1 Making Healthcare Easier: Benefits of an Integrated Electronic Medical Record and Practice Management System An integrated practice management and electronic medical records system refers to applications that are developed by the same vendor, share a single database or development platform, and are designed to share complex data between applications. Practice Partner Medical Billing, Appointment Scheduler, and Patient Records can be purchased individually as standalone applications; however, when deployed together, they function as an integrated system that we call Total Practice Partner. Integration strategies vary among vendors depending on the history and origin of the individual applications. In many cases, applications that are owned by the same company may have originated as standalone applications developed by other companies or teams. In these cases, the vendor typically depends on interfaces to connect the applications because the applications do not share a single database or development platform. Interfaced applications usually do not offer the full range of data sharing functionality or convenient set up and support as integrated applications because they do not share a single database. All three Practice Partner applications were developed and designed to run on a single database. Therefore, Practice Partner has been able to provide a sophisticated level of integration functionality while providing a platform for additional features. This Forum will discuss some of the specifi c benefi ts of integration and their relevance to day-to-day practice workfl ow.
2 BENEFITS OF INTEGRATION This forum will discuss the primary benefi ts of using an integrated electronic medical record and practice management system, with a variety of specifi c examples that are relevant to the day-to-day workfl ow of ambulatory clinics. Specifi cally, integration provides the basis for: A common registration process that encompasses the fi nancial, clinical, and logistical aspects of patient care Enhanced ease of use and easier training Information sharing between applications that improves effi ciency and workfl ow Easier setup and support COMMON REGISTRATION Because all three Practice Partner applications reside on a single database, the boundaries that typically separate practice management and electronic medical records systems are nonexistent. Practice Partner s sophisticated integration allows medical practices to view and manage patient information from a fi nancial perspective, which focuses on guarantors and insurance, and a social and clinical perspective, which focuses on the patient, family, and social relationships all from a common registration. From a practical perspective, this tremendously benefi ts how you register patients and update patient information. From any of the three Practice Partner applications, you can: Register patients Access patient demographic and contact information Enter insurance billing information including account insurance plan billing order, relationship to insured party, and default diagnosis codes for posting Indicate the patient s primary provider and usual provider Edit patient data and have the edits automatically update the other two Practice Partner application Workfl ow Example: A patient checks in for her appointment. She notifi es the front desk that her payer information has changed. The changes are made in the Scheduler and are immediately available throughout the billing and EMR applications as well. During the patient s visit, the provider writes a prescription in Practice Partner Patient Records and places orders in Practice Partner Order Entry. Because the information entered in the scheduling system automatically updates the other applications, the scripts are checked against the newly corrected payer s formularies and the orders are checked against the payer s rules for those specifi c orders in both cases eliminating redundant entry that might be required with less sophisticated integration.
3 The Patient screen in Practice Partner is identical in Patient Records, Medical Billing, and Appointment Scheduler and is automatically updated when a change is made in any one of the applications. In addition, the Patient screen can pull fi nancial, clinical, and administrative information from all three applications. Individual users have access to information that would not be available in a non integrated system. EASE OF USE Because our company developed all of the Practice Partner applications, a set of common user conventions have been applied across all three applications that make training and the daily use of the three applications easier. The Practice Partner system allows users to switch back and forth between charts, schedules, and the ledger with a minimal number of keystrokes. This saves time that would otherwise be spent logging into different applications, or minimizing and maximizing screens.
