Links with docs' offices key to patient satisfaction
Involve docs in development from the beginning
The future of access management will require getting information upfront without duplicating efforts later. Don't make the patient recite demographic information at each health care encounter. Don't have separate files at the hospital, outpatient clinic, and physician's office.
Achieving that goal is the challenge, and developing effective links with and between physicians' offices is key to the transparent, customer-friendly health care encounter of the 21st century. One example of such a physician-hospital communication challenge, says Tabitha Warner, MHA, project manager for seamless access for Provi dence Health System in Portland, OR, has to do with the enterprisewide registration system Providence is developing with Atlanta-based HBOC.
"We're working to resolve how insurance information is handled and stored in the system - how to build those tables - across the acute [care] setting and the physician clinic setting, because the business process needs are different," she says. "Our proposal is a care-site-specific filter, so that if [the patient encounter is] in a clinic, the system defaults to that type of insurance coverage, and if it's in an acute setting, it's smart enough to go there."
Connectivity with physicians' offices is a crucial element of the seamless access initiative to which Providence has committed, Warner says. Building that link begins with the "captive audience," the physicians who are part of the Providence Medical Group or who belong to another group of clinics within the Providence system.
"What becomes more difficult is [connecting with] all the specialists out there," she says. "We have found that it's best to start with those we have relationships with, such as a multispecialty group that does a lot of admissions to our hospital, so they have an interest in having our system work well with them."
She suggests involving physicians in system development from the beginning, "so when it's time to pilot [a project], they step up to the challenge." One such pilot at Providence involved two primary care physician (PCP) clinics and a specialty group of physicians, Warner notes. In conjunction with the system's health plan, they worked to simplify the referral process.
"Just getting them to the table to talk, when some are capitated and some are not, was really a way to build trust," she says. "They came to an agreement on transfer guidelines, and the health plan said, `Based on these, if you agree with each other on who does each piece [of the referral process], we no longer need to put our stamp of approval.'"
Placing control with providersThe outcome was a win-win situation, meeting the goal of making sure the patient's information was at the specialist's office before the patient arrived, as well as decreasing the hassle of waiting for a referral from the health plan by putting control back in the hands of providers, Warner explains. A third result of the project was "tying off the feedback loop" by making sure the information made its way back to the PCP more effectively and efficiently than in the past, she adds.
Another challenge in the push toward seamless access has been ensuring the primary care physician receives timely feedback from a patient's visit to the emergency department. That information, provided through such links as an electronic medical record, is necessary to manage the patient's ongoing care, Warner says.
For Providence, the goal has been not only to have an electronic medical record, but to make sure all the providers involved in that medical record are able to share the appropriate information within confidentiality guidelines. "The real connect needs to be with the PCP and the specialty office."
Additionally, she says, Providence is trying to ensure that if the information is captured at the time of enrollment into the system's health plan - if the member already has filled out a lengthy form - those data can be shared with its various health care facilities.
"When you talk about sharing between health plans and providers, that brings up confidentiality," she adds, "because there's no definitive law that details what's acceptable to share and what's not."
Emory University Hospital in Atlanta gives physicians, other personnel at Emory Clinic, and the physician offices of the Emory health system, selective access to its on-line admissions and patient accounts system, says Peter Kraus, CHAM, systems liaison manager for patient accounts services. Clinic personnel gain access to hospital files by clicking an icon on their PCs, he adds.
"The functions are quite selective," Kraus explains. "[Clinic users] can't update files, and anyone who has no need to know financial information can't see the back end."
Functions are broken down so it's possible, for example, to allow access only to a patient's "visit history," which gives the dates a patient was in the hospital, the type of patient, who the physician was, what the service was, and the general category of insurance.
Hospital creates stewardsAccess to the "corporate patient index" reveals basic demographic and insurance information, and "patient inquiry" goes deeper, giving the guarantor admit and discharge information, admitting diagnosis, next of kin, and whether it's a workers' compensation case. With a "census inquiry," the viewer can determine who's in the hospital as an inpatient or observation patient and can look up the information by location, physician, or other characteristics such as race, sex, or religious code, Kraus says.
To monitor and protect access to the computer system, the hospital designates "data stewards" for various areas. For example, Kraus fills that role for patient accounts and admissions. "If someone from the clinic has need for this data, they request it through information systems [IS] security, which then contacts me. I'll contact that person, find out why they need access, and give approval or not. If they've asked for access to patient accounts or update capability, and there is a legitimate need for it, we authorize it."
Update ability for the hospital's computer files is given occasionally to clinic employees, he says, most notably those who post charges to hospital accounts, such as for EKGs.
When staff in his department leave, Kraus cancels their security access from the functions he controls and notifies IS personnel so they can cancel the access from functions whose security access he doesn't control. IS gets periodic notifications from the human resources department regarding personnel changes.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content