introduction to medical informatics physician office workflows common workflow challenges physician...

Introduction to Medical Informatics

Physician Office Workflows

COMMON

WORKFLOWCHALLENGES

PHYSICIAN OFFICE

SESSION OVERVIEW

Within this session, we will cover:

• Seven Workflow Management Areas

• Additional Sub-Workflows within these Management Areas

• An Introduction to HIPAA Workflows

• Challenges Within all Above Mentioned Workflows

OBJECTIVES

The Objectives of this Session are:

• Restate all 7 Workflow Management Areas

• Restate all Sub-Workflows and Identify their Management Areas

• Identify all Common Points of Failure within these Workflows

• Understand the Reason for the noted Common Points of Failure

WORKFLOW OVERVIEW

MEDICATION MANAGMENT

Medication Management includes:

• Initial Prescription Order,

• Refills,

• Adverse Drug Reactions, and

• Drug Recalls.

MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER

Initial Prescription Order includes:

• Physician Selects Medication

• Physician Checks for Interactions

• Physician Prescribes Medication

• Prescription to Pharmacy

• Pharmacy Fills Prescription

• Patient Takes Medication

Initial Prescription Order Issues:

• Physician Checks for Interactions

• Pharmacy Fills Prescription

• Patient Takes Medication

Physician Checks for Interactions:

Physician checks current medication lists for:

• Interactions

• Drug Allergy Interactions

• Food or other Environmental Interactions

Pharmacy Fills Prescriptions:

If pharmacy does not have the medication:

• Substitution with a Call to Physician

• Patient Takes Prescription Elsewhere

If drug is not on patient’s insurance company’s formulary:

• Call to Physician for Permission for Substitution

• Physician to Appeal to Insurer

• Patient Purchases Medication at Higher Copay or Full Price

Patient Takes Medication:

• Patient Disagrees with Physician

• Patient Does Not Have Money for Prescription

• Patient Does Not Take all of the Medication

• Patient Has a Reaction to Medication

MEDICATION MANAGEMENTPRESCRIPTION REFILLS

Prescription Refills includes:

• Prescription Contains Refills

• Patient Requests Refills

• Physician Approves Refill

• Patient Continues Medication

Prescription Refills Issues:

• Patient Requests Refills

• Physician Approves Refill

• Patient Continues Medication

Patient Requests Refills:

• Patient Remembers Refill

• Patient Requests Refill

Physician Approves Refill:

• Pharmacy Calls Physician to confirm patient has not:

• Had reaction to previously prescribed drug,

• Been prescribed any additional drugs,

• Developed condition contraindicated to prescribed drug,

Patient Continues Medication:

• Patient Disagrees with Physician

• Patient Does Not Have Money for Prescription

• Patient Does Not Take all of the Medication

• Patient Has a Reaction to Medication

MEDICATION MANAGEMENTADVERSE DRUG REACTIONS

Adverse Drug Reactions Include:

• Patient/Pharmacist Reports Adverse Reaction

• Reaction Noted in Patient Chart

• Alternative Medication Prescribed

Adverse Drug Reactions Issues:

• Patient/Pharmacist Reports Adverse Reaction

Patient/Pharmacist Reports Adverse Reaction:

• Patient may stop taking medication

• Patient may need additional medication to treat reaction

MEDICATION MANAGEMENTDRUG RECALLS

Drug Recalls Includes:

• Recall Announced by Drug Company

• Clinical Staff Identifies Patients using the Drug

• Clinical Stall Notifies Patients

• Clinical Staff Document Recalled Drug

Drug Recalls Issues:

• Clinical Staff Identifies Patients using the Drug

• Clinical Stall Notifies Patients

Clinical Staff Identifies Patients using the Drug:

• It may be necessary to pull each paper chart to review the patient medication list or office notes to see which patients have a current prescription for the recalled medication.

Clinical Staff Notifies Patients:

• Telephone Call

• Letter

ORDERS MANAGEMENT

Orders Management Includes:

• Physician Writes Order

• Patient Takes Order to Testing

• Test Is Completed

• Results Sent to Ordering Physician

• Clerical Staff Sorts Incoming Mail or Faxes

• Results Given to Ordering Physician

• Physician Reviews Results

• Physician Communicates Follow-Up to Staff

• Staff Notifies Patient

ORDERS MANAGEMENT

Orders Management Issues:

• Patient Takes Order to Testing

• Results Sent to Ordering Physician

• Clerical Staff Sorts Incoming Mail or Faxes

• Results Given to Ordering Physician

• Staff Notifies Patient

ORDERS MANAGEMENT

Patient Takes Order to Testing:

• Patient Loses Order

• Patient Decides not to Have Test Done

• Insurance Company Denies Authorization for the Test

ORDERS MANAGEMENT

Results Sent to Ordering Physician:

• Results Sent to Wrong Office

• Faxed Results are Blurred

• Faxed Results Never Arrive

ORDERS MANAGEMENT

Clerical Staff Sorts Mail:

• Mail Person is Out or Unavailable

• Papers Stuck Together and Routed to Wrong Provider

• Papers Lost

ORDERS MANAGEMENT

Results Given to Ordering Physician:

• Results Stuck to Other Papers or Mail

• Results Lost in Additional Papers or Files

• Physician Misplaced Results

ORDERS MANAGEMENT

Staff Notifies Patient:

• Phone Call

• Letter

DOCUMENT/CHART MANAGEMENT

Document/Chart Management Includes:

• Document Received in Office

• Incoming Documents Sorted

• Physician Communicates Follow-Up

• Staff Performs Follow-Up

• Chart Located

• Follow-Up Documented

• Document Placed in Chart

• Chart Filed

Document/Chart Management Issues:

• Document Received in Office

• Incoming Documents Sorted

• Physician Communicates Follow-Up

• Chart Located

• Follow-Up Documented

Document Received in Office:

• Document Lost in Mail

• Document Delivered to Wrong Office or Suite

• Wrong Fax Number Dialed

• Fax out of Toner

• Fax out of Paper

• Fax Down Completely

Incoming Documents Sorted:

• Short Staffed

• Illness

• Single Source Vulnerability

Physician Communicates Follow-Up:

Physician Reviews in between Afternoon Appointments

• Additional Walk-Ins

• Emergencies

Staff Performs Follow-Up:

• Time Constraints between Scheduled Patients

• Unable to Return Calls until Late Afternoon/Evening

Chart Located:

Enormous amount of time and manpower wasted looking for paper charts in an office where no EMR is used.

