Data Management

Question 1

Practice priorities - what is important

Answer 1

Quality
Pt satisfaction
Accuracy
Provider satisfaction
Workflow efficiencies
Office flow
Staff
Follow up
\$\$$
Reporting capabilities 
Compliance

Question 2

Practice management systems (PMS) =

Answer 2

A category of software that deals with the day to day operations of a clinical practice

Question 3

Electronic medical record =

Answer 3

A digital version of the traditional paper based medical record for an individual
The EMR represents a medical record within a single facility

Question 4

Integration of EHR and PMS - Generally consists of several functions or modules including

Answer 4

Registration
Scheduling
Insurance verification
Code scrubbing

Question 5

Integration of EHR and PMS - they are typically integrated into

Answer 5

a single system

Question 6

Make staff more efficient in

Answer 6

Registration
Insurance verification
Copay collection
Medication reconciliation
Pre auth tracking
Scheduling
Benefit limitations
Claims and dropping bills
Appt reminders
Wait lists
Forms

Question 7

Make staff more efficient in scheduling - how

Answer 7

Ticklers
Provider can put into the system when they want to see the pt again and then the front desk or system can go ahead and schedule them with that info

Question 8

What is the most valuable asset?

Answer 8

Provider time!

Every minute counts - system set up is key

Question 9

Making providers more efficient - problems with paper charts

Answer 9

Searching for paper
Lost charts
Transferring charts btw practice locations

PMS and EMR eliminate these challenges

Question 10

PMS and EMR provide tools to make providers more efficient including what

Answer 10

Coding guidance
Intuitive templates
Data and Information
Evidence based medicine
Hand offs and follow DM
Delegated authority
Supervising provider

Question 11

PMS and EMR provide tools to make providers more efficient - Data vs. Information

Answer 11

Data - something you enter into system and can run trends on it
Information - scanned in piece of paper for ex - not a lot of room for analysis

Question 12

PMS and EMR provide tools to make providers more efficient - Hand offs and follow decision making

Answer 12

If they are seeing another provider - there can be a process for how the information gets to them

Question 13

Making the practice more efficient - how

Answer 13

Resource allocation and scheduling
Communications
Fulfilling requests for information

Question 14

Making the practice more efficient - Resource allocation and scheduling

Answer 14

Making data driven decisions by tracking resource utilization
Allows you to schedule room (or resources)
Can look at data too to know if you need new equipment

Question 15

Making the practice more efficient - Communications

Answer 15

Referral letters
Provider authorizations
Incoming documentation

Question 16

Making the practice more efficient - Fulfilling requests for info

Answer 16

How easily does the system allow you to get that information if someone wants a copy of the record

Question 17

Enhancing quality through

Answer 17

EBM
Alerts and Alarms (unfilled orders, pt not coming in, schedule follow ups)
Integrated pt ed documents

Question 18

Communication

Answer 18

Intradepartmental

Patient portal

Question 19

Intradepartmental communication

Answer 19

Pt cases between providers and staff

Question 20

Pt portal communication

Answer 20

Communication with pt via secure means - from pt to provider
Ability to: 
- update info
- make payment
- request/schedule appt

Question 21

Pt satisfaction

Answer 21

Pt are getting used to providers being on comp

Set up of the space can be key

Question 22

Pt satisfaction - making the pt feel like you spent more time with them

Answer 22

SIT down with them

Question 23

Insurance and billing - front end

Answer 23

Insurance verification
Benefits verification
Prior auth management
Sliding fee schedule and discounts
Collect at time of service! Captured audience!

Question 24

Insurance and billing - middle

Answer 24

Documentation
Diagnosis codes
Tx/Procedure code capture

Question 25

Insurance and billing - end

Answer 25

Claim creation Custom rules (like maybe claim will not drop without certain codes) Scrubber (probability of insurance denial) Denials management Payment posting

Question 26

Insurance and billing - other

Answer 26

Billing non health insurance - employers - law firms - auto or homeowner policies

Question 27

Payment collection

Answer 27

Insurance | Pt responsibility

Question 28

Payment collection - pt responsibility

Answer 28

When does amount transfer to pt Payment reminders Options for collecting (online, over phone) Ease of transferring an account to collections

Question 29

Compliance

Answer 29

Audits - ease of conducting

Question 30

Compliance - managing and tracking

Answer 30

Consent to call Notice of privacy practices Assignment of benefits ABN

Question 31

Security

Answer 31

``` Track access Monitor use Limit access Setting up user rights and permissions Setting expiration dates for user accounts Managing paper - tracking amendments ```

Question 32

Quality/P4P

Answer 32

``` Quality reporting codes Claims rules (based on quality measures) Dashboards/Monitoring Improvement activities Reporting options - EHR reporting, registry reporting, claims based reporting ```

Question 33

Population health and programming

Answer 33

Call campaigns - via email, phone, portal, text Target patients based on demographics, last visit, clinical info

Question 34

Marketing

Answer 34

Pt reported referral source tracking - how did you hear about us (see if your marketing is paying off) Tracking/Managing provider referrals

Question 35

Interfaces and info exchange

Answer 35

Sending and receiving documents between providers

Question 36

Vendor services

Answer 36

``` Document management Payment posting Denials Credentialing Appt scheduling Registration and front end revenue cycle ```

Question 37

Decision support

Answer 37

Clinical decision support - dx based guidelines User guides User training Release/update info and training User communities Sentinel metrics dashboard Provider and practice performance reviews

Question 38

Peripherals/Integrated partners

Answer 38

``` Collections Digital check in- co pay collection Orders mngmnt and med refill request Voice recognition Chronic care mngmnt Telehealth Satisfaction surveys Clinical decision support ```

Question 39

Selection considerations

Answer 39

Cloud vs Onsite server vs. Partner with another org Process - who is involved Decision criteria - the system that is the least worst Site visits Conversion to new system

Question 40

Selection considerations - pros to partnering

Answer 40

Two heads better than one Cost sharing for build and implementation of costs More users, greater leverage with vendor Shared resources, experience, collaboration

Question 41

Selection considerations - cons to partnering

Answer 41

Collaboration takes time and effort Lots of comm is needed Requires compromise Dep on organization, could lose ind and decision making

Question 42

Costs

Answer 42

Costs and mdoels - purchasing licenses, % of collections model Implementation costs - hire project mnger, dec production Archive system

Question 43

Conversion/Build

Answer 43

Timeline Planning - training, reduced schedule at and after go live Archive - paper records (IA need to for 7 years, minors until age of majority plus 7 yrs) Forms - coding

Question 44

Conversion/Build - What players should be involved

Answer 44

Should it be driven by IT dept? Who should manage the project? - Experienced project manager, Business leaders (like financial or operations mngmt)