How Automated should my office be?

HOW AUTOMATED SHOULD MY
OFFICE BE?
Rosemarie Nelson
Health Care Consultant
OBJECTIVES
Identify opportunities in the practice where
waste can be eliminated by effective application
of technology.
 Evaluate your specific technology
implementation with a checklist tool.
 Discuss new technology spot solutions that can
bring relief to bottlenecks and improve patient,
provider and staff satisfaction.

2
WHERE IS YOUR WASTE? YOUR BACKLOG?
YOUR BACKUP?

Check in and registration and intake

Kiosk/portal
Appointment request
 Appointment confirmation
 Recall for follow up and preventive services
 RTA
 Nurse call/portal



Rx renewal calls – use technology to monitor and
prevent calls
What would your patients say?
3
OPPORTUNITY
•
•
•
•
Thesis – “There are no perfect solutions”
“nothing achieves 100%”
“many small changes add up”
If other practices can be a better performer, why not
your’s?
4
UNDERSTANDING CLINICAL IT


Thinking of EMR and ancillary systems as a way
of documentation misses the point.
Clinical IT is a workflow solution. If
reengineering workflow is not part of the IT plan,
it will happen without planning and many of the
benefits will be lost.
5
CHECKLIST TO GAIN OPERATIONAL
EFFICIENCIES
Document workflow
 Identify “touches” and “handoffs”



Compare job descriptions and policies and procedures
against tasks actually being completed and processes
followed
Identify sources and uses of data
Preparation and identification for interfaces
 Definition of use case models


Anticipate and prepare users for process changes
6
WHAT IS THE GOAL OF THE TECH?
What is it supposed to achieve? To do for our
practice?
 How can it be measured?

Time (eliminate steps/touches)
 Information (data+)
 Revenue
 Provider/patient/employee satisfaction


Measure, implement/modify/monitor, measure
7
KIOSK
8
KIOSKS PROMPT
Update insurance/personal info
 Automatically verify insurance eligibility
 Co-pay collection
 Checking patient health history
 Meaningful use information collection
 Enrollment in the patient portal
 Patient satisfaction survey

9
REVENUE CYCLE-CLAIMS DENIALS
Accurate billing information- Right the first time
Decreased
Better
claims denial rates to 2%
Performers first submission denials: 3.15%
Rod Roeser, MHA, CMPE
CEO, Thomas Eye Group, PC, Atlanta
MGMA Connexion May/June 2013 Pgs 3-5
MGMA Performance and Practices of Successful Medical Groups 2013 Report Based on
2012 Data
10
KIOSK INTAKE
“The biggest benefit of the kiosks is the ability to
verify benefits and decrease denials.”
— Robert
Kaufmann, MD, Kaufmann Clinic, Atlanta, Ga.
90 percent decrease in claims denials
 HIPAA 270 inquiry and 271 response
 Copay, co-insurance, deductible amount met

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CASE STUDY – ONE YEAR POST DEPLOYMENT
Eligibility denial rate decreased from 17% to 10%
 Days outstanding in A/R decreased from 65 days to
42 days
 Over 120 days outstanding balance decreased to
12% (from 37%)
 Streamlined patient check-in process and reduced
data entry errors

12
PATIENT SELF-SERVICE
 Increases patient satisfaction
 Reduces internal costs
Task
Approx
duration
Cost *
Insurance verification via payer Web site
2 minutes
$0.40
Insurance verification via payer Web site
including log on
2 – 4 minutes
$0.40-$0.80
Insurance verification via telephone
5 – 7 minutes
$1.00 - $1.40
*Based on $9.00/hour, $12.00/hour with benefits which is $0.20/minute.
Generally the hourly rate is higher when performed by RCM staff.
13
REGISTRATION AND INTAKE: USE YOUR
PORTAL

When are you introducing it?
When does the patient want it?
 Tablet instead of clipboard


What are you delivering?
Do I care about anything in there?
 Will it save time in the practice?


Portal coach
Reception area
 Escort to exam room


“Authorized agent”
14
QR - - QUICK RESPONSE CODES
Patient scans the QR (like bar codes) using
smartphone camera to access data that links to
your portal
 Add QR code to patient statements that link to
your payment page online
 Free QR code generation:

Qrstuff.com
 Zxing.appspot.com/generator
 Quikqr.com
 Create the code, print it, and it’s ready!

