Finding our Pot of Gold in Patient Access through e

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; 5th largest hospital in Florida.
Introduction
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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, CRCEI; 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 eSignature 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 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.
Pt Access Rep updates Pt
information obtained on
paper forms into
registration system.
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?