4 All three Practice Partner applications use the same lookup screen to fi nd patient data. This helps users quickly fi nd charts, schedules, or billing information. Workfl ow Example: The physician needs to look at his schedule to identify his next patient. He opens his schedule from within the EMR. He then clicks on the name of his next patient and is taken directly to the patient s chart. The screen below shows the ease of toggling between the three applications. One click on the main toolbar allows users to switch between Medical Billing, Patient Records, and Appointment Scheduler. INFORMATION SHARING Information sharing across applications makes each application more powerful. A single patient database provides the essential foundation for information sharing between applications. This allows each application to take advantage of information that typically would not be available in a non-integrated (interfaced) system. This makes each individual application medical billing, appointment scheduling, or electronic medical records more powerful because each application can access all patient information. Some specifi c Practice Partner examples of information sharing are discussed in the following sections. Between Patient Records and Appointment Scheduler This section summarizes some examples of information sharing between Practice Partner Patient Records and Appointment Scheduler. Accessing Provider Schedules in Patient Records Because providers use Patient Records as their primary tool for providing patient care, integrating scheduling information into Patient Records is a very useful tool for workfl ow productivity. From a simple drop-down menu in Patient Records, providers can view their entire schedule, including which patients have checked in, are late, are no-shows, have canceled, or
5 double-booked. This information is automatically updated as the schedule changes. A simple click on the patient from the provider s view of the schedule opens the patient s chart, eliminating the need for a separate patient lookup. Scheduling Overdue Health Maintenance or Tests When scheduling an appointment, the scheduling application automatically alerts the scheduler that the patient has overdue preventative or protocol- based health measures. These are measures based on age/sex recommendations, diagnosis, medication, or individual requirements; all of which are part of the Practice Partner Patient Records health maintenance feature. This helps the scheduler book the appropriate amount of time for the patient s visit, which in turn leads to healthier patients and perhaps even a boost in practice revenue. Documenting No-Shows or Cancellations By linking scheduling data to the progress note section of the patient s electronic chart, Practice Partner automatically generates a progress note each time a patient does not show for or cancels an appointment. The appointment screen in Practice Partner Appointment Scheduler provides the scheduling staff with valuable patient and account information from all three applications. Product integration allows information from Patient Records and Medical Billing to display in the scheduling screen. The scheduling screen below shows specifi c examples of the integration features.
6 Running a Missing Progress Note Report This is another example of linking the schedule with patient documentation. Practice Partner provides a report comparing the provider s schedule with the EMR to determine if any scheduled visits were undocumented by a progress note. The missing progress note report also automatically takes into account no-shows and cancellations. From both a fi nancial and Medicare compliance perspective, this report provides an internal quality control tool that takes advantage of the integration of the two applications. Checking Patients In and Tracking Time To analyze and improve patient satisfaction, you can track the amount of time that patients are in the waiting room and the duration of the overall visit. This requires the interplay of both the front desk and the clinical staff. The Practice Partner Appointment Scheduler check-in feature allows your registration staff to easily time stamp the patient check-in. As the patient moves through the offi ce, the clinical staff can use Patient Records to time stamp the progress of the patient. This information is available on a real-time basis to identify either the location or status of a patient. You can also use this information for reporting purposes, such as fi nding the average time in the waiting room and average time of visit. This information can be used to help better understand the fl ow and logistics of your offi ce. Creating Electronic Encounter Forms in Appointment Scheduler From Appointment Scheduler, the front offi ce staff can create blank electronic encounter forms (EEFs) an electronic version of the superbill that is explained in greater detail below for all the patients scheduled on a given day. The EEF is automatically available to the clinical staff as they see patients, eliminating the need to print, distribute, and collect the paper superbills. In addition, completed EEFs are automatically sent to Practice Partner Medical Billing. Between Patient Records and Medical Billing This section summarizes some examples of information sharing between Practice Partner Patient Records and Medical Billing. Generating Electronic Superbills The electronic superbill, also known as the electronic encounter form or EEF, is one of the most powerful timesaving integration features of the Practice Partner system. After the encounter, ICD-9 and Physicians Current Procedural Terminology (CPT ) codes are automatically transferred to the billing system, either by completing the progress note or simply by fi lling out the EEF manually (CPT is a trademark of the American Medical Association). This also applies to orders created during the encounter. In either case, this eliminates the need for the creation, management, and redundant entry involved with paper superbills. The billing clerk can quickly review the EEF, including relevant notes made by the physician, and post the charge with a minimal number of keystrokes.