15
QR CODE TO LINK SMARTPHONE TO TOOL
Patient Satisfaction Survey Tool (SAMPLE)
Excellent
1
1
1
1
1
1
Very
Good
2
2
2
2
2
2
Good
3
3
3
3
3
3
Fair
4
4
4
4
4
4
Poor
5
5
5
5
5
5
The technical skills (thoroughness, carefulness,
competence)of the person you saw
1
2
3
4
5
The personal manner (courtesy, respect, sensitivity,
friendliness) of the person you saw
This visit overall
1
1
2
2
3
3
4
4
5
5
How long you waited to get an appointment
Convenience of the location of the office
Getting through to the office by phone
Length of time waiting at the office
Time spent with the person you saw
Explanation of what was done for you
Would you recommend this physician to your friends Definitely Probably Probably Definitely
yes
not
yes
not
and family?
Comments
16
PATIENT SURVEY LINKS
https://www.surveymonkey.com/mp/patientsatisfaction-survey/
 http://www.massmed.org/physicians/practicemanagement/patient-satisfaction-surveys-(pdf)/
 http://www.pressganey.com/resources/patientsatisfaction-survey
 PatientPad by digitalassent
 OpinionMeter

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GET WILD AND CRAZY ON THE PORTAL

Informed consent


Webcast for patients v. surgeon’s time
Online scheduling – pick date/time
Flu shot clinic
 Back to school and sports physicals

18
YOUTUBE
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STILL SLOW GETTING DATA INTO THE EHR?
HOW FAST CAN YOU TYPE? (ACCURATELY!)
www.pcshorthand.com
 Not just for your providers
 Never type your name again!
 Better than auto text – it branches
 How about the nursing staff?
 ~ $30 for one year subscription

Try it for $5.95!
 Multi-users: $139.95/year for 5 users

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EFFECTIVE USE OF RESOURCES:
AUTOMATE
 E-statements
 Costs just 58 percent of the price of a paper bill to produce

Gartner Group, HFMA, and HH&N Research
21
PATIENT ONLINE BILL PAYMENT
22
 On your statement: “Pay online at
www.patientpayonline.com”
 Pay a monthly service and transaction fee
 10 percent reduction in accounts receivable

Increased cash flow
22
PATIENT TRACKING
Patient forgotten?
 Patient exam room wait-time
 Patient satisfaction

23
CLAIMS DASHBOARD
APPS TO HELP EDUCATE PATIENTS
DrawMD (free in Apple app store) – physicians
can sketch, stamp or type on detailed anatomic
images and then save to EHRs and/or share
images with patients
 NumeraNET (free in Apple app store) – patients
can share info such as weight, blood pressure,
pedometer results with physicians, who can send
the info to an EHR
 Survey on the Spot (free in Apple app store)

Gather instant feedback on your practice with custom
surveys
 See compiled survey results in your account
 Get software alerts when a patient rates service as
poor

25
APP TO TRACK REAL-TIME GLUCOSE
LEVELS
 App
lets patient
designate
“followers” with
whom to share
data
 Small wire-like
sensor inserted
under skin
continuously
transmits data to
monitor worn
externally
 FDA approval
1/30/15
26
APPS FOR DOCS
Uptodate
 Epocrates
 Isabel
 Micromedix
 Medcalc
 AMiON/Doximity

27
NURSING TECH TOOLS
Skyscape
 Taber’s Medical Dictiona
 Davis’ Drug Guide for Nurses
 RN FastFacts
 ABCs of Interpretive Laboratory Data

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APPS FOR ALLERGY PATIENTS
Find me gluten free
 Zyrtec
 Allergyeats
 Food Allergy Detective
 Cook IT Allergy Free
 AllergyManager
 AroundMe
 Food Intolerances
 iEatOut Gluten Free

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APPS FOR ASTHMA PATIENTS
AsthmaMD
 Wellapets
 AsthmaBuddy
 Pollen
 SPARX
 AsthmaSense
 Assist Me With Inhalers

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WRITE A PRESCRIPTION FOR A MOBILE APP
Daily Carb
 Glucose Buddy
 GoMeals
 DoseCast
 RxmindMe
 Pill Monitor
 MyFitnessPal
 Alivecor: portable heart monitor and app
 iHealth wireless pulse oximeter

31
WHY THEY CALL IT A “SMART” PHONE
Talk to Siri hands free (plugged in while driving)
 Scan credit card (no picture, just scan numbers
and transmit for that purchase)
 Self-timer on the camera app
 VoiceOver, Larger text…
 Alternate keyboards (Swype, SwiftKey…)
 Maps, alarm clock/timer, search, mail…

32
ASK OTHER OFFICES: “WHAT’S YOUR
FAVORITE…”

Who’s doing what “neat stuff”?
Just ask!
 You don’t know what you don’t know

33
ZOCDOC- ONLINE SCHEDULING
Build a new provider’s schedule
 Carve out the availability you want to provide
 Auto update your scheduling system

