Physician Practice Project

Transcription

1 Physician Practice Project This material was prepared by Florida Medical Quality Assurance, Inc., the Medicare Quality Improvement Organization for Florida, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. FL20051dFT1D

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3 Physician Practice Resource Manual Doctor s Office Quality Information Technology 8 th Scope of Work August 1, 2005 July 31, 2008

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5 Table Of Contents 1. Introduction Introduction FMQAI Team Members Acknowledgements New Model of Primary Care Road Map to Electronic Health Records 2. Assess Assessment Phase Checklist On-Site Assessment Professional/Patient Assessments (5) Staff Activity Surveys (6) Personal Skills/Needs Assessment The Case for Improvement Assessing Your Practice Measuring Your Practice (4) 3. Plan Plan Phase Checklist Establish the EHR Team Prioritize Ideas/Recommendations Next Steps Timeline Template Change Management and Quality Improvement Processes/Components of a Successful Implementation Critical Success Factors How to Improve/Setting Aims/Measures/Changes Shortening Wait Times: Six Principles for Improved Access Checklist for Implementing Open Access Scheduling Reduce Scheduling Complexity (5) Start On-Time Agreement Office Visit Cycle Time Unplanned Activity Card DOQ-IT Current Return on Investment (ROI) Literature for EHRs 4. Select Selection Phase Checklist Vendor Evaluation Matrix DOQ-IT Vendor Letter of Intent List Contracting Guidelines EHR Vendors AC Report Link (see section 7) RFP Proposal Preparation Link (see section 7) Glossary, Red Flags, & FAQs

6 5. Implement Implementation Phase Checklist Common Implementation Problems Implementation Options Incremental vs. Big Bang Redesign the System 6. Evaluate/Improve Evaluation/Improvement Phase Checklist QualityNet Exchange for Registration for Data Transmission Link (see section 7) DOQ-IT Measures Overview & Data Submission Process Reliability The Model for Chronic Disease Management Patients: Assessment of Care for Chronic Conditions Assessment of Chronic Illness Care (version 3.5) 7. Links To Article And Websites Websites for Accessing Tools Articles for Phases of the Road Map

7 Introduction Information for Healthcare Improvement Quality Improvement Organizations (QIOs), under contract with the Centers for Medicare & Medicaid Services (CMS), are expected to provide assistance to healthcare providers that enables them to develop the capacity for, and to achieve the vision of the program, which is that every person receives the right care every time. QIOs shall accomplish this by working with providers, practitioners, Medicare Advantage organizations, beneficiaries, and other stakeholders in support of quality improvement. Assistance will typically involve seeking to promote improvements in organizational culture, systems adoption and use, and redesign of care processes. FMQAI, formerly Florida Medical Quality Assurance, Inc., Florida s Medicare QIO, is excited to work with the healthcare community to improve care received by Medicare patients in all areas of care delivery. FMQAI s Physician Practice Team will work with physicians and their office staff to assess how electronic clinical information systems can be used to improve the quality and efficiency of care with a focus on e-prescribing, e-registry/care management, and deployment of full electronic health record systems (EHRs). FMQAI will assist physicians to select health information technology products, reorganize workflow and care processes to implement EHRs, and undertake quality improvement projects to realize the benefits of EHRs. Following the steps outlined in this manual will promote the potential for success of your EHR investment and care improvement processes. The road to a successful implementation of EHR is challenging and cumbersome. FMQAI is ready to walk with you along the path to a successful implementation in your practice. FMQAI is also directed to work toward improving indicators of quality for Diabetes, Cardiovascular Disease and Preventive services. The ultimate outcome of the Physician Practice project is to make it possible for Primary Care Practices to transmit quality data, for the targeted indicators, to a secure data warehouse developed by CMS. This will enable CMS to receive real time, accurate data on which they can build a pay for performance reimbursement program. The Physician Practice Team Project Coordinators are excited to be participating in this project. This project has the potential to enhance patient outcomes and improve physician satisfaction with their practice and improve provider s quality of life. We look forward to working with you and your staff to share with you our knowledge and intervention tools to transform your practice into a winning situation for everyone patients, providers and staff. FMQAI Physician Practice Project Team 5201 West Kennedy Boulevard, Suite 900 Tampa, FL Toll Free (800) Telephone (813) Fax (813) W. Kennedy Boulevard, Suite 900 Tampa, Florida fax