Follow-Up Documented:

By the time the paper chart is located, documentation may have been lost or misplaced.

MESSAGE MANAGEMENT

Message Management Includes:

• Message Written on Message Pad

• Chart Pulled

• Message Placed on Front of Chart

• Chart to Triage Staff

• Staff Takes Action If They Have Authority

• If Not, Chart to Physician

• Physician Decision and Communicates to Staff

MESSAGE MANAGEMENT

Message Management Issues:

• Message Written on Message Pad

• Chart Pulled

• Message Placed on Front of Chart

• Staff Takes Action If They Have Authority

• If Not, Chart to Physician

MESSAGE MANAGEMENT

Message Written on Message Pad:

• Message Illegible

• Incomplete Message

MESSAGE MANAGEMENT

Chart Pulled:

• Chart has been misfiled or is lost in stacks of other charts and cannot be located.

MESSAGE MANAGEMENT

Message Placed on Front of Chart:

• Message has torn away from chart. Once separated, it may never be returned.

MESSAGE MANAGEMENT

Staff Takes Action if they Have Authority:

• No written policies are in place. Staff is unsure that they have authority and simply leave the action undone.

MESSAGE MANAGEMENT

If Not, Chart to Physician:

• Another handoff of chart with attached message. Another opportunity for the message to become separated from the chart.

CODING

Coding Includes:

• Determine Diagnosis and Procedure Codes• Physician Marks Codes on Billing Form• Physician Associates CPT and ICD-9-CM Codes• Form to Patient to take to Check Out

CODING

Coding Issues:

• Determine Diagnosis and Procedure Codes• Physician Marks Codes on Billing Form• Physician Associates CPT and ICD-9-CM Codes• Form to Patient to take to Check Out

CODING

Determine Diagnosis and Procedure Codes:

• Physician Unfamiliar with Diagnosis and Procedure Codes• New Physician• Physician has Previously had Staff do this

CODING

Physician Marks Codes on Billing Form:

• Physician Cannot Locate Proper Diagnosis and Procedure Codes• Physician Unfamiliar with Proper Listing

CODING

Physician Associates CPT and ICD-9-CM Codes :

• Physician Leaves Codes Unmatched on Billing Form• Insurance Interprets Unmatched Codes as Medically Unnecessary

CODING

Form to Patient to take to Check Out:

• Patient Takes Form Home• No copies of Form in Office

CODING

Diagnosis Codes – ICD 9 Codes:

• Based on World Health Organization’s 9th Revision• Used Since 1950• Hospitals – January 1979• Physician’s Required - 1988• Code Changes – October 1st

CODING

Procedure Codes:

• Systematic Listing and Coding of Procedures• Used Since 1960’s• Updated annually every January• Additional Modifiers are available to Further Describe a Code

RECALL MANAGEMENTFOLLOW UP APPOINTMENT

Follow Up Appointment Includes:

• Patient to Return for Follow Up• Patient Makes Appointment• Patient Keeps Appointment

Follow Up Appointment Issues:

• Patient to Return for Follow Up• Patient Makes Appointment• Patient Keeps Appointment

Patient to Return for Follow Up:

• Patient Does not Understand they are to Return for Follow Up• Patient Does not Make an Appointment

Patient Makes Appointment:

• Patient Forgets to Make Appointment• Patient Decides Appointment Unnecessary

Patient Keeps Appointment:

• Patient Does not Keep Appointment

RECALL MANAGEMENTDISEASE STATE MONITORING

Disease State Monitoring Includes:

• Clinical Staff Identify Patients• Clinical Staff Notify Patients• Patient Makes Appointment

Disease State Monitoring Issues:

• Clinical Staff Identify Patients• Clinical Staff Notify Patients• Patient Makes Appointment

Clinical Staff Identify Patients:

• Sift thru Paper Charts to Locate Specific Chronic Disease Patients• Charts Missed or Overlooked• Other more Urgent Needs take Priority

Clinical Staff Notify Patients:

• Phone Call to Patients• Letter to Patients

Disease State Monitoring Includes:

• Notified Patient Responsible to Make Appointment• Patient Does not Make Appointment• Patient Decides Appointment is Unnecessary

What is Disease State Monitoring?

• Certain Chronic Diseases have Disease Management Protocols• American Diabetes Association• American Academy of Family Physicians• Centers for Disease Control• The American Academy of Pediatrics

• Physicians order Monitoring Test and Procedures for Follow Up

What is HEALTH PLAN EMPLOYER DATA & INFORMATION SETS (HEDIS)?

A Set of Standardized Performance Measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.• Performance Measures related to Public Health issues• Includes Standardized Survey of Consumer’s Experiences• Sponsored, Supported and Maintained by National Committee on Quality (NCQA).

New HIPAA Required Practices Include:

• Track Private Health Information (PHI)• Report User Activity• Retain Reporting for Six (6) Years• Limited Access

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