New Richmond Clinic Shadow Project

Presented by: Teri Olds, Amy Hanson, Melissa Traiser, and Melissa Wiederhoft

Introduction

The New Richmond Clinic

We met with Jean, who is the head of the health information management

department and Lori, who is the head of the reception department.

Reviewed and signed confidentiality form and then started our project.

Background

•Division of Western Wisconsin Medical Associates– has provided health  care for the families in the greater New Richmond community for more than half a century– has grown from a small medical practice into a clinic that now offers a broad range of medical services for patients of all ages– have a highly skilled staff of physicians consisting of surgeons, family practice professionals, pediatrician, and a gastroenterologist

Medical Office Reception

Presented by: Melissa Traiser

Process of Receiving Patients

• There are 2-3 providers that still use paper charts– can take up to two days to get the paper record– only pulled if the patient has not been seen

within the last three years– Pulled for specialist appointments and surgeons

• If patient has been seen in the last three years their medical records are in the EMR

Patient Registration

• First they are asked their name• Which physician they are seeing• Current address and phone number• Verification of insurance• Charge ticket is then printed and placed in

the folder for that physician• Billing policy and authorization form

Front desk personnel never asks the patient what they are there for!

Billing policy and authorization form

Notifying Staff of Patient Arrival

• After it is verified that the patient has checked in:– EMR is then highlighted that they arrived– Notifies the physician’s nurse–When nurse views the patients EMR it is

highlighted in green• Nurse views this from a different side than the

front desk personnel

Communication Process when Physician is Running Late

• Physician’s nurse will notify the front desk personnel

• Front desk personnel will relay this to the patient– They do not have to go into details why

physician is running late

Communication Process when Physician is Running Late Cont.

• Then they ask the patient if they want to continue to wait until physician can see them

• Or if willing to reschedule with another physician give them that option

Very important to know how long patients have been waiting – keep an open line of

communication at all times!

Patient Confidentiality

• There is a sign back several feet from the registration desk

• Receptionists try to talk in a low voice– No partitions between each receptionist area

• Receptionist can give patient paper for them to write on if they do not want to give information out loud

Patient Confidentiality Cont.

• Patient waiting area is positioned a good distance away from the front desk– This helps protect patient confidentiality

Never ask what the patient is being seen for!!

Privacy notice -- HIPPA

Group Assessment of Medical Office Reception

• Functioned very well• Staff very friendly and had excellent eye

contact• Staff greeted patients with a smile, patients felt

very comfortable• Handled patient confidentiality very well• Reception desk could handle many patients at

one time – easy flowing• Staff enjoys their jobs and love to work with

patients

Telephone Procedures

Presented by: Melissa Wiederhoft

Telephone Procedures

Phone Greeting- Switchboard

“Good morning/afternoon New Richmond Clinic”

- Appointments“Good morning/afternoon New Richmond Clinic! This is Anna.”

Telephone Procedures

1st, 2nd, 3rd ring?- 1st or 2nd ring, always 3rd ring

- Different departmentNo more than 3 rings

Telephone Procedures

Script - No Script

Training- More Experienced

employee

Telephone Procedures

Putting calls on hold

- Ask permission first- If yes, go to 2nd caller- Return to 1st caller & Thank

Telephone Procedures

Check back with callers

- Every couple minutes- Keep asking what they would like to do

Telephone Procedures

Screening calls

- Switchboard

- Triage

Telephone Procedures

Transferring incoming calls

- Switchboard or TriageI. Callers name & company

II. Nature of call

III. Call back to identify caller and see if person available

IV. Plan of action

Telephone Procedures

Taking Messages

- No message pads, electronically

- Messages in patient's chartsI. Only if medically needed

- Return phone callsI. End of the morning, free time, between patients

& end of the day

Telephone Procedures

Taking Messages Cont.

- Telephone logs- Tracking incoming call messages

Telephone Procedures

Handling certain types of calls­ Angry caller/complaint

I. Keep clam

II. As much information as possible

III. Manager if needed

Telephone Procedures

Handling certain types of calls cont.­ Emergency

I. Triage

­ Personal callsI. Help patients first

II. As long as they don’t interfere with job

III. Don’t spend a lot of time on phone

IV. To make a personal call – business office

Telephone Procedures

Handling certain types of calls cont.­ Calls from Patient's family

I. Can’t give out that information

II. Only with consent

­ Calls from insurance companiesI. Coding question – business office

II. Patient chart question – Triage

Telephone Procedures

Professional answering service

­ Prompts to call 911 if its an emergency­ Gives office hours­ Physicians on call ­ Monday through Saturday

6:30 p.m. – 8 a.m.

­ Saturday through Monday noon – 8 a.m.

Telephone Procedures

Leaving patient information on

answering machines

­ House phonesI. Who is calling

II. Appointment time

III. Call back number

­ Cell phonesI. Who is calling

II. Call back when they get a chance

Telephone Procedures

Group assessment• Handles scheduling and patient check-in

very efficiently• Switchboard separate room

• Appointment schedules located in two spots in reception area

• More than one receptionist at front desk at a time

• Phone system only takes one call at a time

Medical Office Scheduling Procedures

Presented by: Amy Hanson

Scheduling System

The New Richmond Clinic uses a Computerized Scheduling System.

The Software they use is called CERNER

Scheduling Process

Physician's have their own set of fixed time intervals

Most appointments are 15 minutesPap smears and male physicals are 45

minutesFor longer appointments the receptionist

uses scheduling codes to choose a longer appointment time

Visit Codes

Visit Codes Cont.