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9 The Right Care for Every Patient Every Time FMQAI Physician Practice Project Team Diane Chronis, RN, BS Project Director x 3558 dchronis@flqio.sdps.org Project Coordinators Joan Crosby, RN, MS, CPHIT, CPEHR Project Coordinator, DOQ-IT x 3537, jcrosby@flqio.sdps.org Christine Lalios Kuykendall, RHIA, CPHQ Project Coordinator, DOQ-IT x 3592, ckuykendall@flqio.sdps.org Darleen Luzod, MS, RN HIT Project Coordinator, DOQ-IT x 3811, dluzod@flqio.sdps.org Sharon Sopczak, RN Project Coordinator, Underserved Populations x 3510, ssopczak@flqio.sdps.org Laura Gamba, BA, CBA Senior Project Coordinator, Underserved Populations x 3920, lgamba@flqio.sdps.org Kathleen Lightbourne, MPH Project Coordinator, Underserved Populations , x 3562, klightbourne@flqio.sdps.org Jan Murray, BSN, RN Project Coordinator, DOQ-IT x 3585, jmurray@flqio.sdps.org Farah Tavakoli, MSHA, MT-ASCP HIT Project Coordinator, DOQ-IT x 3805, ftavakoli@flqio.sdps.org Chitra Yeshwanth, MS, MPH Project Coordinator x 3319, cyeshwanth@flqio.sdps.org Ancillary Staff JiFeng Ma, Ph.D Statistician x 3861, jma@flqio.sdps.org Bonnie Mason Communication Specialist x 3570, bmason@flqio.sdps.org Cindy Olejnik Administrative Assistant x 3578, colejnik@flqio.sdps.org

10 The Right Care for Every Patient Every Time Physicians Ferdinand Richards, MD Medical Director, FMQAI , Mark Michelman, MD, MBA Clinical Director, FMQAI , R. Scott Hanson, MD, MPH Physician Consultant

11 The Right Care for Every Patient Every Time ACKNOWLEDGEMENT FMQAI has derived much of the material in this tool kit from the following: Institute for Healthcare Improvement Website, The Dartmouth-Hitchcock Medical Center, The work of Mark Murray, MD, MPA and Catherine Tantau, BSN, MPA, who first created and used the Open Access Scheduling processes and procedures. Lumetra California s Medicare Quality Improvement Organization s DOQ-IT Pilot Program We wish to thank the above persons and facilities who have spent time and effort to put together the pieces of the path that give us the greatest potential for successful redesign of Primary Care Office Practice using Electronic Clinical Information.

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13 The Right Care for Every Patient Every Time TWENTY-FIRST CENTURY PRIMARY CARE A personal medical home for each patient Patient-centered care A team approach to care Elimination of barriers to care Advanced information systems, including integrated electronic health records (EHRs) Redesigned, functional offices Whole-person orientation; culturally sensitive care Care provided within a community context Emphasis on quality and safety Enhanced practice finances (through operating efficiencies and new revenue streams) A commitment to provide a specific basket of services Adapted from American Academy of Family Physicians 21 st Century Primary Care Model

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15 Electronic Health Record Roadmap The Right Care for Every Patient Every Time ASSESS PLAN SELECT IMPLEMENT EVALUATION/ IMPROVEMENT BEYOND During this step office processes are assessed and analyzed to identify areas that can be improved. This lays the groundwork for planning and prioritizing EMR selection criteria and office redesign projects. In addition it allows you to have a better picture and understanding of the practice patient profile. During this step the results of the assessment and analysis are utilized to develop the priorities for the EMR system you will select. You will identify a Project Team that will participate in the ongoing process. This team will assist in all aspects of the EMR and redesign processes. During this step, using the criteria and plans from your previous work, your team will narrow down to the three to five vendors whose software most closely match your needs. Demonstration scenarios will be developed and vendors will be invited to demo their product to you Project Team. At the end of this phase your team will select the EMR best suited to your practice. During this step the Project Team will work with the staff to plan for the implementation of your system. This is an important step in minimizing the disruption to your office and a successful implementation. The team should be very active in setting up training and assuring that each staff member is trained appropriately. During this step the impact of the EMR on your practice and staff will be assessed. Process redesign will be reviewed and population management will be discussed and plans will be developed to identify and target the chronic illnesses within your practice. Plans will be generated to manage patients with the most frequently seen chronic illness diagnosis, such as Diabetes, CHF, etc. The ability to transmit data to the CMS Data Warehouse will also be checked. During future years of your practice the continual use of the EMR system to enhance patient care and outcomes will be available to your practice. Measurement of outcomes will assist you and your staff to provide and monitor care using evidence-based criteria on real time data. You will be able to provide data to payers to support your delivered standard of care. This will promote your ability to negotiate pay for performance reimbursements.

