Workflow Optimization Intake Process

Transcription

1 The patient check-in process at a physician office is an opportunity to update and collect information about the patient. The goal of this document is to guide a practice in the transition of this workflow from a paper-based operation to one that includes the use of an electronic health record (EHR). It also highlights data elements integral in meaningful use (MU) attainment and patient-centered medical home (PCMH). Analysis of the Check-In Process What type of information is collected by the front desk at check-in? Verification of name and address Verification of Insurance Copayment Demographics (DOB, preferred language) Copy of the insurance card HIPAA forms RHIO/HIE Consent Other: If you are using a practice management system (PMS), what information must be entered or checked at each visit? Does the EMR connect to the PMS system? Yes No If Yes, which components? Demographics Billing Appointments List any information that goes forward with the chart after check-in. Superbill Extra labels Chief Complaint Consent Documents Patient Hx/ROS forms HIPAA forms RHIO/HIE Consent Other: How does the clinical staff know that the patient has arrived? This material was originally prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services and was revised by the New York ehealth Collaborative in conjunction with the New York State Department of Health. This publication was made possible by Grant/Cooperative Agreement Number 90RC0007/01. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the HHS Office of National Coordinator for Health Information Technology. 10/2011

2 The check-in process is an opportune time to ensure that the patient information used by your practice is current. Below is an extensive list of data points that your practice can collect when using your EHR. Identify the data elements your practice will want to collect in your EHR by placing a check mark in the box next to the category. Circle the demographic data components that are required/will be required for registration in your EHR. Demographics, Meaningful Use and NCQA 2011 PCMH: Data collected during the check-in process may be required for MU attainment and for PCMH. Meaningful Use stage 1: Record demographics for more than 50% of all unique patients seen by the EP as structured data. NCQA 2011 PCMH: Practice organizes patient-population data using an electronic system that includes searchable information of 15 elements for 75% of the patient population. (Note: some of the required patient information details for this measure may not be captured in a EHRs demographics section). Refer to the PCMH survey tool for details. Data points that are required for MU are denoted by a + to the right Data points that are required for PCMH are denoted by a * to the right Prefix First Name* Last Name * Middle Initial Previous Name Address City, State, Zip County Home Phone #/Mobile Phone # * Work Phone # Pager Address * Patient Photo Photo of Identification Marital Status * Race+ * Ethnicity+ * Social Security # Date of Birth Gender+ * Birth Order Translator Advance Directives Preferred Language+ * Student Status External/Old MRN * Contact Preferences Sensitive Patient Primary Care Giver* Patient Case Manager Referring Provider Emergency Contact Info Patient Social Worker Patient Attorney Employer Information Guarantor Information Insurance Information Insurance Identification Numbers Rx History Consent Retail Pharmacy Do not send patient statements Mail-Order Pharmacy Patient billing type (e.g., self-pay vs. insurance) Vaccines for Children (VFC) eligibility RHIO Consent Immunization Registry Consent Exclude from registry* Preferred Laboratory HIPPA Consent Other The above data points can be stored in the EHR in a structured field or other area based on how the health record captures data. Please utilize your vendor implementation staff and trainings to identify where these data points can be captured. Keep in mind that the fields you have identified as required will need to be configured as such in your EHR. p2

3 Documenting Patient Flow in the Check-In Process Answer the questions below to document the patient check-in process currently in place at your practice. DESCRIPTION OF ACTIVITY PROCESS OWNER Example: Who registers the patient at the front desk? Patient signs in and the paper chart that was pulled the night before is located. Margie Where are the charts for the current day visits stored? Who registers the patient at the front desk? What paperwork is provided to the patient? What paperwork is collected from the patient at check-in? How is insurance verified? How are copayments collected? How is information placed in the paper chart? How is the patient is queued for his/ her slot? How does the patient get called for rooming? p3

4 Documenting Patient Flow in the Check-In Process: Current State This flow diagram is an example of a paper check in process. It captures movement of the patient and paper chart through this workflow. This tool helps a practice visualize and identify redundant and/or missing steps that can make their process more efficient. PATIENT Patient arrives Signs in at front desk Patient completes forms Marks patient arrival New patient? YES Give Pt forms to fill out, collect & copy insurance card FRONT DESK RECEPTIONIST Workflow diagrams visually show how a task is handed from one person to another until it is completed. Each symbol represents a step in the workflow process: Collect payment & generate record of payment for billing department NO Pull paper chart (from medical records) Does Pt info need to be updated? NO YES Collect and file forms in newly created chart Record changes in paper chart, collect & copy insurance card if needed YES Does co-pay need to be collected? NO Generate flowsheet Put chart & flowsheet in bin indicating patient is ready for rooming LEGEND Terminator symbol represents the beginn-ing or end of a process Process step Represents an independent step or task Decision step Represents a question or decision where there are multiple options p4

5 Use the below grid to document your current workflow process for patient check-in. If you need additional help, please refer to the How to Create a Flowchart instruction guide. PATIENT CHECK-IN PAPER PROCESS FRONT DESK RECEPTIONIST PATIENT In the above process, identify steps that are not necessary and/or wasteful. Think about how the process can be simplified or more efficient. How will the EHR change these steps? p5

6 Documenting Patient Flow in the Check-In Process: After EHR Go-Live Given your understanding of how this paper process will change, document your new workflow with the EHR and highlight steps where your staff will now record data in your new system. PATIENT CHECK-IN PAPER PROCESS FRONT DESK RECEPTIONIST PATIENT p6

7 Patient Check-In Rules of Thumb! Here are a couple of tips for streamlining the check-in process: Collect co-payments prior to the visit to ensure this source of revenue is not missed. Take this opportunity to review demographic data with patient. This is a good way to update an address, phone number and insurance information. Use the check-in process as a time for your staff to education your patients about the on-going changes when implementing an EHR. Clearly identify user types during check-in. This can help avoid confusion downstream in your process. If you can, have the practice management system send demographic and patient schedule information to the EHR. Consider the forms a patient needs to complete. How will this data fit into the EHR. Your EHR is a great tool to track HIPAA and other consent forms you need to have your patients sign. Collecting/Updating patient demographic data may be easiest if the practice uses a kiosk or patient portal. p7