New Patient Workflow Process 20071002

8/7/2019 New Patient Workflow Process 20071002

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New Patient Workflow

Clinical Information ManagementCommittee

Prepared byPatrick Antonelli, MD and Michael FecteauOctober 2, 2007


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Notes and Assumptions

1. Refer to Key found on the last page for more information concerningconventions and other terms.

2. Diagrams show standard New Patient workflow from booking theappointment to collections.

3. A New Patient should be construed as a person who has not beenpreviously treated by Shands Healthcare (SMS) and UFP (GE CentricityBusiness).

4. Assume that EpicCare will be loaded with established patientdemographics. The source and scope will be determined at a later date.

5. The workflow assumes the physician does not require pre-appointment

orders.

6. Dotted line parallelograms denote new or proposed interfaces.

7. Insurance company follow-up (telephone and EDI 276/277) not included.

8. Secondary insurance workflow not included.

9. Self-pay follow-up activities not included.

10. Collection agency interface and workflow not included.

11. Paper super bill reconciliation with EpicCare charge interface is notshown.

12. Radiology results include interpretation and a link to the Stentor image file.

13. EpicCare supports DICOM image viewing therefore appropriatelyauthorized users may view radiology images from EpicCare.

14. Study patients will be flagged in EpicCare. Rules will be written inEpicCare to alert providers at critical steps in the workflow.

15. Vaccination registry interface not shown.

16. Transcription interface not shown.


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Look-up Patient inGE Database

(GE CB)

New PatientVisit Workflow

Find Patient?Generate New

MRN(SMS)

Book Appointment(GE CB)

Interface:ADT SMS

to GE

No

Yes

VerifyInsuranceEligibility(GE CB)

Interface:SchedulingGE CB toEpicCare

New-2

Patient UpdatesMyChart

(EpicCare)

Patients may use MyChart to updatekey information

Examples:Contact Information

Allergies

Medications

Past Medical History

MyChart also support securecommunication with providers.

Inquiry using MRN, Name, SSN, InsuranceNumber, Invoice Number

ADT Interface FieldExamples:

Name

MRNAddress

DOB

Gender

SSN

Financial Information

Scheduling Interface Field Examples:

MRN

Provider

Visit Date

Visit Time

Location

Duration

Type of VisitVisit Status (New Appointment)

Interface:ADT SMS

to EpicCare

Discussion Draft Printed 10/1/2007 Page 1 of 19 Prepared by Patrick Antonelli, MD and Michael Fec


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New-2

Patient Presents:Appointment

Status Changed toArrived(GE CB)

Interface:SchedulingGE CB toEpicCare

Patient UpdatesHistory Using

Welcome Kiosk(EpicCare)

Patient may update keyinformation using WelcomeKiosk

Examples:Contact Information

AllergiesMedications


Patient Signs

Authorizations andNotices

Scan and

VerifyDocuments(GE CB)

Batch

Documentsfor Imaging

New-3

Scheduling Interface Field Examples:

MRNProvider

Visit Date

Visit TimeLocation

Duration

Type of Visit

Visit Status (Arrived)



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MA EscortsPatient to Exam

Room and CollectsVital Data

Vital DataKeyed or

Uploaded to

EpicCare

Mid-level Provider(MLP) Examines

Patient

New-3

MA Keys Patient Height, Weightinto EpicCare

Blood Pressure and TemperatureMay Be Uploaded into EpicCareif Clinic is Equipped withAppropriate Equipment

MA ReviewsKey Info?

Update Medical

Information(EpicCare)

Review Key Medical Informationwith Patient

Examples:Allergies

Medications


Yes

Mid-levelProvider Sees

Patient?

Yes

No

New-5

New-4No



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Orders?OrdersProcess

Yes

No

MLP ReviewsKey Info?

Update MedicalInformation

(EpicCare)

Review Key MedicalInformation with Patient

Examples:

AllergiesMedications

Past MedicalHistory Yes

No

New-5

Faculty PhysicianEvaluates Patient

Procedure?

ProcedureProcess

Yes

New-6

No

New-4



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Prescriptions?Prescription

ProcessYes

No

Finalize

Encounterand Sign

(EpicCare)

End of NewPatient Workflow

Document(EpicCare)

PatientCheckout(GE CB)

Insuranceand Patient

Billing(GE CB)

Post Visit(EpicCare)

Orders?Orders

ProcessYes

No

New-6



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Eligibility Process

Interface: EDI 270Eligibility Inquiry

GE CB to GEeCommerce

Eligibility Check(GE eCommerce)

Interface: EDI 271Eligibility Response GEeCommerce to GE CB

End EligibilityCheck

Work EligibilityResponses

(GE CB)

Accept or Decline

EligibilityResponses

GE eCommerce manages EDIflow between UFP and insurance

carriers and clearing houses

Workfiles generated by GECB based on results of EDI271 responses.

