introduction to medical informatics physician office workflows common workflow challenges physician...
TRANSCRIPT
Introduction to Medical Informatics
Physician Office Workflows
COMMON
WORKFLOWCHALLENGES
PHYSICIAN OFFICE
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office 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
Introduction to Medical Informatics
Physician Office Workflows
WORKFLOW OVERVIEW
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGMENT
Medication Management includes:
• Initial Prescription Order,
• Refills,
• Adverse Drug Reactions, and
• Drug Recalls.
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER
Initial Prescription Order Issues:
• Physician Checks for Interactions
• Pharmacy Fills Prescription
• Patient Takes Medication
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER
Physician Checks for Interactions:
Physician checks current medication lists for:
• Interactions
• Drug Allergy Interactions
• Food or other Environmental Interactions
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER
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
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER
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
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTPRESCRIPTION REFILLS
Prescription Refills includes:
• Prescription Contains Refills
• Patient Requests Refills
• Physician Approves Refill
• Patient Continues Medication
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTPRESCRIPTION REFILLS
Prescription Refills Issues:
• Patient Requests Refills
• Physician Approves Refill
• Patient Continues Medication
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTPRESCRIPTION REFILLS
Patient Requests Refills:
• Patient Remembers Refill
• Patient Requests Refill
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTPRESCRIPTION REFILLS
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,
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTPRESCRIPTION REFILLS
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
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTADVERSE DRUG REACTIONS
Adverse Drug Reactions Include:
• Patient/Pharmacist Reports Adverse Reaction
• Reaction Noted in Patient Chart
• Alternative Medication Prescribed
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTADVERSE DRUG REACTIONS
Adverse Drug Reactions Issues:
• Patient/Pharmacist Reports Adverse Reaction
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTADVERSE DRUG REACTIONS
Patient/Pharmacist Reports Adverse Reaction:
• Patient may stop taking medication
• Patient may need additional medication to treat reaction
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTDRUG RECALLS
Drug Recalls Issues:
• Clinical Staff Identifies Patients using the Drug
• Clinical Stall Notifies Patients
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTDRUG RECALLS
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.
Introduction to Medical Informatics
Physician Office Workflows
MEDICATION MANAGEMENTDRUG RECALLS
Clinical Staff Notifies Patients:
• Telephone Call
• Letter
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
ORDERS MANAGEMENT
Patient Takes Order to Testing:
• Patient Loses Order
• Patient Decides not to Have Test Done
• Insurance Company Denies Authorization for the Test
Introduction to Medical Informatics
Physician Office Workflows
ORDERS MANAGEMENT
Results Sent to Ordering Physician:
• Results Sent to Wrong Office
• Faxed Results are Blurred
• Faxed Results Never Arrive
Introduction to Medical Informatics
Physician Office Workflows
ORDERS MANAGEMENT
Clerical Staff Sorts Mail:
• Mail Person is Out or Unavailable
• Papers Stuck Together and Routed to Wrong Provider
• Papers Lost
Introduction to Medical Informatics
Physician Office Workflows
ORDERS MANAGEMENT
Results Given to Ordering Physician:
• Results Stuck to Other Papers or Mail
• Results Lost in Additional Papers or Files
• Physician Misplaced Results
Introduction to Medical Informatics
Physician Office Workflows
ORDERS MANAGEMENT
Staff Notifies Patient:
• Phone Call
• Letter
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Document/Chart Management Issues:
• Document Received in Office
• Incoming Documents Sorted
• Physician Communicates Follow-Up
• Staff Performs Follow-Up
• Chart Located
• Follow-Up Documented
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
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
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Incoming Documents Sorted:
• Short Staffed
• Illness
• Single Source Vulnerability
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Physician Communicates Follow-Up:
Physician Reviews in between Afternoon Appointments
• Additional Walk-Ins
• Emergencies
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Staff Performs Follow-Up:
• Time Constraints between Scheduled Patients
• Unable to Return Calls until Late Afternoon/Evening
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Chart Located:
Enormous amount of time and manpower wasted looking for paper charts in an office where no EMR is used.
Introduction to Medical Informatics
Physician Office Workflows
DOCUMENT/CHART MANAGEMENT
Follow-Up Documented:
By the time the paper chart is located, documentation may have been lost or misplaced.
Introduction to Medical Informatics
Physician Office Workflows
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
• Staff Performs Follow-Up
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
MESSAGE MANAGEMENT
Message Written on Message Pad:
• Message Illegible
• Incomplete Message
Introduction to Medical Informatics
Physician Office Workflows
MESSAGE MANAGEMENT
Chart Pulled:
• Chart has been misfiled or is lost in stacks of other charts and cannot be located.
Introduction to Medical Informatics
Physician Office Workflows
MESSAGE MANAGEMENT
Message Placed on Front of Chart:
• Message has torn away from chart. Once separated, it may never be returned.
Introduction to Medical Informatics
Physician Office Workflows
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.
Introduction to Medical Informatics
Physician Office Workflows
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.
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
CODING
Determine Diagnosis and Procedure Codes:
• Physician Unfamiliar with Diagnosis and Procedure Codes• New Physician• Physician has Previously had Staff do this
Introduction to Medical Informatics
Physician Office Workflows
CODING
Physician Marks Codes on Billing Form:
• Physician Cannot Locate Proper Diagnosis and Procedure Codes• Physician Unfamiliar with Proper Listing
Introduction to Medical Informatics
Physician Office Workflows
CODING
Physician Associates CPT and ICD-9-CM Codes :
• Physician Leaves Codes Unmatched on Billing Form• Insurance Interprets Unmatched Codes as Medically Unnecessary
Introduction to Medical Informatics
Physician Office Workflows
CODING
Form to Patient to take to Check Out:
• Patient Takes Form Home• No copies of Form in Office
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
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
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTFOLLOW UP APPOINTMENT
Follow Up Appointment Includes:
• Patient to Return for Follow Up• Patient Makes Appointment• Patient Keeps Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTFOLLOW UP APPOINTMENT
Follow Up Appointment Issues:
• Patient to Return for Follow Up• Patient Makes Appointment• Patient Keeps Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTFOLLOW UP APPOINTMENT
Patient to Return for Follow Up:
• Patient Does not Understand they are to Return for Follow Up• Patient Does not Make an Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTFOLLOW UP APPOINTMENT
Patient Makes Appointment:
• Patient Forgets to Make Appointment• Patient Decides Appointment Unnecessary
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTFOLLOW UP APPOINTMENT
Patient Keeps Appointment:
• Patient Does not Keep Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
Disease State Monitoring Includes:
• Clinical Staff Identify Patients• Clinical Staff Notify Patients• Patient Makes Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
Disease State Monitoring Issues:
• Clinical Staff Identify Patients• Clinical Staff Notify Patients• Patient Makes Appointment
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
Clinical Staff Identify Patients:
• Sift thru Paper Charts to Locate Specific Chronic Disease Patients• Charts Missed or Overlooked• Other more Urgent Needs take Priority
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
Clinical Staff Notify Patients:
• Phone Call to Patients• Letter to Patients
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
Disease State Monitoring Includes:
• Notified Patient Responsible to Make Appointment• Patient Does not Make Appointment• Patient Decides Appointment is Unnecessary
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
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
Introduction to Medical Informatics
Physician Office Workflows
RECALL MANAGEMENTDISEASE STATE MONITORING
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).
Introduction to Medical Informatics
Physician Office Workflows
HIPAA
New HIPAA Required Practices Include:
• Track Private Health Information (PHI)• Report User Activity• Retain Reporting for Six (6) Years• Limited Access