2012 Merge Healthcare

Transcription

1 RIS SUCCESS STORY SHARING Jason Dodds, Tri-State Imaging Cindy Fisicaro, Radiology Imaging Associates Laverna Hubbard, North State Radiology Jeff Tumbleson, Outpatient Imaging Associates Facilitated by Julie Pekarek, Merge Healthcare Tuesday, August 28, Merge Healthcare

2 session objectives 2 Provide attendees with real-world case studies on optimizing the RIS Enable discussion and problem solving with peers on additional RIS situations Learn to use the RIS in new and different ways Connect with peers and RIS best practice users

3 discussion topics 3 Introduction of speakers Success stories Panel Q&A

4 OPTIMIZING WORKSTATION IMPLEMENTATION & MAINTENANCE Jason Dobbs, IT Administrator Tristate Imaging Consultants

5 background 5 Tristate Centers About Tristate Imaging 28 centers in three states (PA, NJ, DE) 17 in the Philadelphia region Using Merge RIS/Financials/Dashboards and a GE supported PACS system, Dynamic Imaging 300+ workstations and servers 270+ employees and 16 full-time radiologists Philadelphia Area Centers About Me Worked in Outpatient Imaging for nine years On IT side for past five years Maintain Merge systems, HL7 interfaces, and user workstations Have maintained, configured, and upgraded Merge RIS since implementation

6 our issue: Merge RIS workstation configurations Domain environment with non-admin users Local, user-specific profiles means Internet Explorer (IE) settings were per user IT staff would have needed to log onto each PC under each site user and apply changes as admin Any OS/program changes or updates could reverse configurations Updates to IE Update to MS Office (specifically Word) New users would require being set up on every PC they would use Any future changes to the Merge RIS configuration would require doing it all over

7 our solution: group policy settings Windows Group Policy (GP) Allowed for standardization of some IE policies across the domain Could apply policies regardless of account rights Ability to force policies on a general scale (entire OU), or on a more granular scale (individual users) *Group Policy alone was not enough* PolicyMaker by DesktopStandard.com Free third party software add-on for GP that allowed pushing and applying of any registry entry Integrated directly into Microsoft Management Console (MMC) snap-in One time install on server side One time application of license Workstations required client side install MSI package that could be distributed via GP

8 using PolicyMaker PolicyMaker located under Computer or User settings within each Group Policy Object (GPO) Each registry entry for the GPO listed Can be sorted by any column category Editing as easy as double clicking Simply right click and select New to add new registry policy

9 anything not covered by Group Policy -> added as a registry policy through PolicyMaker This specific registry policy is for Word documents. It configures them to follow the Browse in same window specification in the RIS configuration. The key is knowing the correct Value data to turn the feature on or off. Each registry key had to be either created or updated if already existing Other options are available, but weren t needed for the Merge RIS configuration The key location then had to be identified in the registry The path could be browsed for or input manually The value name, type, and data needed to then be specified

10 results All Center workstations now controlled with Group Policy and PolicyMaker Any Merge RIS update/change in configuration can now be made in one place, and applied across the board New user accounts are simply added to an Active Directory group where the Merge RIS policy is applied GP ensures consistent policy application, even when there are local program changes Application of the policy is ensured no matter the user rights Unintended consequences GP now used for distributing software packages to certain workstation groups GP now used for other web based applications, such as InstaMed GP now used to create security policies for both users and computers GP now used to correct configuration issues with commonly used websites

11 while I have the microphone 11 Additional best practices I wish I had more time to share see me after the session if you want to collaborate Areas of the RIS where we could use help looking for peers to share / collaborate

12 RIS CUSTOM WORK QUEUES Cindy Fisicaro, Director of Business Systems Radiology Imaging Associates, P.C.

13 background 13 Employed with RIA for 25 years Currently director of business systems Previous positions include implementation, system management, Pre-cert, centralized scheduling Radiology Imaging Associates (RIA) is a community based radiology practice since early 1960s Leading provider of inpatient and outpatient professional services for diagnostic imaging in Denver, CO Provide full-time professional imaging services at seven Denver metro hospitals, Aspen Valley Hospital and several critical access hospitals in Colorado and Nebraska Co-own and manage 14 outpatient facilities, the largest such network in the Denver metro area. 70 sub-specialized radiologists, 290 employees Merge Products: Merge RIS, Merge Financials, Merge Dashboards and Merge Documents Converted from legacy Sentinel & Tracker to Merge RIS in August 2008 and Merge Financials in May 2010

14 clinical review work queue 14 Scope: Goals: Review all MR, CT and Pain Management exams scheduled with written order, patient signs and symptoms and radiologists protocols to proactively address scheduling errors /concerns prior to working pre-authorization and/or patient arrival. Reduce cancelled and rescheduled exams Reduce re-authorizations Reduce schedule delays Schedule correct exam the first time Reduce unnecessary call backs Reduce potential additional radiation exposure to patient

15 RIS custom work queue Problems: Current workflow involved Merge Documents, Merge RIS and manual processes served its purpose but was cumbersome Time consuming Multiple indexing points required to move patient through workflow Redundancy and duplication across systems Difficult to have multiple techs in the work queue at the same time Staffing restrictions Little flexibility Backlog

16 solution: RIS custom work queue Qualifiers MRI and CT exams in Scheduled status Exam auto populates in to CR work queue at time of scheduling no longer a need for scheduler to status in Merge Documents to initiate CR workflow CR tech works entirely out of Merge RIS Filters allow multiple techs to be in work queue at the same time Custom status codes allow for easy workflow identification Add-ons auto populate to top of queue without manual intervention