Both batch and real-time eligibilityinquires

EDI 270 Interface Field Examples:

Subscriber/Dependent Name

Subscriber/Dependent DOB

Subscriber Insurance Company

Subscriber Policy NumberService Inquiry Date


Subscriber/Dependent Name

Subscriber/Dependent DOB

Subscriber Policy Number

Coverage Status IndicatorsCoverage Effective Date



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ProcedureProcess

Patient SignsNotices and

Consent Forms

Consent orNotice Req?

Yes

ImageDatabase(EpicCare)

ScanPatientForms

(EpicCare)

Perform Procedure

End of Procedure

No



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Document Process

Select Template(EpicCare)

Assign Tasks toSelf and Others as

Needed(EpicCare)

UseQuickNotes?

Use Text?

Use Dictation?

Update

QuickNotes(EpicCare)

Update RecordUsing Keyboard,

SmartText orVoice Recognition

(EpicCare)

Dictate and Log(TranscriptionVendor andEpicCare)

New Tasks?

End of DocumentVisit Process



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Order Process

Select LabProcedures to

Order(EpicCare)

Lab Order?

Interface:Order

EpicCare toLab

Yes

Fulfill Lab Order(Lab)

Interface:Result Lab

to EpicCare

Orders-2

Generate Task:Request

Acknowledgement(EpicCare)

Evaluate Order(EpicCare)

Warning orAlert?

Acknowledge orResolve Warning

or Alert(EpicCare)

Yes

No

Sign Order(EpicCare)

AccountGeneration or

Selection(Lab and SMS)

No

Order Interface FieldExamples:

Patient Name

Patient DOB

Patient Gender

MRN

Account NumberSpecimen Source

Ordering ProviderProcedure Code

Priority

Result Interface FieldExamples:

Patient Name

Patient DOB

Patient Gender

MRN

Account NumberObservation Valu

Result Range

Evaluation Examples:

Contraindications

ABN CheckStudy Patient



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Orders-2

(continued)

Select RadiologyStudy to Order

(EpicCare)

RadiologyOrder?

Interface:

OrderEpicCare toRadiology

Yes

Fulfill RadiologyStudy Order(Radiology)

Interface:Result

Radiologyto EpicCare




Warning or

Alert?


or Alert(EpicCare)

Yes

No



Selection(Radiology and

SMS)

Orders-3

No


Contraindications

ABN CheckStudy Patient

Order Interface Field

Examples:

Patient NamePatient DOB

Patient Gender

MRN

Account Number

Specimen Source


Priority


Patient Name

Patient DOBPatient Gender

MRN

Account Number

Interpretation

Link to Image Fil



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(continued)

Orders-3

Select OtherProcedure to

Order

(EpicCare)

Other Order?

Interface:

OrderEpicCare to

OtherSystem

Yes

Fulfill Order(Other System)

Interface:Result Other

System toEpicCare




Warning orAlert?


or Alert(EpicCare)

Yes

No



Selection(Other System and

SMS)

End of OrderProcess

No


Contraindications

ABN Check

Study Patient

Order Interface Field

Examples:

Patient NamePatient DOB

Patient Gender

MRN

Account Number

Specimen Source


Priority


Patient Name

Patient DOB

Patient Gender

MRNAccount Number

Observation ValueResult Range



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PrescriptionProcess

Select Medication,Dosage, Route

(EpicCare)

Finalize and SignScript

(EpicCare)

Print orElectronic?

Print

Print Script(EpicCare)

Select Pharmacy(EpicCare)

Electronic

Finalize and SignScript

(EpicCare)

Interface: EDIRx Order

EpicCare to RxHub or

SureScrtipts

End of PrescriptionProcess

EvaluatePrescription

(EpicCare)

Warning orAlert?

Resolve orAcknowledge

Warning or Alert(EpicCare)

Yes

No

Medication InterField Examples:

Patient ID

Medication

Quantity

Frequency

RouteRefills


Drug-DrugDrug-Allergy

Other Contraindications

Formulary

Study Patient



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Finalize EncounterProcess

Select ProcedureCode (CPT)(EpicCare)

Select Diagnosis(ICD-9)

(EpicCare)

Validate Encounter(EpicCare)

Alerts, Errors,Omissions?

