. Approved cases can be found in the Submitted Case List for both providers and compliance users.

1.11 Case Status

The status of a case in the Compliance Module changes as it goes through the edit and review process, and different actions can be performed at each step. A case’s current status is indicated on the compliance user’s Case List.

Etch case status workflow diagram

2. Procedures Covered

List of available procedures in Etch CV

3. Provider Case List Interface: Active Cases

Interface screenshot - Provider Case List Active
  1. Menu Item: The Active Cases Case List opens automatically upon logging on to CV CAPD. To shrink the menu item list, click the left arrow button. Only the icon for each tab will be displayed. To reopen the menu item list, click the CV CAPD icon.
  2. Tabs: Click the appropriate menu item to enter a different tab. Some tabs are inactive unless you are documenting a case. 
  3. Current User: The user account that is currently logged in to CV CAPD.
  4. Administrative Settings: Customize your access site cocktail and Post-Procedural Summary options. 
  5. Active Cases: Cases currently in your queue for documentation or compliance review.  
  6. Case List Toggle: Each provider can review their submitted cases by clicking this button.
  7. Sort Cases: Click any of the column headings to sort the cases by that property. Click again to reverse display order.
  8. Case Status: Each case displays its current status, indicating action needed by the provider or compliance user. Cases with a status of Requires Review need to be amended by the provider and resubmitted to the Compliance Module.
  9. Search: Search for a case by patient name or case status. 

4. Provider Case List Interface: Submitted Cases

Interface screenshot - Provider Case List Submitted
  1. Menu Item: Open the Case List screen by clicking the appropriate menu item, then use the Case List Toggle to enter Submitted Cases.
  2. Case List Toggle: Review and document active cases in a separate case list.
  3. Filter Cases: Filter the case list by Date Range & Facility. Reset cases back to the default filter.
  4. Submitted Cases: A list of all cases that have been approved and sent to billing. 
  5. Sort Cases: Click any of the column headings to sort the cases by that property. Click again to reverse display order.
  6. Review Case: Select a case to add an addendum, review documentation, or review the physician codes for approved cases. 
  7. Search: Search for a case by patient name or facility within the given date range.

5. Forms Interface

Interface screenshot - Form entry
  1. Menu Item: Open the Forms screen by clicking the appropriate menu item.
  2. Create Form: Create a new form.
  3. Form Type: Select the type of form.  
  4. Edit/Delete: Click a form to edit or delete it. 
  5. Forms: Forms created by designated Forms Users and those created by the provider will populate here. 
  6. Case Description: Add a form identifier when creating a new form to associate the form with a specific patient.
  7. Form Creator: See who created each form.
  8. Date Created: Only forms created within a certain length of time will populate the Forms List.
  9. Search: Use keywords to search for a specific form.

6. Patient Info Interface

Interface screenshot - Patient Info
  1. Menu Item: Open the Patient Info screen by clicking the appropriate menu icon.
  2. Patient & Case Info: Displays patient demographic information provided by the hospital EHR system, as well as information specific to the current case.
  3. Case Details: Document whether pre-procedure antibiotics were used during the case or whether the provider was on call.
  4. Indication: Enter patient history related to the case.
  5. Informed Consent: Enter whether informed consent was obtained and by whom.
  6. Anesthesia: Enter patient sedation details using the provided fields.
  7. Saved: Icon indicates changes have been saved. All data entry on the Patient Info screen is saved automatically.

7. Body Map Interface

Interface screenshot - Body Map
  1. Navigator: Contains all Body Map display controls.
  2. Vessel Inspector: Displays the name of the vessel on which the cursor is resting.
  3. Zoom: Zoom in and out using the + and – buttons. Alternatively, use the mouse scroll wheel when the cursor is over the Body Map.
  4. Location Pane: The blue rectangle indicates which portion of the Body Map is currently visible. Click and drag the pane to adjust.
  5. Toggle Map View: Choose which anatomical system the Body Map displays.
  6. Re-center: Adjusts the Body Map to its default position. 
  7. Show, Hide, and Target Anatomy: Click a region to show or hide it on the Body Map. Click the zoom button to center on that region.
  8. Procedure Markers: Toggle the procedure icons on or off. 
  9. Coronary View Toggle: Once zoomed into the coronaries or structural heart, a shortcut to toggle between the arterial and venous Body Map views. 

8. Anatomy Interface

Interface screenshot - Anatomy
  1. Menu Item: Open the Anatomy screen by clicking the appropriate menu item.
  2. Locked Value: If a procedure or finding has been entered within the affected area of a variation or graft, the corresponding field will be locked. The procedure or finding will need to be deleted in order to change the variation or graft. 
  3. Coronary Customization: Click Customize Vessels to add or remove arteries, including a ramus intermedius, to match the patient’s coronary vasculature.
  4. Coronary Grafts: Add RCA, LAD, RI, and/or LCX bypass grafts from the provided options. Click +Add Graft to add additional grafts.
  5. Variant Anatomy: Select variation from the provided options. As selections are made, the Body Map will update to reflect the new anatomy.
  6. Peripheral Grafts: Add peripheral grafts in the same manner as coronary grafts. 