17 RIS custom work queue

18 RIS custom work queue

19 RIS custom work queue Efficiencies gained: Reduced redundancy, no duplication of work Entire workflow, tracking and documentation in Merge RIS Staff location flexibility for better coverage and working backlogs Changed approximately 10% prior to patient arrival Reduced patient call backs and reschedules Reduced schedulers time no additional steps to place exam in queue Reduced scheduling errors Reduced pre-cert re-authorizations Reduced schedule delays at outpatient sites Better communication between techs and schedulers

20 RIS custom work queues Considerations: Prepare map your workflow Get schedulers, pre-auth, tech, manager and radiologist involvement Clinical Review tech staffing Training across multiple departments Communicate with your referring offices Reporting what do you want to track? Time analysis TEST validate your workflow Challenges: Auditing/Tracking of changes for reporting Pre-auth work queue and workflow already existed: occasionally pre-auth and CR bump in to working on the same case at the same time

21 while I have the microphone. 21 Encourage users to develop and utilize RIS Custom Work Queues to solve workflow problems and eliminate the need for secondary applications or manual processes Possibilities with linking Work Queues to enhance workflow Need for reporting on Custom Work Queues in Merge Dashboards Provide feedback to Merge and your peers Get involved in MUGONA group

22 CHALLENGES OF OBTAINING AND MANAGING AUTHORIZATIONS Laverna Hubbard, Executive Director North State Radiology Medical Group, Chico, CA

23 background I ve been working in diagnostic imaging for 24 years and with North State Radiology for 16 years Previously provided development and management services to multiple imaging centers across the country About North State 23 radiologists Only group in our county of 200,000 residents Staff all three hospitals, including a L2 trauma center Own two imaging centers in Chico, one that is a JV with the largest hospital. Plus we have an Interventional procedure facility. We have 80 employees and perform over 60,000 procedures a year in these centers which amounts to 20% of our total practice Merge clients since early 2004 starting with Merge RIS, Merge PACS and Merge Documents and adding Merge Financials in 2008

24 Merge solutions at North State: we use it all!

25 challenges of obtaining and managing authorizations 25 All private payers and some government payers require prior authorizations for advanced imaging and most interventional procedures. Many private payers use RBMs who make it difficult for the referring physician offices to obtain authorizations. Medicare is planning to use them in the near future. Regulations and some carriers limit what radiology practices can do legally to assist referring physicians obtain authorizations. Patients often arrive for their procedures without appropriate authorization causing delays an reduced reimbursements.

26 solutions for obtaining and managing authorizations 26 SOLUTIONS: Customize the Work Queue to maximize work flow and give us the tools to manage our authorizations Continued to create additional filters for more detailed reporting With the custom features, we filtered on insurance companies, referring physicians and exams Allowed efficiency in calls to insurance companies, multiple procedures and or patients would be identified and worked at the same time RESULTS: Able to assist our referring physicians in obtaining their authorizations Obtain our own authorization more efficiently, resulting in happier patients and referring physicians, and better reimbursements

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30 custom work queues: build it and they will come 30 Cancellation / No Show Reschedule: don t lose patients New Physicians Use as a marketing tool Prioritized pending orders By physician, exam, insurance Patient follow up for RX, procedure Better tracking of patients Appointment reminders Fewer no shows with calls

31 while I have the microphone 31 Merge RIS product has improved dramatically over the years. We feel that Merge is moving RIS, along with its other applications, in the right direction enhancing efficiency for the end users in their daily operations is always the goal. What do we wish Merge would do now with the RIS product? Enhance the scheduling efficiency!

32 PREPARING FOR UPGRADES AND CONVERSIONS Jeff Tumbleson, CIO Outpatient Imaging Affiliates

33 background Imaging Centers in eight states, 300+ workstations, 50 VMView clients, mostly WinXP, some Win employees. OIA was founded in JV partners with several academic health systems, hospitals, radiology practices, as well as wholly owned centers. Current volume 375,000 studies annually. Merge customer since If they sell it, we probably own it Fusion RIS/PACS, Merge Financials, MDM, CAP, efilm, Merge PACS. Converting to Merge RIS Q1, 2013

34 my case study migrations! 34 CHANGE IS GOOD! But, how can you be sure? How to deploy a complete development environment for under $10K. In the past 12 months, we have replaced FUSION PACS, MX read stations, Elligence, and Fusion document management. Next year we will convert to Merge RIS. Never let the developer do the testing You know how you use the product. Chances are, the way you expect things to work will be different than the way the developer intended it to work. Always test before you deploy.

35 my Merge sandbox 35 FUSION RIS Merge Financials Merge Dashboards Merge Document Management (MDM) Merge PACS Merge RIS Merge Referral Portal (MRP) (CAP) FUSION PACS

36 migration must-haves 36 YOU CAN T AFFORD NOT TO Server $6,500 VMware Hypervisor Free Microsoft MSDN subscription $2000 Backup software $1500 Getting through an upgrade without any surprises Priceless!

37 while I have the microphone 37 Is anyone getting traction integrating with referring physician EHRs?

38 PANEL DISCUSSION

39 session objectives met? 39 Provide attendees with real-world case studies on optimizing the RIS Enable discussion and problem solving with peers on additional RIS situations Learn to use the RIS in new and different ways Connect with peers and RIS best practice users

40 THANK YOU!