34
DIRECT SECURE MESSAGING
Enable secure HIE
 Transmit/receive PHI
 Looks/operates like email



Point-to-point encryption
Transmission standard developed by ONC
35
VOICE RECOGNITION SOFTWARE
Don’t let authors edit
 Save wave file
 Delegate editing to your medical transcriptionist

36
FACEBOOK
37
FACEBOOK

How best to use a fan page





Keep the information current
Make it personable
Share great content and encourage your fans to share their
input
Post photos or videos
Ask questions of your fans. This encourages interaction
with them
38
Micro-blogging service that maxes out at 140
characters
 Used for quick thoughts or passing on messages
or links
 Information is not verified, nor would it be
practical to do so
 Employs its own language with @, # and RT
 Great way to monitor the conversation through
searches

39
TWITTER
40
TWITTER
41
SERMO – FOR PHYSICIANS ONLY
42
Squareup.com
•Register online
•Small hardware device plugs into iPhone and
reads credit cards
43
Scanner Pro app
A scanner in your pocket - scan on the go.
“We use it quite a lot,” said Ashish Toshniwal, founder and CEO of
eight-person Y Media Labs, a Redwood City, Calif.-based iPhone
app developing company. “Scanner Pro allows you to take a photos
of a document through iPhone and then save it as a PDF. You
don’t need to go through the pain of scanning a document and
then converting it. Scanning is much more cumbersome than
taking photos.”
Scan multiple page documents, send scans by email and set
custom page sizes.
44
Dropbox.com
•Files in different places?
•Download the software
•Access Dropbox files on other devices (iPhone,
iPad)
“Instead of putting documents in ‘My Documents’ on my hard drive, I put them
in Dropbox,” said provider. “For example, I put all of my transcription into
Dropbox and if I get a call after hours, I can pull up the last office note on my
45
iPhone or iPad.; you can access everything electronically.”
EVERNOTE
Collect and find
 Knowledge sharing and discovery among practice
team
 Ideas, research and expertise easily discoverable

46
ASANA
Project management
 Virtual assistant
 Collaborate without email snafu’s

47
SPEEK – CONFERENCE CALLS MADE EASY
No Dial-in Number or PIN – just URL
 Who Is On the Call -see who is on the call;
see who is speaking at any given time
 Protect Your Phone Number – calls with
vendors keeps your cell number private.
 Share Files During the Call – (Pro Account
Feature) – no email confusion or email
address problems.

FREE for an account that hosts up to 5 callers. (A
Pro account currently costs $10/month.)
48
DOODLE
Meeting scheduling tool
 So simple to use

49
TIMECARD APPS
Android Time Card
 ClockedIn 2
 iPunchclock
 TimeClock-TimeTracker
 TimeCatcher
 Timewerks

50
PASSWORDS
 Change
routinely (quarterly)
 Do not post
 Alphanumeric combo

Scheme: song/phrase first letter of words and
insert numbers
 Case
matters
 Not less than four characters (six-to-eight)
 Isn’t it obvious that it should not be the
obvious?
51
PASSWORDS MADE EASY
 RoboForm
www.roboform.com
 Saves user name and PW
 Heavy encryption
 Master password – reboot, sleep mode,
inactive time
 Creates passwords – random character
generator
 Inserts a toolbar into your browser
 $29.95 (free version for up to 10
passwords)
52
LAPTOP SECURITY
nTracker (www.synet.biz) – ISP change
 TheftGuard (www.softex.com) – remote recover and
destroy data
 Computrace LoJack software – monitoring center and
recovery team can remotely delete PHI when stolen
computer logs on Internet
 Caveo Anti-Theft PC Card – issues audible signals if
PC moved beyond distance specified when on or off
 SprintSecure Laptop Guardian – mobile broadband
connection card as ignition key (must insert to use)
 Encrypt entire hard drive with SafeGuard Easy
(preboot authentication)
53
 Biometric identifiers

RESCUETIME
Monitor how you spend your digital days
 Records how much time you expend on
everything

Excel spreadsheets
 Balancing your bank accounts online
 Watching surfboarding kittens on YouTube

Switch windows, clock reset, running tally
 View easy-to-understand tables and graphs that
show exactly how you’ve used your time (and
where)
 Free. Paid version can keep you on-task.

54
BE AFRAID…
“Nothing fails like success. You think you’re really
good. You get smug. You relax. And you’re no
longer as good as you thought you were.”
Peter Gross, MD
Senior Vice President and Chief Medical Officer
Hackensack University Medical Center
55
QUESTIONS?