2. Introduction to Medical Informatics Physician Office Workflows COMMON WORKFLOW CHALLENGES PHYSICIAN OFFICE

3. 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

4. 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

5. Introduction to Medical Informatics Physician Office Workflows WORKFLOW OVERVIEW

6. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGMENT Medication Management includes: Initial Prescription Order, Refills, Adverse Drug Reactions, and Drug Recalls.

7. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT INITIAL 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

8. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT INITIAL PRESCRIPTION ORDER Initial Prescription Order Issues: Physician Checks for Interactions Pharmacy Fills Prescription Patient Takes Medication

9. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT INITIAL PRESCRIPTION ORDER Physician Checks for Interactions: Physician checks current medication lists for: Interactions Drug Allergy Interactions Food or other Environmental Interactions

10. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT INITIAL 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 patients insurance companys formulary: Call to Physician for Permission for Substitution Physician to Appeal to Insurer Patient Purchases Medication at Higher Copay or Full Price

11. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT INITIAL 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

12. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT PRESCRIPTION REFILLS Prescription Refills includes: Prescription Contains Refills Patient Requests Refills Physician Approves Refill Patient Continues Medication

13. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT PRESCRIPTION REFILLS Prescription Refills Issues: Patient Requests Refills Physician Approves Refill Patient Continues Medication

14. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT PRESCRIPTION REFILLS Patient Requests Refills: Patient Remembers Refill Patient Requests Refill

15. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT PRESCRIPTION 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,

16. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT PRESCRIPTION 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

17. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT ADVERSE DRUG REACTIONS Adverse Drug Reactions Include: Patient/Pharmacist Reports Adverse Reaction Reaction Noted in Patient Chart Alternative Medication Prescribed

18. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT ADVERSE DRUG REACTIONS Adverse Drug Reactions Issues: Patient/Pharmacist Reports Adverse Reaction

19. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT ADVERSE DRUG REACTIONS Patient/Pharmacist Reports Adverse Reaction: Patient may stop taking medication Patient may need additional medication to treat reaction

20. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT DRUG 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

21. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT DRUG RECALLS Drug Recalls Issues: Clinical Staff Identifies Patients using the Drug Clinical Stall Notifies Patients

22. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT DRUG 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.

23. Introduction to Medical Informatics Physician Office Workflows MEDICATION MANAGEMENT DRUG RECALLS Clinical Staff Notifies Patients: Telephone Call Letter

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Introduction to Medical Informatics Physician Office Workflows ORDERS MANAGEMENT Staff Notifies Patient: Phone Call Letter

31. 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

32. 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

33. 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

34. Introduction to Medical Informatics Physician Office Workflows DOCUMENT/CHART MANAGEMENT Incoming Documents Sorted: Short Staffed Illness Single Source Vulnerability

35. Introduction to Medical Informatics Physician Office Workflows DOCUMENT/CHART MANAGEMENT Physician Communicates Follow-Up: Physician Reviews in between Afternoon Appointments Additional Walk-Ins Emergencies

36. 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

37. 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.

38. 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.

39. 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

40. 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

41. Introduction to Medical Informatics Physician Office Workflows MESSAGE MANAGEMENT Message Written on Message Pad: Message Illegible Incomplete Message

42. 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.

43. 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.

44. 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.

45. 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.

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. Introduction to Medical Informatics Physician Office Workflows CODING Diagnosis Codes – ICD 9 Codes: Based on World Health Organizations 9 th Revision Used Since 1950 Hospitals – January 1979 Physicians Required - 1988 Code Changes – October 1st

53. Introduction to Medical Informatics Physician Office Workflows CODING Procedure Codes: Systematic Listing and Coding of Procedures Used Since 1960s Updated annually every January Additional Modifiers are available to Further Describe a Code

54. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT FOLLOW UP APPOINTMENT Follow Up Appointment Includes: Patient to Return for Follow Up Patient Makes Appointment Patient Keeps Appointment

55. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT FOLLOW UP APPOINTMENT Follow Up Appointment Issues: Patient to Return for Follow Up Patient Makes Appointment Patient Keeps Appointment

56. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT FOLLOW 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

57. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT FOLLOW UP APPOINTMENT Patient Makes Appointment: Patient Forgets to Make Appointment Patient Decides Appointment Unnecessary

58. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT FOLLOW UP APPOINTMENT Patient Keeps Appointment: Patient Does not Keep Appointment

59. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE STATE MONITORING Disease State Monitoring Includes: Clinical Staff Identify Patients Clinical Staff Notify Patients Patient Makes Appointment

60. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE STATE MONITORING Disease State Monitoring Issues: Clinical Staff Identify Patients Clinical Staff Notify Patients Patient Makes Appointment

61. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE 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

62. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE STATE MONITORING Clinical Staff Notify Patients: Phone Call to Patients Letter to Patients

63. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE STATE MONITORING Disease State Monitoring Includes: Notified Patient Responsible to Make Appointment Patient Does not Make Appointment Patient Decides Appointment is Unnecessary

64. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE 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

65. Introduction to Medical Informatics Physician Office Workflows RECALL MANAGEMENT DISEASE 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 Consumers Experiences Sponsored, Supported and Maintained by National Committee on Quality (NCQA).

66. 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