Emergency Appointments

For a patient that walks in to the clinic needing an emergency appointment, the receptionist will page a nurse up to assess the situation.

If a patient calls in needing emergency assistance the receptionist will route the call directly to triage.

Walk-in Appointment

The receptionist will check the days schedule for the earliest available appointment.

Double booked Appointment

On the rare occasion that the receptionist finds it necessary to double book patients, they try to fit the double booking in at the end of a longer appointment slot.

Late Appointment

The receptionist will call back to the physician’s nurse and see if the physician is still available to see the patient.

If the physician is unable to see the patient the receptionist will help the patient reschedule their appointment.

No-Show Appointments

If it has been more than 15 minutes and the patient has not yet arrived for a scheduled appointment then the receptionist will pull up the patients chart and mark them as a no-show.

Extended Appointments

The receptionist, using her own personal judgment, can extend the allotted appointment time by an additional 15 minutes for patients that have several issues or who are unwilling to share the reason for appointment.

Canceling an Appointment

The receptionist will take the appointment out of the schedule.

Other Appointments

Laboratory appointments are made at the clinic’s appointment desk.

If a patient has a referral from their physician for an X-ray, the nurse will take them over to the specialty reception desk.

Surgery appointments are scheduled through the hospital.

Visitors

Drug company representatives and Vendors are given a pass at the front desk and allowed to go back into the clinic.

Only one representative or vendor is allowed back into the clinic at a time.

Language Barriers

The clinic has a phone interpretation system that can be utilized by all staff.• The system has a 1-800 number that the

receptionist calls• Interpreter gets information from the patient• Interpreter relays information to the receptionist

Translations is available in many languages, but Spanish is the most common.

Group Assessment

The New Richmond Clinic has an excellent patient scheduling system. The

receptionists are well trained and capable of handling front desk check-in duties while also answering the phone and scheduling

appointments.

­

Filing and Health Information Management

Presented by: Teri Olds

Type of records used

Paper• Some physicians and specialists• Surgeons• Length of time since last visit

Electronic• Cerner – 3 years ago

Observation of the EMR in Use

Home page • messages/items in queue

Summary Page • diagnoses, last visit summary, alerts,

insurance info.

Orders/Lab• May enter and review results

Seemed very similar to Medisoft

Security Measures to protect patient confidentiality within EMR

• Automatic log-off after three minutes• Security screens• Monitor positioning• Change passwords/logins every 90 days• Certain areas require dual sign-on/log-ins• Restricted access – need to know basis

Process of converting to an EMR

“Very painful process”

• Extensive training required• Whole new way of doing things

Training to prepare staff to use EMR

Extensive• Webinars• Super users/trainers• On-site for two weeks once live• Specialized per department or unit

Costs associated with converting to an EMR system

Very expensive• More comprehensive/popular system

available• Penalties in future for non-compliance

Benefits of EMR system

• Multiple users can access• Quicker/more efficient flow of information• Critical access for emergencies• Decreased loss of

documentation/misplaced files• Capability to dictate directly into the EMR• Multi-functional – billing, lab orders,

progress notes, etc.

Disadvantages of the EMR

• Need to change screens to access different data

• Incapable of having two sections of a chart open at once

• Constantly changing – updates and upgrades

• A “work in progress”• Scanning is very time consuming

Patient Health History Cont.(Scanning Example)

Paper Records

Open Shelving• 35,000-40,000 on shelves• Active/most current records• Filed alphabetically• Color coded by letter• Each file – year sticker, first two letters of last

name, first two letters of first name• Name alert stickers – refer to M.I./DOB• Use of Out folders

Out guide used for paper records in filing room

Paper Records

Lateral File Cabinet• Charts of people from out of town

Banker’s Boxes• Organized alphabetically and by year• Inactive & Deceased • Boxes labeled and lists maintained

Off-Site Storage• Retain 10 – 12 years or longer• 25 years worth of deceased• Process of getting rid of records

Organization of the Medical Record

Source-oriented • Divided into sections on right side• Left side contains summary documents

Maintaining patient confidentiality when the record is stored

Storage• Room always locked, building locks

after hours• Cleaning people supervised• Only Health Information Department

can access• Location of file storage room

Maintaining patient confidentiality when the record is checked out

• Kept in staff possession• Physical control over or visual

Process of correcting record

Paper• Place a line through error• Write correct information above or below• Date and initial correction• Never use white out or remove things

Electronic• Create addendum• EMR is “stamped” with date and author’s

name

How records are locked after hours

• Record room is always locked• Building locked after hours

How to find misplaced files and occurrence rate

• Check for out guide• Check with physicians, business office,

etc.• Look at color coding

Rarely have misplaced records

Fairly easy to locate, small facility

Process for records retention

Paper• Active kept on open shelving indefinitely• Inactive moved to banker’s boxes after five years• Deceased moved to banker’s boxes, on-site one to two

years, then off-site. Currently have 25 years worth.

NR Clinic does not use microfilm

Electronic• Any paper records are scanned in• Kept indefinitely• Take up less storage space

Handling employees who breach patient confidentiality

Varies based on severity• Suspension• Termination

Utilize co-workers• Files of relatives/friends

Group Assessment of Medical Records Function

• Well organized• Scanning is very time consuming• Benefits of copier in medical records

room• Inconvenient access to records

Conclusion

We really enjoyed the opportunity to shadow the New Richmond Clinic.

Everyone was very nice and more than willing to show us what their job entails.

Recommendations

Our only recommendation is that the New Richmond Clinic invest in a computer and

copy machine for the filing room.

There is a significant distance between the filing room and the HIM department and the

women who work in the HIM department are in the filing room approximately 4 times

a day.