AcknowledgeAlerts, Resolve

Errors andOmissions(EpicCare)

Yes

Sign Encounter(EpicCare)

No

End of FinalizeEncounter

Interface:Charge

EpicCare toGE CB

Charge InterfaceField Examples:

MRN

PatientName

Patient DOB

PatientGenderDate ofService

Provider

Diagnosis

Procedure

Validation Check Includes:

Completed

DocumentationBilling Inconsistencies

Study Issues or Conflicts



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Post Visit Process

New Result?

Review andAcknowledge New

Result(EpicCare)

New Tasks?

Review andAcknowledge New

Task(EpicCare)

Yes

Yes

New Order?OrdersProcess

NewPrescription?

PrescriptionProcess

Yes

Yes

No

No

No

End of Post VisitProcess

No

Perform Task asRequired

Document(EpicCare)

Finalize and

Sign(EpicCare)

Stentor images may be viewedwithin EpicCare



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Patient CheckoutProcess

Charge Entry(GE CB)

Post Payment(GE CB)

CollectPayment

PatientPayment

Required?

Print Receipt(GE CB)

End of PatientCheckout

Yes

No

TransactionEditing System

Evaluate Charge(GE CB)

Charge Evaluation(Ingenix

ClaimsManager)

Edits?

Resolve Edits(GE CB)

Yes

No



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Insurance andPatient Billing

Nightly EditEvaluation(GE CB)

Night Jobs(GE CB)

Charge Evaluation(IngenixClaimsManager)

Edits?

Generate WorkFiles

(GE CB)

Resolve Edits(GE CB)

Yes

No

Third PartyResponsibility?

Third PartyBilling

Process

Yes

Patient

Responsibility?

No

PatientStatementProcess

Yes

End of Insuranceand Patient Billing

No



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Generate PaperClaims

(GE CB)

Prepareand Mail

Claims

Claim Adjudication(Insurance Carrier)

EDI 835 ProviderInsurance Claim

Payment(Carrier to GE

eCommerce to GE CB)


Invoice

Patient ID

ProviderProcedure

Billed Amount

Payment AmountRejection Code

Post Payment,Electronically

(GE CB)

Third Party BillingProcess

ElectronicClaim OK?

GenerateElectronic Claims

(GC CB)

EDI 837Interface

(GE CB to GEeCommerceto Carrier)


Patient NamePatient ID

Carrier

Date of Service

Place of ServiceProvider

Billing DiagnosesProcedures

Modifiers

Yes

No

ElectronicRemit OK?

Yes

Paper EOB(Insurance Carrier) No

Post PaymentManually(GE CB)

End Third PartyBilling



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Generate PatientStatements

(GE CB)

AddressChange or

Return

Post Cash(Patient) Payment

(GE CB)

Patient StatementProcess

PaymentReceived

(Bank)

PatientStatementFile Upload

(IXT)

Generate PatientStatements

(IXT)

Prepare andMail

Statements

AddressChange Update

(IXT to GE CB)

Update PatientRegistration

(GE CB)

Update MailingAddress and

Resend Statement

(IXT)

Yes

Self-Pay LockBox

Interface(Bank to GE

CB)

No

Patient Statement File Upload Field

Examples:

Patient NameGuarantor Name

Guarantor AddressService Date(s)

Balance Due

Address Change Update Field Examples:

Patient ID

Patient Name

Address

End of PatientStatement

Self-Pay Lock Box Interface Field Examples

PatientInvoicePayment Date

Payment Amount



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EpicCare: Epic Ambulatory Electronic Medical Record

GE CB: GE/IDX Centricity Business (Practice Management System)

GE eCommerce: GE EDI Business Unit (Value-Added Network)Ingenix ClaimsManager: Evaluate Medical Claim Compliance

IXT: Mail Clearing House

Rx Rub: Prescription Clearing House

SMS: Shands Hospital Information System

SureScripts: Prescription Clearing House

New or Proposed Interfaces Shown with Dotted Lines

CurrentInterface

(You to Me)

ManualProcess

Printed DocumentAction

File inDatabase

Decision This Way

Routine orFunction

Start or Stop

Or That Way

ConcurrentProcess 1

ConcurrentProcess 2

Jump toPage x

NewInterface

(Me to You)

New Patient Workflow Process 20071002

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