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17 EHR Roadmap Practice Name: Date: FMQAI DOQ-IT Team Facilitator: Phone: Physician Champion: EHR Team Leader: Phase Assessment Planning Practice Tasks Recommended for successful movement along the EHR Roadmap Complete IT readiness assessment Assess current workflow (identify pain points) Begin or continue regular staff meetings (at least monthly) Assign physician champion Organize an EHR selection/implementation team Assign an individual (EHR team leader) or team to lead practice changes Commit to: o Full provider engagement to enter data o Workflow changes necessary to maximize results List goals and priorities (include functions and specific provider needs) Translate identified EHR goals into available EHR system functions s and features Identify staff at lower levels of readiness and address their concerns Develop a timeline and project plan Gain support from team members and staff and prepare staff for changes Optional: Write RFI/RFPs Complete a cost/benefit analysis and ROI for an EHR system Milestone Checklist To demonstrate measurable movement along the EHR Roadmap (check the box as each milestone is completed; sign and date when all tasks in phase are complete) IT readiness assessment Readiness/next steps reviews Physician champion assigned Team leader assigned for practice changes Current workflow processes assessed Give signed participation agreement to FMQAI Proposed implementation target date Initials: Date Phase Completed: Practice has identified goals, priorities and any staff concerns EHR goals and associated system functions are listed Business plan developed, includes such items as: - Target implementation schedule/timeline - Estimates of EHR budget and ROI - Measurable EHR goals Initials: Date Phase Completed: Tools and Services Provided by FMQAI See Physician Practice Project Manual Section 2 See Physician Practice Project Manual Section 3

18 Evaluation Implementation Selection Attend structured demonstrations at Vendor Fair Evaluate vendors and create short list of 2-3 vendors Review EHR systems by: o Run vendors through a practice specific case cenario o Going on at least one site visit o Obtaining at least three vendor references Identify and select vendor for hardware, office wiring, and necessary network support for all services and products not included in EHR Negotiate contracts including all aspects of implementation, training, and technical support Continue workflow assessment and changes Draft EHR system implementation plan and timetable Assign data manager/administrator Assure data conversion and testing completed Assure interfaces completed and tested for: Laboratory Radiology Practice Management (billing and scheduling) Referrals Assign a go-live date Train staff Celebrate success and address problems Conduct post go-live reviews of implementation Conduct additional staff training as needed Evaluate EHR system goals met to date Verify vendor has provided technical infrastructure to capture clinical measures for future data submission Negotiate contracts and financing EHR vendor selected Hardware vendor selected Vendor selected for office wiring and cabling needs that are not included in EHR package Initials: Date Phase Completed: Implementation plan completed Contracts completed and signed Data manager assigned Data conversion and testing completed Interfaces tested and working properly Go-live completed and celebrated Vendor will be the primary driver of this phase; therefore vendor should be thoroughly engaged in all aspects of the implementation. Initials: Date Phase Completed: Post go-live reviews for EHR goals, implementation and additional staff training completed Schedule additional staff training Data capture verification completed with vendor Data submission to CMS Assess full use of EHR system and address lags Initials: Date Phase Completed: See Physician Practice Project Manual Section 4 See Physician Practice Project Manual Section 5 See Physician Practice Project Manual Section 6 Improvement Commit to continuous review of clinical and administrative processes Identify and target additional care management and process improvement opportunities Use EHR to optimize practice of evidence-based medicine Continue submission of data to CMS Re-analyze clinical and administrative processes Review performance reports Identify quality improvement opportunities Re-design work processes to use EHR clinical decision support tools with each patient encounter Initials: Date Phase Completed: See Physician Practice Project Manual Section 6

