1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9 Administrative Technologies

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Complete the chapters on Communication (Chapter 7) and Patient Education (Chapter 8) before beginning this chapter. Many of the principles discussed in those chapters also apply to administrative techniques. This chapter lends itself to lunchtime reading and other “learning moments.” Carry the review book with you and open it when you have a free moment. Review Tip

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The wired telephone and the cellular telephone are the most common but not the only methods of electronically transmitting messages and information. Advancing communication technology is found in all aspects of health care. This chapter also covers some of the technologies found in the medical office, such as computers and facsimile machines. Overview

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Despite the increasing use of advanced technology, the telephone remains the number one technologic method for patients and health care providers to communicate with each other. Although the medical office also relies on the phone for real-time communication with insurance companies, pharmacies, medical supply companies, and hospitals, the primary emphasis of this chapter is telephone communication between the medical office and the patient. The use of specific skills and guidelines helps ensure that telephone communication is effective. Telephones

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Telephone Voice Qualities ■ Enunciation—speak clearly ■ Pronunciation—say words correctly ■ Volume—use normal voice level ■ Speed—use normal rate of conversation ■ Inflection—change voice pitch to avoid a monotonous tone that implies boredom ■ Facial expression—put a “smile” in your voice by having a pleasant look on your face while speaking even though the caller cannot see you ■ Courtesy—speak politely, without irritation or impatience ■ Attention—focus on the caller and listen Telephones, cont’d.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Office Calls ■ Attempt to answer by the third ring ■ Use standard office greeting Greet caller (e.g., “Good morning”). Provide name of facility. State your name. Inquire “How may I help you?” ■ Use standard closing Thank the patient for calling. Allow caller to hang up first. Telephones, cont’d.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Direct multiple incoming calls Obtain permission of the first caller to be placed on hold. Explain that you have another incoming call. Allow time for the patient to respond before placing him or her on hold. Ask the second caller to wait; allow time for response before placing him or her on hold. Attempt to respond to callers within 30 seconds. Provide options if the hold will be longer. Thank the caller for waiting. ■ Screen calls Know who and where to refer patients for appropriate assistance. Manage physician’s time by referring necessary calls only and taking messages for other calls. Telephones, cont’d.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Route calls Tell caller to whom you are forwarding the call. Provide the forwarding phone number to which you are transferring the call in case of disconnection. Inform the patient that if the party does not respond, the patient may leave a voice mail message (if available). Suggest the patient include a time when he or she is available for a return call. ■ Know the office policy regarding calls that should be directed to the physician Forward calls from other physicians, hospital staff, and patients to whom the physician indicated he or she would like to speak directly (e.g., close colleagues). Provide the patient’s medical record (chart or file) for the physician when transferring a call or leaving a message if he or she does not have access to the EMR. Telephones, cont’d.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assure a patient who insists on speaking only to the physician, when the physician is unavailable, that the physician will return the call; if possible, provide a time range during which the call will be returned. Inform callers who will not identify themselves that you need their name and number to have the physician return the call. ■ Record message Use carbonized message pad, e-mail, or other methods that allow the message to be forwarded but saved. Maintain a copy of the message in the patient’s medical record if that is office policy. Record the caller’s name (confirm spelling), date, time, reason for call, phone number of caller, and convenient time to return call. Telephones, cont’d.

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Inform the caller who will return the call and give an approximate time the call will be returned. Initial and forward the message to the appropriate person with the patient’s medical record, if needed. ■ Deal with emergencies Notify the physician immediately. Activate the emergency medical system (EMS/911); if telephone system allows, keep the caller on one line while you notify 911. Instruct caller to hang up and activate EMS himself or herself, if the office phone system does not have at least two lines. Provide EMS or emergency facility with information, including advance directives and other important details. Follow up with the emergency facility. Telephones, cont’d.