7 When the physician initiates orders using Practice Partner Order Entry, a procedure code can be attached to the order automatically creating a billing entry in the EEF. This helps you more accurately bill services because everything ordered is noted on the EEF. From Practice Partner s Electronic Encounter screen, the billing specialist can review charge information for each visit and quickly post a charge to the patient ledger with minimum keystrokes. Checking Formularies and Entering Orders As previously noted, sharing a single database helps eliminate redundant entry and makes information instantly available from other parts of the application. For example, the formulary checking feature of the Patient Records prescription writer and Practice Partner s integrated order entry system both use the patient s insurance information, which is typically entered and updated in the medical billing application. With Practice Partner integration, insurance information entered in Practice Partner Medical Billing automatically updates the formulary and order entry links, eliminating the need to manually update the information for these specialized functions and thus ensuring that providers are using the most up-to-date administrative information. Between Appointment Scheduler and Medical Billing This section summarizes some examples of information sharing between Practice Partner Appointment Scheduler and Medical Billing. Viewing Billing Information While Scheduling Patients In addition to preventative health information, the
8 scheduler can view billing information such as the patient s co-pay amount and balance. This information helps the scheduler keep patients aware of overdue fees and leads to more timely collections. Tracking Insurance Authorization Billing applications track insurance authorizations for worker s compensation and specialist referrals; scheduling applications track the number of appointments that a patient has made towards the authorized number of visits. When both applications are integrated, users are alerted if the scheduling application makes an appointment that exceeds the authorized number of appointments stored in the billing application. Without integration, both applications store numbers that are never crosschecked and staff members fail to receive warnings about unauthorized visits. Between Patient Records, Appointment Scheduler, and Medical Billing This section summarizes some examples of information sharing between Practice Partner Patient Records, Appointment Scheduler, and Medical Billing (Total Practice Partner). Unifi ed Messaging An integrated application has the power to link all members of the physician s offi ce, from the front desk, to providers, to the billing clerks. Unlike stand-alone applications, Practice Partner s messaging system allows all Practice Partner users to communicate with each other. With an integrated system, intra-offi ce messages can be sent between staff members regardless of their function or the application they are using. Furthermore, if the recipient switches to a different application, the message will be available from that application as well. This ensures that messages reach their intended recipients as soon as possible. Staff members can easily communicate amongst themselves without the aid of post-it notes or a separate application. Unifi ed Flagging/Notes System Many systems, including Practice Partner, allow users to insert patient-specifi c notes or reminders (fl ags) that may be applicable to all members of the offi ce or to specifi c members, such as the clinical or billing staff. These fl ags are triggered as you access information about a particular patient or account. As a powerful byproduct of integration, Practice Partner allows a practice to specifi cally designate where these fl ags appear across all applications or confi ned to specifi c sections of the individual application, depending on the nature of the fl ag. This is simply another tool to facilitate intra-offi ce communication. EASIER SETUP AND SUPPORT There are many practical advantages of Practice Partner s integration that make setup and support much easier than non-integrated applications. Installation on a Single Application Server You can install all three Practice Partner applications on a single server; this makes the installation process both easier and less expensive and simplifi es the administration and backup process.
9 Easier User Setup Integrated operator login (operators are the people actually using the applications) allows the practice to setup usernames, passwords, and security levels for all of the applications from a single confi guration menu. This is particularly useful for staff members who may need access to all three of the Practice Partner applications. In non-integrated systems, this setup task has to be completed independently for each operator for each application. Easier Printer Setup Practice Partner s integrated printer controls allow you to setup your practice printers for any Practice Partner application from a central confi guration setup. Again, non-integrated applications require an often-tedious printer confi guration for each application. Centralized Technical Support and Problem Solving Because the Practice Partner applications are created by the same development team and supported by a single technical support team, you only have to call one number, regardless of which application you are calling about. Having the entire development team under one roof helps simplify both feature requests and advanced problem solving. Easier Update Installation Integration also simplifi es the update process because all updates are shipped as unifi ed applications with the same version number (as opposed to managing separate updates for each individual application). Integrated Provider, Practice, Insurance, Procedure, and Diagnosis Tables Because these tables are shared across all applications, you only need to set them up once. As you update the information in these tables, it automatically updates across all applications. This eliminates errors and inconsistencies from having to enter information twice. A DAY IN THE LIFE: WORKFLOW EXAMPLES OF INTEGRATION Practice Partner applications are designed to improve effi ciency at the daily workfl ow level. As noted in the examples in the previous section, integration is a powerful tool to achieve this objective. Let s pull some of these together to see how they impact the practice in the context of a typical day. The patient calls for an appointment... The scheduling screen displays information contained in other applications to facilitate better patient care, such as overdue health maintenance items from the EMR that are age/sex, medication, and disease specifi c. Additionally, you can reserve special resources, such as an ECG or procedure room, to ensure the patient receives the appropriate care.
