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COMMON

COMMON. PHYSICIAN OFFICE. WORKFLOW. CHALLENGES. 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.

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COMMON

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Presentation Transcript

  1. COMMON PHYSICIAN OFFICE WORKFLOW CHALLENGES

  2. 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

  3. 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

  4. WORKFLOW OVERVIEW

  5. MEDICATION MANAGMENT Medication Management includes: • Initial Prescription Order, • Refills, • Adverse Drug Reactions, and • Drug Recalls.

  6. MEDICATION MANAGEMENTINITIAL 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

  7. MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER Initial Prescription Order Issues: • Physician Checks for Interactions • Pharmacy Fills Prescription • Patient Takes Medication

  8. MEDICATION MANAGEMENTINITIAL PRESCRIPTION ORDER Physician Checks for Interactions: Physician checks current medication lists for: • Interactions • Drug Allergy Interactions • Food or other Environmental Interactions

  9. MEDICATION MANAGEMENTINITIAL 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 patient’s insurance company’s formulary: • Call to Physician for Permission for Substitution • Physician to Appeal to Insurer • Patient Purchases Medication at Higher Copay or Full Price

  10. MEDICATION MANAGEMENTINITIAL 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

  11. MEDICATION MANAGEMENTPRESCRIPTION REFILLS Prescription Refills includes: • Prescription Contains Refills • Patient Requests Refills • Physician Approves Refill • Patient Continues Medication

  12. MEDICATION MANAGEMENTPRESCRIPTION REFILLS Prescription Refills Issues: • Patient Requests Refills • Physician Approves Refill • Patient Continues Medication

  13. MEDICATION MANAGEMENTPRESCRIPTION REFILLS Patient Requests Refills: • Patient Remembers Refill • Patient Requests Refill

  14. MEDICATION MANAGEMENTPRESCRIPTION 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,

  15. MEDICATION MANAGEMENTPRESCRIPTION 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

  16. MEDICATION MANAGEMENTADVERSE DRUG REACTIONS Adverse Drug Reactions Include: • Patient/Pharmacist Reports Adverse Reaction • Reaction Noted in Patient Chart • Alternative Medication Prescribed

  17. MEDICATION MANAGEMENTADVERSE DRUG REACTIONS Adverse Drug Reactions Issues: • Patient/Pharmacist Reports Adverse Reaction

  18. MEDICATION MANAGEMENTADVERSE DRUG REACTIONS Patient/Pharmacist Reports Adverse Reaction: • Patient may stop taking medication • Patient may need additional medication to treat reaction

  19. MEDICATION MANAGEMENTDRUG 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

  20. MEDICATION MANAGEMENTDRUG RECALLS Drug Recalls Issues: • Clinical Staff Identifies Patients using the Drug • Clinical Stall Notifies Patients

  21. MEDICATION MANAGEMENTDRUG 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.

  22. MEDICATION MANAGEMENTDRUG RECALLS Clinical Staff Notifies Patients: • Telephone Call • Letter

  23. 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

  24. 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

  25. ORDERS MANAGEMENT Patient Takes Order to Testing: • Patient Loses Order • Patient Decides not to Have Test Done • Insurance Company Denies Authorization for the Test

  26. ORDERS MANAGEMENT Results Sent to Ordering Physician: • Results Sent to Wrong Office • Faxed Results are Blurred • Faxed Results Never Arrive

  27. ORDERS MANAGEMENT Clerical Staff Sorts Mail: • Mail Person is Out or Unavailable • Papers Stuck Together and Routed to Wrong Provider • Papers Lost

  28. ORDERS MANAGEMENT Results Given to Ordering Physician: • Results Stuck to Other Papers or Mail • Results Lost in Additional Papers or Files • Physician Misplaced Results

  29. ORDERS MANAGEMENT Staff Notifies Patient: • Phone Call • Letter

  30. 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

  31. 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

  32. 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

  33. DOCUMENT/CHART MANAGEMENT Incoming Documents Sorted: • Short Staffed • Illness • Single Source Vulnerability

  34. DOCUMENT/CHART MANAGEMENT Physician Communicates Follow-Up: Physician Reviews in between Afternoon Appointments • Additional Walk-Ins • Emergencies

  35. DOCUMENT/CHART MANAGEMENT Staff Performs Follow-Up: • Time Constraints between Scheduled Patients • Unable to Return Calls until Late Afternoon/Evening

  36. DOCUMENT/CHART MANAGEMENT Chart Located: Enormous amount of time and manpower wasted looking for paper charts in an office where no EMR is used.

  37. DOCUMENT/CHART MANAGEMENT Follow-Up Documented: By the time the paper chart is located, documentation may have been lost or misplaced.

  38. 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

  39. 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

  40. MESSAGE MANAGEMENT Message Written on Message Pad: • Message Illegible • Incomplete Message

  41. MESSAGE MANAGEMENT Chart Pulled: • Chart has been misfiled or is lost in stacks of other charts and cannot be located.

  42. MESSAGE MANAGEMENT Message Placed on Front of Chart: • Message has torn away from chart. Once separated, it may never be returned.

  43. 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.

  44. 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.

  45. 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

  46. 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

  47. CODING Determine Diagnosis and Procedure Codes: • Physician Unfamiliar with Diagnosis and Procedure Codes • New Physician • Physician has Previously had Staff do this

  48. CODING Physician Marks Codes on Billing Form: • Physician Cannot Locate Proper Diagnosis and Procedure Codes • Physician Unfamiliar with Proper Listing

  49. CODING Physician Associates CPT and ICD-9-CM Codes : • Physician Leaves Codes Unmatched on Billing Form • Insurance Interprets Unmatched Codes as Medically Unnecessary

  50. CODING Form to Patient to take to Check Out: • Patient Takes Form Home • No copies of Form in Office

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