9. Prior Findings Interface

Interface screenshot - Prior Findings
  1. Menu Item: Open the Prior Findings screen for the current patient by clicking the appropriate menu item. 
  2. Procedure List: All Prior Studies and their corresponding diagnostic procedures & findings are displayed in this area.
  3. Prior Diagnostic: Add the appropriate diagnostic procedure and region of the prior study. 
  4. Prior Finding(s): Findings are nested under the diagnostic procedure in which they are discovered. 
  5. Add/Create New: Add further prior diagnostics for the current prior study or create additional new prior studies.
  6. Body Map: Interactive map for entering the findings of a patient.
  7. Navigator: Toggle anatomy in the Body Map, change zoom level, and adjust location

10. Procedure Entry Interface

Interface screenshot - Procedure Entry
  1. Menu Item: Open the Procedure Entry screen by clicking the appropriate menu icon.
  2. Procedure List: All procedures and findings will be added chronologically to this list
  3. Access Site (Active): Active access sites are green. Any procedures will be entered in the active access site until another is activated.
  4. Diagnostic Procedure: Nested inside the access site.
  5. Findings: Added in Findings Entry Mode and nested inside their corresponding diagnostic procedure. 
  6. Interventions: Procedures that treat existing findings. 
  7. Access Site (Inactive): Inactive access sites are red. Click the toggle to activate an inactive access site.
  8. Reorder Procedures: Reorder the documented procedures in the order they were performed in the cardiac catheterization lab. Procedures cannot be reordered across an access site. 
  9. Entry Mode: Indicates the type of procedure that can be entered, along with information on the current parent procedure. 
  10. Body Map: Interactive map for entering procedures, findings, interventions, device placements, and complications.
  11. Procedure Marker: Indicate the type of procedures performed, and corresponds with the respective item in the Procedure List.
  12. Vessel Inspector: Rest cursor on vessel to view vessel name.
  13. Navigator: Zoom and pan on the Body Map. Show, hide, or target anatomical regions as needed.

11. Documentation Interface

Interface screenshot - Documentation
  1. Menu Item: Open the Documentation screen by clicking the appropriate menu icon.
  2. Attach FormsAttach forms to the case.
  3. Post-Procedural Summary: Enter Adverse Events, Recommendations, and Impressions. 
  4. Patient and Case Information: Data specific to the current patient and case.
  5. Report Navigation: Click any of the buttons to jump to that section of the report, or scroll through the report manually.
  6. Report: The case documentation consists of the Report Summary, Virtual Dictation, Graphical Report, and Report Details.
  7. Print OptionsClick to print the Full Report (draft), Graphical Report, or Text Report. 
  8. Submit Case: Click to submit the case to the Compliance Module for review.

12. Compliance Case List: Active Cases

Interface screenshot - Compliance Case List Active
  1. Menu Item: The Active Cases Case List opens automatically upon logging on to CV CAPD. Alternatively, open the Case List screen by clicking the appropriate menu icon.
  2. Active Cases: Cases currently in your queue to be reviewed and approved. 
  3. Current User: The user account that is currently logged in to CV CAPD.
  4. Addenda: If addenda are added to a case, that case will appear for review under the heading ADDENDA ADDED. If all addenda have been reviewed, it will state NO ADDENDA ADDED. 
  5. Case List Toggle: Submitted cases can be reviewed separately for all providers in the system by clicking this button.
  6. Sort Cases: Click any of the column headings to sort the cases by that property. Click again to reverse display order.
  7. Case Status: Each case displays its current status, indicating action needed by the provider or compliance user. 
  8. Time to Approval: Based on creation time, the Case List displays elapsed time in hours from case creation to completion.
  9. Search: Search for a case by patient name or case status.
  10. Archive Case: To remove an unwanted case from the Case List, archive the case with this button.

13. Compliance Case List: Submitted Cases

Interface screenshot - Compliance Case List Submitted
  1. Menu Item: Open the Case List screen by clicking the appropriate menu icon, then use the Case List Toggle to enter Submitted Cases.
  2. Case List Toggle: Active cases can be reviewed separately for all providers in the system by clicking this button.
  3. Filter Cases: Filter the case list by Date Range, Facility, Provider, and Has Addenda. Reset cases back to the default filter.
  4. Submitted Cases: A list of all cases that have been approved. 
  5. Sort Cases: Click any of the column headings to sort the cases by that property. Click again to reverse display order.
  6. Review Case: Providers may add an addendum to their cases. Select a case to review the documentation and codes.
  7. Search: Search for a case by patient name or case status.

14. Compliance Review

Interface screenshot - Compliance Review
  1. Menu Item: Open the Compliance Review screen by clicking a case with a status of Requires Review in the Case List.
  2. Flags Management: Total number of flags for the case is indicated here, along with bulk display actions. 
  3. Flags: Possible issues with the case are generated and displayed based on the provider documentation. Review and dismiss as applicable.
  4. Generated Codes: CPT and charge codes are displayed to review. Edit, delete, or add additional rows as necessary.
  5. Report Navigation: Click any of the buttons to jump to that section of the report or scroll through the report manually.
  6. Case Documentation: Comprehensive, provider-generated documentation for side-by-side review with the coding output. 
  7. Approve/Reject:  Approve or Reject the case. Rejected cases are sent back to the provider with a note containing the reason for rejection.

Compliance Flags

CV CAPD’s coding engine checks for discrepancies between the facility records and the provider’s documentation of a case. Any issue generates a flag. Flags are for the compliance user’s reference only, and do not become part of the case record.

Urgency

Flags appear in two levels of urgency and indicate areas of the documentation that should be reviewed before approval along with suggested next steps.

  • Error: Indicate a likely error in the case documentation or CPT and charge code output. Missing device information or hemodynamic data discrepancies will also receive this flag.
Error Flag screenshot
  • Warning: Indicate probable action needed. Discrepancies with the patient MRN or Account Number will generate this flag. Additionally, provider notes or complex procedures may require special attention to ensure coding accuracy. 
Warning Flag screenshot
Flag dismissal UI screenshot

Flags can be dismissed individually or as a group to reduce clutter. Click the X icon to dismiss individual flags, or click Dismiss All to hide all flags. Once dismissed, they remain in the system and can be easily retrieved by clicking Show All.