10 From the same screen, Appointment Scheduler also shows important fi nancial information from Medical Billing, such as type of account, patient balance, and co-pay amount. The person answering the telephone can remind the patient about a past due balance and/or their co-pay amount. This lowers A/R by actively helping to collect money upfront and also provides a mechanism to fl ag accounts when patients call. The patient cancels or no-shows... If a patient cancels or no-shows, Appointment Scheduler automatically triggers a progress note in the patient s EMR, documenting the no-show. As the front desk updates the daily schedule, information becomes immediately available to a provider through a schedule view in the EMR, providing real-time notifi cation of changing appointments, patient load, and the status of double bookings. The patient arrives... When the patient enters the clinic, the front desk staff can use the Appointment Scheduler check-in feature to time stamp the patient s arrival in the clinic. This allows the clinic to monitor patient fl ow and location in the clinic. As you pull up the patient s account in Practice Partner, the front desk staff is fl agged that the patient is hearing impaired. Because the applications are integrated, the provider would be fl agged with the same message as the front desk staff when opening the patient s chart. Or the patient calls and says she will be late As the front desk updates the daily schedule, information becomes immediately available to a provider through a schedule view in the EMR, providing real-time notifi cation of changing appointments, patient load, and the status of double bookings. While the patient is in the waiting room When the patient enters the waiting room the front desk staff will use Appointment Scheduler s checkin features to time stamp the arrival of the patient. Because the scheduling system is integrated with Practice Partner Medical Billing, offi ce staff can view insurance and co-pay eligibility information without leaving the check-in screen. Unifi ed messaging across all three applications allows front desk staff, billing clerks, providers, and nurses to communicate about the daily clinic activities, regardless of what Practice Partner application they are using. Having the ability to send messages between staff members with the chart attached, record messages into the chart, and set future reminders is a powerful communication tool that will save your staff time.
11 The physician enters the room Using the schedule s Provider View in the EMR, the physician simply double clicks the patient name on the schedule to open the patient s chart. As the patient waits in the exam room, the physician can use the integrated timing feature in Patient Records to note the start time of the physician portion of the visit. The physician fi nishes the exam and the progress note The physician documents the visit in Practice Partner Patient Records and, using the electronic encounter form feature (either directly or within the progress note), sends the billing data (ICD9/CPT codes contained in the progress note and any relevant notes) directly to the billing staff, eliminating the paper superbill. As the patient leaves the exam room, the physician can time stamp the end of the physician portion of the visit. The clinic will use the check-in statistical report to determine the average amount of time patients spend in the waiting room and with providers. And the billing clerk... The billing clerk can review and post the charges on all incoming electronic encounter forms from the Medical Billing screen with a few simple keystrokes. This eliminates both additional data entry from a paper superbill and the ineffi ciency of managing a paper-based system. And, if the billing clerk needs to refer to details within a progress note, one click takes the billing clerk from the patient s account information to the patient s chart. Now, do all of last week s visits really have progress notes?... The Missing Progress Notes Report compares last week s appointments with progress notes in the EMR to provide a list of any visits that are not documented.
12 SUMMARY Increasingly, the boundaries that have separated the clinical, fi nancial, and logistical aspects of physicians practices are being lowered as physicians and their staff seek methods to improve customer service while maintaining a healthy business. Integrated systems provide a tool for linking all of the complex aspects of a practice together in ways that improve both offi ce effi ciency and patient care and service. The Practice Partner integrated system offers the advantages of a single database and development organization, providing both a rich set of integration features plus a robust platform for future development. Microwize Technology, Inc. 1 Kalisa Way, #104 Paramus, NJ
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