ambulatory practice management system report

AMBULATORY PRACT ICE MANAGEMENT SYSTEMS:

Research Report

HADM4880 – HEALTH INFORMATION TECHNOLOGY

SPRING 2015

JASMINE AMOO, VALERIE LIVERETT, BJ TRIMBLE, SAVANNA WILLIAMS,

AND HALEY WRIGHT

TABLE OF CONTENTS

EXECUTIVE SUMMARY 1

GENERAL PURPOSE 2 POTENTIAL USERS AND USES 2 PATIENT REGISTRATION AND SCHEDULING 2 BILLING AND CLAIMS SUBMISSION 3 PATIENT AND WORKFLOW ANALYSIS 3

POTENTIAL BENEFITS AND PROBLEMS 4 BENEFITS AND OBJECTIVES 4 POTENTIAL IMPLEMENTATION ISSUES 4

SYSTEM SAFETY 5 SECURITY MEASURES 5 DATA RECOVERY 5

SYSTEM INTEGRATION 6

REFERENCES 7

1

EXECUTIVE SUMMARY

Ambulatory practice management systems are used in any ambulatory care setting, including physician offices of any size, outpatient clinics, and public health clinics. Any employee of the setting, such as physicians, nurses, technicians, human resources, administrative assistants, etc., can use the system. The reason for the diversity of users of ambulatory practice management systems is because it achieves a large variety tasks. The system has functions that focus on patient registration and scheduling, billing and claims submission, and patient flow and workflow analysis. The major benefits of these systems include that they are highly customizable, improve practice productivity and efficiency, and increase revenue. The system automates so many functions that used to be done by hand, freeing up employees’ time and resources to devote them to patient care. However, with all of these benefits come potential issues with implementation, such as having to devote a lot of time and effort to the initial go-‐live and time period after to ensure the system is working effectively. Additionally, there are security issues to take into consideration in order to protect patient data as well as practice data, like claims submissions and financial data. Having a plan for data recovery in the event of a system malfunction is imperative. Overall, ambulatory practice management systems are a great asset to any ambulatory care setting because of the benefits they provide to the practice as well as their potential for integration with other administrative and clinical information systems.

2

GENERAL PURPOSE

The purpose of the ambulatory practice management system is to assist the practice, whether it is a small private practice or a large multi-‐physician practice, with administrative tasks. These tasks include:

• Patient registration and scheduling, • Billing and claims submission, and • Patient and workflow analysis

Having a practice management system is a vital part of running a health care practice because it can aid in increasing productivity, bringing in more revenue, contributing to the ease of scheduling patients, streamlining processes, and ensuring compliance with regulations like HIPAA, ICD-‐10, and Meaningful Use. Many ambulatory practice management systems also include a wealth of professional knowledge and standardized reports that the practice can use as a template for things like patient information collection and claims submission. The systems promote communication across organizations, are highly customizable, and can automate tasks that once took minutes to perform into just a few clicks.

The system can aid in generating reports on billing and claims submissions, patient flow and workflow, and the revenue cycle, all of which are vital in increasing productivity and revenue. Reports from practice management systems help gain operational and financial insight. The system measures actual day-‐to-‐day operations and helps identify trends to drive efficient administration, process improvement, compliance, and revenue.

POTENTIAL USERS AND USES

Ambulatory practice management systems can be utilized in a variety of ambulatory clinical settings, such as essentially any physician practice, outpatient clinics, and public health clinics. These ambulatory care providers deliver care that does not require a stay longer than 24 hours. Because of the variety of services ambulatory care settings perform, ambulatory practice management systems are equally diverse. Specifically, this type of information system is used for administrative tasks, which are outlined below.