19 The Right Care for Every Patient Every Time Assessment Phase Checklist TASK On-Site Practice Readiness Assessment with EHR On-Site Practice Readiness Assessment without EHR Professionals Primary Care Staff Satisfaction Survey DATE STARTED DATE COMPLETED SENT TO FMQAI INITIALS Primary Care Practice Profile Patients Patient/Family Satisfaction with Primary Care Practice Access Survey Point of Service Patients Primary Care Practice Patient Viewpoint Survey (Choose one o f these two) Patients Through the Eyes of Your Patients Staff Activity Surveys Provider Activity Survey RN Activity Survey LPN Activity Survey MA Activity Survey Receptionist Activity Survey Activity Survey Personal Skills Needs Assessment Microsystems Resources Case For Improvement Assessing Your Practice Discoveries and Actions Measure 3 rd Next Available Appointment Measure Daily Demand Measure No Show Rate New Patient Panel Size Document Review

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21 On-Site Practice Readiness Assessment With EHR Contact Information Practice Name: Team Member Completing Assessment: Physician Practice Staff Interviewed: Assessment Date: CMS Required Scoring Information 1. Is the practice affiliated with an IPA or a large medical group? Yes No 2. What types of technology is the practice currently using on a regular basis? 3. Does the practice conduct regularly scheduled all-staff meetings (including providers)? Yes No 4. Please indicate staff s current attitude towards the EMR/HIT system: 5 = Very positive, 4 = Positive, 3 = Neither positive or negative, 2 = Somewhat negative, 1 = Very negative Physicians Mid-level providers Clinical Staff Office Manager Administrative staff Does the practice use the EMR/HIT system to identify patients with one or more chronic conditions or who require preventive services (e.g., identify patients due for influenza vaccination or patients with diabetes who require a HbA1c test)? Yes No Don t Know If yes, what does the practice do with the data? Submit for Pay-for-Performance programs. Yes No Create reports to use for peer review and feedback Yes No Create reports to use for performance improvement projects Yes No Schedule preventive services Yes No Other, please verify: FMQAI Data Collection Name of PMS System: Name of EMR System: Date began using? Date began using: Are they integrated? Yes No Interfaced? Yes No Do all staff and providers use the EMR system? Yes No Do all staff and providers use the system in the same manner? Yes No On-site Assessment 1

22 What components of the Eight Core Capabilities do your EMR: Health Information and Data: Immediate access to key information, i.e. diagnoses, allergies, lab results and medications. (Patient summary sheet, problem list, medication list, lab results, etc.) Result Management: Ability to quickly access test result, both new and past, in multiple settings. (PDA or other access when away from the office home, hospital, nursing home, etc.) Order Management: The ability to enter and store orders for prescriptions, tests and other services. (Direct order messaging to labs, diagnostic facilities, hospital, etc.) Decision Support: Ability to use reminders, prompts and alerts, computerized decision-support re: screening, drug interactions and evidence-based medicine. Electronic Communication and Connectivity: Efficient, secure and readily accessible communication among providers and patients. (Secure for patient and physician communication, Web Site with Patient portal, on-line scheduling, etc.) Patient Support: Patient access to health records, interactive education and help to carry our home monitoring and self-testing (on practice web site through patient portal, etc.) Administrative Processes: Scheduling, registration, and billing. Reporting: The ability to electronically store and retrieve uniform data standards. POSSESS USE How is documentation done in this practice? Template Dictation Typing Voice Recognition Other, specify: Does this practice use E-Rx? Yes No How? Printed Faxed E-Fax Electronic Transmission Does your office staff need additional EMR training to further utilize the EMR for these documents? Yes No Does this practice have interfaces for Lab results? Quest LabCorp Other Is this practice using any direct digital equipment access? (Check all that apply.) Vital Signs EKG Other Does this practice have access to their hospital portal for downloading information? Yes No What can they access? Does this practice have an efficient scanning system for paper management? Yes No Describe the process. On-site Assessment 2

23 Does this practice use the messaging/task system to communicate with staff and in-house providers/departments? Yes No Does this practice track referrals on the computer? Yes No Describe the process. Quality Improvement/Population Management Is this practice carrying out any Quality Improvement processes at present? Yes No What are they doing in this area? How does this practice identify patients with specific diseases? Yes No Explain. Does this practice print lists of patients who are overdue for specific care? Yes No Describe how these lists are used. Does this practice use a registry to monitor and manage chronic illness care? Yes No Please check all that apply: Diabetes C-V Disease Hypertension CHF Asthma Coumadin use Preventive screening MI Cholesterol COPD Depression Other, specify: Be more specific about process: Does this practice create and print reports from the EMR (not PMS) to monitor care your patient s receive? Yes No What? Does this practice monitor provider performance based on designated measures? Yes No Policy. Involved in any P4P bonus programs? Yes No What companies? Does this practice use disease specific templates to facilitate and improve patient care? Yes No Which disease? On-site Assessment 3

