Benefit of immediate, specific problem solving is priceless’
Can you imagine the advantage of having a full-time systems analyst in the patient access department, working with access staff on a daily basis to solve information systems (IS) problems — days, maybe weeks before a service request would have been answered by your organization’s IS department? That situation is reality at the University of Pennsylvania Medical Center (PMC)-Presbyterian, where Anthony Bruno, MPH, MEd, director of patient access and business operations, has been creating an access department from the ground up since he joined the organization in July 2001.
When Bruno learned that Marilyn Williams — a 30-year Presbyterian employee who most recently had been working with First Consulting Group (FCG), a national consulting firm to which the hospital had outsourced its IS operation — was about to accept a position with another health care system, he took immediate action. "Marilyn had been working for me on numerous projects [while with] FCG, and I got to know her as someone with expertise in [Malvern, PA-based] SMS [computer systems] and with systems in general," he says. "Based on my observations and dealings with her, I felt it would be a tremendous hit for PMC to allow someone with her knowledge and background to leave."
While he had to "cash in some chips in the form of other positions" — giving two for one — Bruno says the trade was more than worth it. "The importance of having someone like her is priceless," he notes. "She’s physically housed in admissions and, almost daily, people go to her and say, Look at this, look at that, look at what happened in the system — something just fell off the screen’ or I can’t get this account to drop.’ She can go in and fix problems and dissect and interpret things that we couldn’t do on our own.
"Her knowledge of systems is valuable on a daily basis," Bruno adds, "and that includes the emergency department, the business office, and outpatient registration."
Also on a daily basis, he says, Williams writes computer reports and "does things in the system we don’t have the skills to do." Her expertise was crucial, Bruno adds, during a recent project that targeted accounts in the discharge-not-final-billed and outpatient-exception categories. During a two-month period, the number of unbilled accounts in those categories was reduced dramatically, representing a dollar amount of more than $5 million.
An important part of her role, Williams says, is acting as a liaison between patient access and the hospital’s IS operation, which still is outsourced to FCG. "I can talk the talk’ and know exactly what we need to do to keep things moving," she adds. "I do my own research when we have system problems and let [IS] know the details." Before her stint with FCG, Williams notes, she was a systems analyst for Presbyterian, handling patient accounting, order entry and charge entry issues, working with patient registration pathways, and building screens.
While FCG is contracted to do those functions for the entire hospital, Bruno says, "having our own inside person" means problems are handled efficiently and quickly. "In the old days, we would have to put in a service request [to the IS department], go in a queue, and it might take weeks or months before we got a response," he adds.
It’s opened my eyes’
Working for the patient access department, rather than coming in as a representative of IS, she "looks at everything from a different perspective," Williams says. "I see how working with IS can be challenging. It’s opened my eyes a lot. I can understand the frustration that a lot of users have if they don’t have IS knowledge." Now that Williams has the "user perspective," Bruno points out, "she can be even more instrumental to us in getting across to IS the problems patient access employees face, but can’t describe accurately enough. It helps expedite things."
Recently, for example, that perspective came in handy in regard to an interface between the outpatient clinical system that physicians use and the patient registration system, Williams says. "Instead of [patient access] duplicating registrations in SMS, [physicians] interface that information with us," she explains. "We had a lot of different mapping tables and a piece in between to make it work, and it didn’t."
"I could identify where the pieces were broken and, after working with patient access, identify other places that were broken," Williams adds. "I was able to compile a list of 31 interfaces, give it to IS and say, We need these fixed.’ They weren’t even aware of the different problems we were having."
Williams actually started her career at Presbyterian as an admissions clerk, and worked in the ED and as a unit secretary, before starting her IS experience as a data entry clerk and then moving on to database administrator and beyond. Those early positions later helped her understand when users called with an IS problem, she says. "Now in patient access, I can see how every-one has to work as a team and pull everything together," Williams adds.
The only way to go
Bruno notes that he had been lobbying to make Williams a part of the access department for a year before the move took place, but had not been able to convince hospital administrators at that time. Fortunately, he says, when she was poised to leave the organization for another job, "cooler heads prevailed. My boss says now, Boy, am I glad I listened to you.’ Having your own systems analyst is the only way [for access departments] to go," Bruno contends. "If I had to say one thing [to argue the case], it would be that it’s a matter of getting problems solved on a timely basis, and making everyone she works with work smarter." Other managers, he notes, have acquired system skills they would not have learned without having Williams to teach them.
In response to the question that hospital administrators will likely raise — "We’ve got IS; why does patient access need someone?" — Bruno underscores the importance of the different perspective that is provided. "When she was just serving us," he adds, "Marilyn had a different set of hats on. Now that she’s with us, she’s also part of team building, part of the management team. It’s just a better approach toward helping the front end do the job you want it to do."
(Editor’s note: Look for the next step in the creation of the University of Pennsylvania Medical Center-Presbyterian’s access department — adding responsibility for medical records — in a future issue of Hospital Access Management. Anthony Bruno can be reached at [email protected]. Marilyn Williams can be reached at [email protected].)
Can you imagine the advantage of having a full-time systems analyst in the patient access department, working with access staff on a daily basis to solve information systems problems days, maybe weeks before a service request would have been answered by your organizations IS department? That is reality at the University of Pennsylvania Medical Center - Presbyterian.
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