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Manage difficult callers Keep your voice at a normal level and remain calm with angry callers. Determine the problem and notify appropriate staff to help the patient. Follow up to ensure the problem was addressed. Ensure that the physician or the administrator is aware of irate callers or callers with unresolved problems. Attempt to obtain identity of threatening callers and notify the physician or the administrator immediately. Telephones, cont’d.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Assisting and Medical Administrative Specialist Calls The following are telephone calls that a non-physician may handle if he or she is the designated person in that office: ■ Appointments (scheduling, rescheduling, canceling, reminding, recalling) ■ Patient financial statements, insurance, fees, and service questions ■ Prescription refills verified by the physician ■ Diagnostic testing and other procedural preparations as written ■ Satisfactory test results if reviewed and approved by physician following Health Insurance Portability and Accountability Act (HIPAA) guidelines ■ Routine and satisfactory progress reports from patient if office policy allows Telephones, cont’d.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Reinforcement of patient educational plan ■ General information regarding office policies, locations, or appointment preparation ■ Schedule procedures at other facilities ■ Record diagnostic and other procedural results telephoned from health care facilities (within the continuity of care or with patient consent) ■ Activate answering service ■ Retrieve messages from answering service or voice mail Telephones, cont’d.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Telephone Confidentiality The HIPAA confidentiality standards, expected in all health care activities, also apply to the telephone: ■ Give information only to authorized persons. (Note: Spouses, friends, parents of adults, or adult children of patients are not generally authorized unless specifically approved by the patient in writing.) ■ Verify that you are giving information to an authorized person (e.g., the patient’s insurance carrier). ■ Ensure telephone conversations are not overheard or that messages are not seen by unauthorized persons. Telephones, cont’d.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Avoid discussing telephone conversations except in carrying out medical assisting duties with authorized persons. ■ Avoid leaving information on the patient’s voice mail; only state the name of the office and the phone number. Ask the patient to return the call, and leave the name of the party he or she should request Telephones, cont’d.

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins In addition to the telephone, you may use or come in contact with other technologic devices. It is your responsibility to keep up with advances. The exams will continue to incorporate new technologies. Computers The computer is an electronic device programmed to take in, store, retrieve, and process data. Other Technological Devices

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 9-1. Basic components of a computer. Other Technological Devices, cont’d.

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Hardware—the central processing unit, motherboard, hard drive, disk drive, keyboard, and monitor of the computer Motherboard—the fiberglass plank of the computer that contains the central processing unit, memory, and other circuitry - Central processing unit (CPU)—circuit on a microchip that processes data; microprocessor -Random access memory (RAM)—main memory bank of a computer located on the motherboard; the more RAM the computer has, the more data and the faster the data manipulation; memory is measured in bytes (e.g., megabytes—1 million bytes; gigabytes—1 billion bytes) Hard drive—a box containing the computer’s programs and data files Keyboard—a set of typewriter-like keys that plugs into the computer and allows input of data Other Technological Devices, cont’d.

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Monitor—visual display terminal that allows data to be seen on a television-like screen Disk drive—a device that allows information to be accessed from a floppy disk or compact disc ■ Accessories Mouse—a device that plugs into the computer and allows the user to control the cursor (pointer) as viewed on the monitor Modem—a device connecting the computer to a telephone line and allowing data to be transmitted over telephone wires ■ Software—computer programs that tell the computer what to do ■ Floppy disks—diskettes; magnetic discs that can be inserted in the disk drive; they allow for storage of data outside the computer and for transmission of data into and out of the computer Other Technological Devices, cont’d.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Compact disc (CD)—a disc that can be inserted into a CD-ROM (compact disc read-only memory) drive and read by a laser beam, allowing storage of data, including audio and visual programs, outside the computer and transmission of the data into and out of the computer ■ ZIP drive—a drive that allows several megabytes of data to be saved to a special disc; can be internal or external to the computer ■ Digital video disc (DVD)—a high-density optical disc the contents of which can be displayed on a computer or television screen ■ USB (universal serial bus) drive—small, lightweight, removable data storage device; also called USB stick, USB key, memory stick, flash drive, or thumbdrive Other Technological Devices, cont’d.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 9-2. Compact discs and USB drives. Other Technological Devices, cont’d.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common File Formats A file format is a mechanism used by the computer to save and retrieve specific computer information, such as text or photographs. ■ DOC—document files (DOCX is a more current version, but the general recommendation is to save files in DOC for ease of opening from all senders) ■ GIF—Graphics Interchange Format ■ JPEG—Joint Photographic Experts Group ■ RTF—rich text file ■ PDF—portable data format Other Technological Devices, cont’d.

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Computer Networks A computer network is the ability of two or more computers to communicate. ■ LAN (local area network)—a router is used to connect computers, generally of a single organization and all its sites ■ WAN (wide area network)—using telephone systems, coaxial cables, or satellites, connects the computers of a geographic area; the Internet, which contains the World Wide Web (www), is the largest example of a WAN Other Technological Devices, cont’d.

