Finding our Pot of Gold in Patient Access through e-signature March, 2016
Stats: Lakeland Regional Health Medical Center (LRHMC) is a not for profit hospital; Licensed for 851 beds; Level II Trauma Center; Level II NICU; Busiest single site ED in the State of Florida; 5 th largest hospital in Florida.
Introduction LRHMC has embarked on a comprehensive performance improvement effort utilizing Information Technology and Patient Access registration processes to implement electronic Signature (e-signature) throughout the hospital. By analyzing the use and performance of a computer tablet in the ED, an opportunity to improve the registration process was realized to be an important factor in improving access to patient registration in the busiest single site ED in the State of Florida. After the successful trial of the tablet in the ED, it was determined that the use of the tablet alone would not provide the overall successful outcomes to assure that each patient received a true bedside registration without having to print and use paper documents. A collaborative team was formulated consisting of IT, HIMS, Patient Access and Project Management to develop an e-signature platform using our existing Siemens/Cerner Electronic Imaging system. We contacted other hospitals to determine best practices using e-signature with a Cart and tablet. Prior to e-signature implementation all registration forms were paper forms and passed from one area to the next which contained inherent risk for lost paperwork, missed opportunities for patient signatures on important regulatory forms, etc. As a result of the e-signature implementation and process redesign through-out the Patient Access services department, the time interval for patient registration was reduced overall by approximately 10 minutes for the majority of our patients with the most significant improvement being realized in the ED.
Process Improvement Model Objectives Identify LRHMC patient forms that require a signature. Select a vendor for e-signature. Find a cost-effective, easy to use computer tablet that will accommodate the e-signature platform. Find a signature pad solution for those areas that are using a desk-top. Ensure that the e-signature solution will feed documents to the HIMS imaging solution Horizon Patient Folder (HPF). Improve the patient experience through technology.
DYAD PARTNERSHIP/MULTIDISCIPLINARY TEAMS EXECUTIVE SPONSORS: CFO; CIO PROJECT COMMITTEE: IT Leadership; Patient Access Leadership; HIMS Leadership, Quality Management; Project Management PROJECT TEAM Ana Kalman, AVP, Information Solutions; James LaLonde, Manager, Business & Financial Applications/Revenue Cycle; Anthony Schrock, IT Business Analyst; Matt Mahon, HIMS System Administrator; Deborah Newbern, BA, CHAM, CRCE- I; Jane Dyer, CHAM, CRCE-I; Diane Campbell, MSN, RN, CSSBB; Anita Trainer, PharmD, MBA, PMP; Paula Cullins, MBA, RHIT; Deshonda Dobie, Supervisor, HIMS Imaging Services.
E-Signature Timeline Overview Current process defined May, 2014 Registration Observations May July, 2014 Hardware (Tablet) and Software Selection July, 2014 Proof of Concept Design Complete September, 2014 Integrated Testing Completed September, 2015 Tablet Pilot with e- Signature in ED Pod October, 2015
Former Process: Start ED Registration Process Pt Arrives for Registration Pt is Triaged by Nursing Pt is Quick Reg d in System and armband placed on Pt Pt Escorted to ED area for treatment Patient Access Rep checks Cerner Tracking Board for physician notification Pt Access assembles registration packet based upon Financial Class/Payer Pt Access Prints forms for presentation to patient. Pt Access Rep Interviews Pt and documents information on Paper form. Collects Ins. Card for scanning. Pt signs paper registration forms and receives copies as appropriate. Pt Access Rep scans Pt s insurance card into Siemens EDM system and returns card with any additional forms to Pt. Pt Access Rep Quotes Pt Co-Pay amount. Requests payment method. Pt Access processes payment and returns pt s credit card, if obtained, and receipt to pt. Pt Access Rep updates Pt information obtained on paper forms into registration system. Pt Access Rep verifies insurance eligibility using Passport ecare Next System and updates as appropriate. All signed patient forms are scanned into Siemens/Cerner EDM system Registration is complete and Cerner Board is updated. Paper forms are placed into basket for pick-up by HIMS and manual scanning into HPF.
Current Process using e-signature Pt Arrives for Registration Pt is Triaged by Nursing Pt is Quick Reg d in System and armband placed on Pt Pt Escorted to ED area for treatment Patient Access Rep checks Cerner Tracking Board for physician notification Pt Access greets Pt in room with Tablet and Cart Pt Access Rep reviews all information with Pt at bedside using tablet to update registration system Pt signs forms on tablet using Siemens/Cerner EDM Imaging System Insurance card is obtained from pt at bedside and scanned into Imaging using Photosnap application on Tablet Co-payment is received at bedside using on-line process (Your Pay). Registration is complete and Cerner Board is updated. All electronically signed forms are automatically sent to HPF from EDM system for clinical team and HIMS to view.
Prior Bedside Registration Process Prior cart that was used in the ED for the registration process. Carts were bulky, hard to push and battery power limited. Paper registration process in place.
New tablets and carts Top of tablet is removable so that it may be presented to patient to sign directly on the tablet. Pt s insurance card is easily scanned directly on the tablet using Photo Snap Application.
New e-signature Registration Process
E-Signature Project Results Patient registration time savings (~10 min. per reg) Annual estimated paper cost savings (~$33,000) Increased Cash Collections in the ED through efficiencies gained in the registration process FTE efficiencies Patient satisfaction Team member satisfaction Improved clinical processes through real time viewing of documents for nursing and HIMS
Lessons Learned Trial Period Allowed staff to experience using the new tablets and carts with e-signature. Provided staff the opportunity to provide feedback on process prior to full implementation. Allowed a period to work out the kinks in the new process. Collaboration Between Patient Access, IT, HIMS and clinicians to ensure that patients feel cared for treasured Change Team was extremely engaged in the process through early collaboration and training with super users.
Thank You! Questions?