PATIENT REGISTRATION AND SCHEDULING

One use of a practice management system is that it aids with patient registration, meaning collecting new patients’ demographic and personal information. The system can store this information so that the patient does not need fill out the initial information form each time they revisit the practice. The system can assist the practice with patient scheduling, ensuring that patients are not overbooked and are only booked with the proper healthcare provider is available to see them. It can also do automated appointment reminds. These systems will usually contain a conflict-‐checking function and offer solutions for visits and procedures that are complicated and take a longer amount of time. According to Epic’s practice management system, a “rules-‐based scheduling feature accommodates the needs of each clinician, room and piece of equipment – optimizing the use of staff and capital resources throughout your organization.” (Epic)

3

BILLING AND CLAIMS SUBMISSION

A second major area of use for an ambulatory practice management system is in billing and claims submission. The system allows a practice to move to an entirely paperless system and promotes streamlined data entry. Most top of the line systems will contain a function to review claims submissions and alert the user of any deficiencies. The system will sure the practice is only submitting accurate claims that prove medical necessity and comply with HIPAA, Medicare, and Medicaid requirements. This can save the practice the time and money previously used to correct claims, as well as increasing reimbursement rates. By having a practice management system that can assist in billing and claims submissions, the practice can easily track revenue and reimbursement coming in from a variety of payers. The system can generate crucial revenue cycle reports that help the practice to analyze what drives their economic engine and make adjustments to increase revenue.

PATIENT AND WORKFLOW ANALYSIS

An ambulatory practice management system is incredibly useful in analyzing a practice’s patient flow and workflow. It can generate productivity reports that ensure each patient’s time in the office is well spent and efficient. This area ties in with automating patient registration and scheduling. Additionally, the system can reduce employee time spent on administrative tasks like paper claim filing, appointment reminders, and collections follow-‐ups. Many of these tasks can be done automatically overnight by the system, allowing the practice employees to be more productive during work hours. Because most ambulatory practice management systems are customizable, the practice users can create rules that check for overdue collections, make sure all patient information data is entered correctly, etc., which removes the necessity for practice employees to spend time reviewing documents.

4

POTENTIAL BENEFITS AND PROBLEMS

BENEFITS AND OBJECTIVES

Implementing an ambulatory practice management system can greatly help improve several aspects of the system. Practice management systems can help streamline the clinicians’ workflow, closing loops in communication and response the results in delays or gaps in ambulatory care. Since practice management systems main focus is the revenue cycle and patient flow in an ambulatory setting, it benefits in the support of collection of data for uses other than direct clinical care such as, accounts payable and receivable and all other aspects of patient billing, quality management, outcomes reporting, resource planning and public health disease surveillance and reporting. Benefits of implementing a practice management system include allowing physicians to become more efficient with their time and resources. In terms of the revenue cycle, it promotes more accurate billing and claims submissions. The less time and money spent on billing errors, the more time and resources can be allocated to patient care and improving productivity in the practice.

POTENTIAL IMPLEMENTATION ISSUES

Many steps need to be followed in order to prevent conflicts and ensure a timely and effective implementation of a practice management system. Goals, leadership roles, a set timeline of steps that need to be met, and training are some of the key factors that must take place when implementing a system. For instance, without people placed in leadership roles for the project, communication can be lost. Lack of open dialogue is a common problem faced by many implementation teams. If someone is passionate and educated about what the goals are for the system, such as the team champion, he or she will be able to lead other staff members to meet the goals in a timely manner.

The transition to a practice management system can be a timely and complicated one if communication between physicians, nurses, administrative staff, and even the patients is not thorough. Since many practice management systems involve patient portals and other involvement from patients with scheduling and appointments, it is important to communicate the implementation of a system to patients so the system may be properly and effectively used. In addition, making sure the system for patient information is secure, protected, and following HIPAA standards. If the implementation is not communicated to the patients, then the system will not be used properly and will not end up being an asset to the institution.

Ambulatory patient care covers a variety of health care areas with different needs for systems within a particular practice. A practice will need to work with whatever vendor they have chosen to personalize the system to that institution's needs. This may become complicated and complex, adding potential confusion to the medical staff and administration. Again, communication is key along with proper training to all individuals.

5

SYSTEM SAFETY

SECURITY MEASURES

Generally, a practice management system will need to meet certain security measures in order to be compliant with HIPAA and keep information private and safe. Measures would include having code sets for both the clinic and also for the patient in the case of a patient portal. Login information and security software would need to be implemented as well. Doc-‐tor.com's Practice Management software is an example of a system that addresses security issues. These include restricting user access to records, and more importantly, track what activity took place with a patient's record. The system meets standards defined by HIPAA and provides code sets for patient information that is electronically stored. This keeps information safe and secure and is compliant with HIPAA regulations.