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Common Computer Terms ■ Blog—a type of website, generally maintained by an individual who posts regular commentary or other material such as graphics or video ■ Electronic social network—a group of people interconnected by the web for the purpose of interacting on a specific topic or multiple topics of common interest such as Facebook and Twitter ■ HTML (HyperText Markup Language)—the language used to transfer documents on the Internet ■ HTTP (HyperText Transfer Protocol)—how messages are formatted and sent over the Internet ■ Browser—software that locates and displays web pages on the computer; an example is Internet Explorer Other Technological Devices, cont’d.

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Search engine—an extensive program allowing searches for information and websites by using key words; examples are Yahoo and Google ■ Spreadsheet—values arranged in columns and rows that may be electronically manipulated using formulas or other processes ■ URL (Uniform Resource Locator)—identifies the global address and domain to access web pages ■ Website—a collection of screens with text, images, videos, or other digital information with a common domain ■ Word processing—one of the most common computer applications used to create, edit, and produce text documents Other Technological Devices, cont’d.

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Computer Uses in the Medical Office ■ Appointment and procedure scheduling ■ Patient statements ■ Day sheets ■ Financial ledgers ■ Requisitions ■ Payroll and other personnel functions ■ Reports ■ Correspondence ■ Online patient registration ■ Electronic medical records ■ Insurance billing and claims Other Technological Devices, cont’d.

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Research using the Internet ■ Digital imaging ■ Patient educational materials ■ Patient reminder and recall notifications ■ Staff training ■ Inventories ■ Electronically operated patient tests and procedures ■ Website information regarding the practice Other Technological Devices, cont’d.

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Computers and Confidentiality The health care standards for confidentiality and release of patient information also apply to computers. Computer-specific requirements and guidelines have come about through standard practice or HIPAA. One of the significant components of HIPAA is the filing of Medicare claims through a secure electronic database exchange. To ensure compliance: ■ Require authorized persons to use an exclusive “electronic signature” or password to view patient records ■ Change passwords frequently ■ Ensure computer screens are not in view of unauthorized persons ■ Turn off computers when not in use Other Technological Devices, cont’d.

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Install privacy filters on monitors to prevent passersby from seeing the screen ■ Protect computers from illegal access with appropriate security devices such as firewalls ■ Shred confidential copied materials when no longer in use Other Technological Devices, cont’d.

30. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 9-3. HIPAA standards also apply to computers. Other Technological Devices, cont’d.

31. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Transcription and Equipment Transcription is basically a written copy of dictated or recorded information. Although generally done by a person specifically trained in this field, medical transcription may be the duty of the medical assistant or the medical administrative specialist. Common information transcribed for the medical office is: ■ Patient history and physicals ■ Admission and discharge notes ■ Surgery and other procedural reports ■ Consultations ■ Correspondence Other Technological Devices, cont’d.

32. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The equipment used includes: ■ Transcription machine with earpieces and foot pedals ■ CDs or audiocassettes ■ Computer and monitor ■ Keyboard ■ Specific software (e.g., medical terminology spell check, pharmacology reference) Other Technological Devices, cont’d.

33. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Common Electronic Devices ■ Facsimile machine (fax)—an electronic machine that sends copies of documents over telephone wires (fax confidential information only to secured areas; fax cover sheets should include a confidentiality statement) ■ Scanner—software-required device that reads documents (text, graphics, photos) and transfers the image to the computer ■ Automated routing unit (ARU)—programmable device that answers calls and plays prerecorded telephone messages to prompt a caller to choose options based on needs; the ARU automatically directs the caller to the chosen option; some ARUs are programmed to telephone patients and leave appointment reminders or other messages (these messages should not be left without patient consent) Other Technological Devices, cont’d.

34. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Electronic mail (e-mail)—a system of communicating electronic messages, images, and sounds via the computer through a modem and the Internet (e-mails should not be sent to patients without their consent) ■ Cellular telephones (cell phones)—portable, wireless telephones; their use should be restricted in health care facilities because they may interfere with electrical medical devices or the noise may impede patient care; medical assistants should not use personal cell phones during working hours ■ Personal digital assistant (PDA)—a palm-sized, handheld, wireless computer that may be synchronized with other computers; an example is a Palm Pilot Other Technological Devices, cont’d.

35. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Pagers—battery-operated devices that alert a person to a message left through a telephone or wireless source; pagers may also display other information, such as news bulletins ■ Digital camera—a camera that uses a memory card instead of film, allowing pictures to be viewed, altered, or printed through a computer Other Technological Devices, cont’d.