24 Is this practice doing any Population Management? Yes No If so, what? Which groups? Does this practice use Group Visits? Yes No What group? Does this practice use Open/Advanced Access scheduling? Yes No What are their goals for QI? What are their goals for PM? How much time and effort are they willing to devote to QI? Data Transmission Is this practice willing to transmit data to Medicare s Secure Data Warehouse when this is developed? Yes No On-site Assessment 4

25 # Use a separate sheet of paper to complete long processes. Complete step by step appointment to check out process.# Complete step by step prescription refill process.# Complete step by step telephone triage process.# On-site Assessment 5

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27 On-Site Practice Readiness Assessment Without EHR Contact Information Practice Name: Team Member Completing Assessment: Physician Practice Staff Interviewed: Assessment Date: CMS Required Scoring Information 1. Who will lead the practice s EMR/HIT system implementation? (Check all that apply.) Physician(s) Office Manager Mid-Level Provider(s) Administrative staff (e.g. Medical Records) Clinical Staff (e.g. RN, MA, etc.) 2. Does the practice currently have an EMR/HIT implementation project manager? Yes No If yes, how many hours per weeks will be devoted for managing the project? If no, does the practice plan on designating a project manager to the project? Yes No 3. Has the practice engaged a health information technology consultant in addition to QIO staff? Yes No If no, does the practice plan to hire a consultant? Yes No STAFF 4. Does the practice conduct regularly scheduled all staff (including providers) meetings? Yes No If yes, how often does the practice staff meet? Weekly Monthly Quarterly Annually Other, please specify: 5. Has the practice tried to address workflow issues or operational inefficiencies in the past? Yes No If yes, how successful were these efforts? Very successful Some what successful Neither successful or unsuccessful Some what unsuccessful Very unsuccessful 6. Has the practice tried to implement clinical information systems, such as EMR or electronic prescribing, in the past? Yes No On-site Assessment 1

28 7. How receptive has staff been to efforts to implement clinical information systems or other practice changes? Very receptive Some what receptive Neither receptive or unreceptive Some what unreceptive Very unreceptive 8. Does the practice have other projects either currently going on and/or starting soon that might affect the planning for and/or success of the EMR/HIT implementation project? Yes No If yes, please specify: 9. Please indicate the current status of the practice s EMR/HIT system implementation efforts: CHOOSE: I (see below) II (see page 3) I. Beginning the process of selecting a system. Date process began: I a. For each of the groups listed below, please indicate their level of support for an EMR/HIT system: 5 = Very supportive, 4 = Somewhat supportive, 3 = Neither supportive or unsupportive, 2 = Somewhat unsupportive, 1 = Very unsupportive. Physicians Mid-level providers Clinical Staff Office Manager Administrative staff I b. Please indicate which of the following EMR/HIT implementation related activities the practice has either done or plans to do (Check all that apply.). Have done Plan to do No plans Establish a multidisciplinary implementation team. Identify practice s inefficiencies, problems. Map out and analyze key and/or problematic processes/workflows. Develop written list of EMR/HIT system requirements. Involve staff in EMR/HIT system selection process. Assess technical proficiency of staff and address identified needs. I c. What would you and your staff like to gain from participating in the program? On-site Assessment 2