As for privacy standards, patients are in "control of their medical records, including restrictions on the access, uses, and disclosures of their personal and medical information. It also imposes stringent safeguards to protect paper-‐based medical records, and requires that a "Notice of Information Practices" be given to patients that outlines how the healthcare organization plans to use and safeguard all health information gathered. Electronic security measures and safeguards are in place in the Doc-‐tor.com programming to insure that sensitive information remains private, whether paper-‐based or not." ("HIPAA")

DATA RECOVERY

Establishing a formal business continuity plan is the key to preparedness in disaster recovery. There are many mechanisms in a BCP that ambulatory practice managers can use to achieve a more effective recovery. The Recovery Point Objective measures, in time, the acceptable amount of data an organization can afford to lose to remain in operation. For instance, if a clinic has a one-‐hour RPO, the organization can manage to lose an hour’s worth of data. The Recovery Time Objective measures the amount of time the system must be recovered and operational after a disaster, in order to sustain patient care. Ambulatory practice management utilizes RPOs and RTOs in EHR recovery, as well as, LIS and PACS. Another mechanism that can be useful in a BCP is SAFER Guides. These guides recommend safety practices that can be exercised when an EHR system is unavailable.

6

SYSTEM INTEGRATION

Many patients see multiple ambulatory care providers, so the ability of a management system to integrate with others of its kind is very useful. Effective system coordination can prevent the duplication of services and provide a physician with clinical information necessary to a specific patient. For example, Allscripts Practice Management System is incorporated with its own claims clearinghouse to capture errors and ensure timely reimbursement. Allscripts’ system also has the ability to be coordinated with ambulatory practice workflows. This improves the use of resources available by scheduling patients at optimal times and increases the productivity of clinicians.

Many ambulatory practice management system providers also provide clinical information systems, such as electronic health records, computerized physician order entry systems, medication administration systems, and laboratory systems. Additionally, these vendors may offer other administrative information systems. An advantage of implements a practice management system that can be integrated with other administrative systems and clinical systems is that all processes will be streamlined and connected, promoting continuity in the practice. For example, patient information will be contained in both the practice management system as well as the EHR system, so having two integrated systems would decrease the need for data entry. In terms of administrative systems, integrating a practice management system with a financial information system would aid in generating more accurate revenue cycle reports and potentially lead to increased revenue.

There is high potential for integrating an ambulatory practice management system with various other administrative and clinical information systems, which can lead to greatly increased productivity, continuity, and revenue.

7

REFERENCES

Allscripts Solutions. (2015). Allscripts Practice Management. Retrieved from http://www.allscripts.com/products-‐services/products/practice-‐management

Agency for Healthcare Research and Quality. (2013). Findings and Lessons from the AHRQ Ambulatory Safety and Quality Program. Retrieved from http://healthit.ahrq.gov/sites/default/files/docs/page/alternate-‐findings-‐and-‐lessons-‐from-‐the-‐ahrq-‐ambulatory-‐safety-‐and-‐quality-‐program.pdf

Cole, C., & Cheriff, A. (2011). Ambulatory Systems. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/Code%2017-‐Ambulatory%20systems_in%20Ong_Medical%20Informatics_HIMSS2011.pdf

Doc-‐tor.com (n.d.). HIPAA Compliant Medical Practice Management. Retrieved from http://www.doc-‐tor.com/hipaa.php#3

Eastern Shore Rural Health System, Inc. (2008, November). Practice Management and Electronic Medical Record Implementation Best Practices. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/Code 67 Practice Mgmt And EMR Best Practices_2008.pdf

Epic (n.d.). Practice Management Software. Retrieved from https://www.epic.com/software-‐practice-‐management.php

iPatientCare, Inc. (n.d.). Practice Management System Benefits. Retrieved from http://www.ipatientcare.com/PMSBenefits.aspx

NextGen Healthcare (n.d.). NextGen Practice Management. Retrieved from https://bridge.nextgen.com/Media/637

Schein, H. (n.d.). Practice Management Software. Retrieved from http://www.micromd.com/practice-‐management/

ambulatory practice management system report

Documents