Epic Insights

Improving Deficiency Management

The Client

Our client is a non-profit company dedicated to improve lives by delivering exceptional care and to inspire the pursuit of optimal health. Through its subsidiaries and its partnerships with doctors and other clinicians, healthcare and community organizations, and, most importantly community members, our client is dedicated to care that is coordinated across all care settings to meet each person’s goals and needs.

The Challenge

The HIM departments and clinicians had a lot on their plate. They needed help in repairing relations and accountability between Providers and HIM. The following were the challenges faced by our client:

  • Epic was misrepresenting staffing deficiency and suspension protocols
  • The Provider Pull List was not generating accurate and appropriate follow-up
  • Hundreds of “Orphaned Deficiencies” had accumulated, without being tied to an Episode of Care or responsible party/location

The Solution

Through review of ticketing trends, stakeholder collaboration, and direct system analysis, Healthcare Triangle evaluated the root causes of these issues. The analysis of Epic build, deficiency statuses, reports, and suspension notification build, revealed numerous factors requiring attention. Extracting relevant data from Epic in advance, and with answers and understanding in hand, we sat down with HIM leadership and outlined the following recommendations for improvement, which were ultimately executed:

  • Aging parameters in the Deficiency Configuration (DEF)Records needed to be re-configured
  • Duplicate checking logic needed to be corrected and enhanced
  • Limitations needed to be put in place to prevent Providers from re-assigning deficiencies to other Providers, resulting in a “Ping-Pong” effect, and continually extended deadlines.
  • Outdated methods and criteria for generating letters out of Epic needed to be replaced
  • Disparities between Deficiency notifications, letter generation criteria, and the suspension pull list needed to be corrected. Furthermore, batch print configuration is now set to automate and replace the twice-weekly practice of printing provider letters
  • EAF (location) build for three specific areas (Psych, Rehab, & Skilled Nursing) needed to be enhanced to fill gaps in Deficiency linking logic. Since these “orphan” notifications had only been queued up for HIM investigation, they now were being routed to Providers who were accountable for resolution


Completing a detailed review of Epic build directly with key HIM stakeholders not only brought resolution to the challenges described above, but it also helped them to better understand the Epic design and configuration that they use daily. Tangible improvements from this body of work include:

  • Deficiency dates now automatically adjust and update through various statuses
  • New Epic WQs provide real time data and visibility
  • Hyperlinks now take providers directly to what needs to be addressed in Epic. A conservative estimate of MD time saved represents $1,000,000 in new potential productivity*
  • Almost 1500 verbal/co-sign order deficiencies, having been orphaned from their corresponding charts were identified, and those that could be addressed were tracked and monitored
  • The HIM department saved two hours a week they used to spend running Pull List reports and printing letters.
  • Real time information on where a Provider is in the suspension process is now directly available in the system


When EHR system deficiencies and organizational expectations are aligned, staff can be automatically directed to an e-solution for the task, which can save time, clicks, and money. HIM operational staff benefit as well. Data tracking and pattern identification, along with follow-up and management tasks, can be dramatically improved.

One of the primary HIM stakeholders at the organization put it bluntly: “Thanks to Healthcare Triangle, we now have an accurate and efficient process for Deficiencies and ensuring Provider documentation compliance, and we are so much more confident in what we are doing in Epic.”

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Non-profit Organization





...Thanks to Healthcare Triangle, we now have an accurate and efficient process for deficiencies and ensuring Provider documentation compliance, and we are so much more confident in what we are doing in Epic

-HIM Director

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