29 I d. Please indicate how likely the following will be obstacles to the practice s implementation of an EMR/HIT system. 5 = Very likely, 4 = Some what likely, 3 = Neither likely nor unlikely, 2 = Some what unlikely, 1=Very unlikely Availability of funds Experience with IT Physician/Mid-level provider support Clinical staff support Office manager support Administrative staff support Inadequate project management Technical proficiency of staff Inability of physicians/mid-level providers to enter data in the system Insufficient time to select and implement a system Lack of IT infrastructure to support system Other, please specify: II. In the process of implementing a system. Date vendor/system selected Name of vendor II a. Please indicate which of the following activities the practice completed during its EMR/HIT selection process (Check all that apply.). Established a multi-disciplinary implementation team. Yes No Identified practice s inefficiencies, problems, etc. Yes No Mapped out and analyzed key and/or problematic processes and workflows. Yes No Developed a written list of EMR/HIT system requirements. Yes No Involved staff in EMR/HIT system selection process. Yes No Communicated to staff the overall goals and reasons for implementing an EMR. Yes No Assessed technical proficiency of staff and developed plan for addressing identified needs. Yes No II b. Does the practice have a written project plan for implementing the EMR/HIT system? Yes No II c. Does the practice have a formal written training plan for implementing the EMR/HIT system? Yes No II d. Please indicate how likely the following will be obstacles to the practice s implementation of an EMR. Physician/Mid-level provider resistance Clinical staff resistance Office manager support Administrative staff resistance Inadequate project management Inadequate training on EMR/HIT system Inability of physicians/mid-level providers to enter data and use system Insufficient time to implement a system Insufficient funds for consultants/training Other, specify II e. What would you and your staff like to gain from participating in the program? On-site Assessment 3

30 FMQAI Data Collection Does Practice have multiple locations? Yes No How many? Can a patient visit all location? Yes No Number of exam rooms: Treatment Rooms: STAFF Total FTE s: Physicians MA Phlebotomist Front Desk Referral Coord. LPN Billing RN Management Other Is your staff cross-trained to maximize the efficiency of your office? Yes No How do you cover call-ins and vacations? Does the staff s assignments make maximum use of their education/training? Yes No Estimate the total time, each day, that administrative staff spends doing inefficient tasks (looking for charts, redoing work, calling facilities for results, etc) CHARTS Estimate average time to pull a chart (includes any prep needed). Estimate average time to locate misplaced charts. When are charts pulled for appointed patients? Are these charts prepared prior to patient check-in? Yes No Where are they placed? Who most often pulls charts? How often are charts misplaced? How many patients are seen without their chart? Identify the process for finding a misplaced chart? Charts pulled per day: Appointments Billing Prescription refills Referrals Lab results Non-patient Rad./diagnostic results (Pharm, Insurance company, etc.) Other - list: Who files loose papers into chart? Who files charts to the shelf? On-site Assessment 4

31 LABORATORY Does office do waived* labs in-house? Yes No Does office do phlebotomy in-house? Yes No Who does this? Average number of labs ordered per day. Average number of labs drawn per day. * Simple test for which a license is not required, just a certificate of waiver. Includes U/A dipstick, finger stick glucose, cholesterol, hemoglobin/hematocrit, etc. Estimate percentage of lab referrals made to: Quest LabCorp In-house Local hospital Other Estimate the percentage of lab results received by the following methods: Electronic (E-fax, Lab computer, etc.) Regular fax Hard copy (office printer, delivered) Other RADIOLOGY/DIAGNOSTIC TESTS Does the office do any in-house x-rays? Yes No Who does this? How many per day? How many Radiology or other diagnostic tests are ordered per day? How are the results received for these tests? Electronic (E-fax, Lab computer, etc.) Regular fax Hard copy delivered Other Generally, Who completes the requisitions for labs, radiology, etc.? Physician MA Front desk Other How often does staff need to call for test results? Lab Radiology (MRI, CT, Sonogram, etc.) Other (Cardiology, Neurology, Pulmonary, etc.) How many calls for reports are made in a week? Lab Radiology Other Estimate the time it takes to call for results (any test) daily. On-site Assessment 5

32 Describe the process used to follow up on lab reports: Abnormal Routine Does this process ever fail to complete the notification: Yes No How often? PRESCRIPTIONS Are any prescriptions renewed based on a written policy? Yes No Are calls accepted from patients requesting refills? Yes No Estimate the average number of new (non-refill, non-renewal) prescriptions written daily by all providers. Estimate the average number of refill, renewal prescriptions that are written daily by all providers. How often does a pharmacy call to clarify a prescription (or ask that it we rewritten) because it was not legible? REFERRALS Estimate the average number of referrals processed each week. How are these processed? Telephone % Fax % Computer % What is the range of time to complete a referral? to TRANSCRIPTION Do any providers use transcription? Yes No What is your transcription turn around time? Do you ever see patients without the most recent dictation? Yes No What is the average cost of transcription per month? OFFICE PROBLEMS Please list the three most serious problem processes in your office. 1) 2) 3) ELECTRONIC MEDICAL RECORDS What vendors have you reviewed or demo d? On-site Assessment 6