Access to Referral  Data 
Access to Patient Scheduling Data
Access to Surgery Data
Access to Charge Entry Data
Access to Insurance Authorization Data
Access to All Data
Access Summary

Access and Integrated Scheduling………Why are they synonymous?

Access in a hospital means different things to different people. To the business office it means utilizing data to help in providing the best possible opportunities to attract a patient/customer base and ensuring that all charges for the events scheduled are captured. To the patient it means ensuring a satisfactory experience at your hospital. In all cases, however, it means being able to get at the critical data surrounding the patient's experience. The data surrounding a patient emanates from many sources.

Why is Scheduling (and more importantly Integrated Scheduling) an important resource for collecting this data?

The A/D/T process accumulates significant amounts of data, and it is the entry to your HIS system. So the patient's experience starts there. 

This white paper examines the patient's experience (and the data that follows the patient) and concludes that it is integrated scheduling and its related functionality that provide a critical opportunity to collect and evaluate the broad scope of data relative to a patient encounter.

Referral Information and Access to the Experience

Access begins with the referral management process. Where did this patient come from? In order to be able to go back later and analyze its referral process, the hospital needs to know where the patient came from in the first place. Referral management allows you to track and monitor referrals from internal and external user-defined sources, be they individuals, agencies, physicians, hospitals, home health agencies, social workers, case managers, attorneys, promotions, industrial contracts, HMOs or other. Referral resource reporting becomes an integral part of the process. This process also includes:

• Collecting pre-admission information to expedite the admission and scheduling.
• Collecting insurance information to verify benefits, obtain authorizations and offer financial counseling.
• Monitoring the types of services to which patients are being referred.
• Creating a disposition log by tracking the reasons why patients did NOT come to the facility.

The referral process leads to admission and subsequent performance of services. Can't you find a way to simply append a "referral source record" to your current Admission process?

Yes, of course you could, but simply knowing the source of the referral is only the beginning of Access.

Did the referral show up? The average cancellation rate is 12-18% of visits!

Was there a significant number of cancellations?

What were the reasons for the cancellations?

Were you able to rebook the cancellations?

Where did the best referrals come from?

In order to have access to the data and properly market your facility and services, a Referral Management System is eventually required. This function also needs to be integrated with BOTH your Admission System and Scheduling System so that the referral analysis function can have access to the actual results of the referral.

Why is Integration of Referrals with Admissions and Scheduling Critical to Access?

• IAMSystem allows flexibility in integrating your hospital information system's patient admission/registration processes with scheduling.  
• Some hospitals may prefer to (1) Register the patient (2) Gain additional user-defined referral source information and (3) Link to Scheduling.  
• Others may prefer to (1) take a minimal set of data to being the referral process (2) immediately schedule the patient, to be sure not to loose the business and ensure top notch customer service and (3) complete a full registration later in the process.  
• Interfacing T4 enterprise scheduling to your HIS registration side may be unidirectional, or of requested, bi-directional. 

Scheduling…The Key to Access

Scheduling systems handle the operation of scheduling patients, providers, and resources in a projected format with easy-to-follow screens in appointment book style. Other benefits include: 

• Multi-task screens that allow the user to Book, Cancel, Delete, View details, Reschedule, Wait-list appointments, Print schedules for patients or providers, and more, from one location.
• Management of individual appointments, complex procedures, group scheduling, double-bookings, time conflicts, cancellation logs, and off-hour schedules.
• Automated Search Engine capabilities that coordinate patient schedules, selecting days, times, services, and providers.
• Handling of special needs (transportation, interpreter services, etc.).

 Why is the Integration of Scheduling the Key to Access?

• Once the patient is admitted, every activity throughout the patient encounter is choreographed by the Scheduling System:

The patient is referred and admitted/registered

THEN, or in a combined workflow...

Services are scheduled and provided or cancelled, rebooked, etc.

THEN

Charges are generated and entered

WITH

All of this activity under the watchful eye of  Insurance Authorization Tracking (i.e., monitored electronically against the authorized limits established at the time of scheduling)

Significance: The ability to tie back and gain access to the patient's experience stems from the fact that all the pertinent data is available in one place. Because the patient's experience is derived through the scheduling of services, Scheduling is one necessary and logical access point.

• In order to have access to provider availability and productivity, the number of treatments and visits delivered in a specified time is important.

Significance: Which clinicians were available to be scheduled? The Scheduling System must not only know what was scheduled but also what happened regarding the scheduled service. Was it performed as planned? By the scheduled clinician? What are the cancellation rates by patient and/or clinician? What are the reasons for the cancellations? These questions can be answered only if the hospital has the ability to collect and access this data.

Access to Surgery Data

Surgery Management systems allow you to capture complex data that enables the department to accomplish the following tasks:

• Maximize equipment and operating room/suite scheduling.
• Allocate staff for productivity analysis and resolution of scheduling conflicts.
• Design preference templates per procedure and per physician.
• Create pick lists for supplies.
• Interface with Materials Management for inventory reduction.
• Allow on-line charge submission, interfacing to your billing side.
• Collect pre-operative and post-case surgical data.
• Create the surgical log and surgery management reports.
• Retrieve detailed surgical procedures and statistical information.

Why is Access to Surgery Information important?

• Surgery Management allows the facility to track and monitor the patient from the initial phone call to the pre-op appointment through discharge and follow- up appointments.

Importance: Providing a high level of customer (patient) satisfaction and the best possible outcome results from having the ability to easily access all the data pertinent to their encounter with the hospital.

This, in turn, requires that the hospital know everything from the referral source to the actual charges submitted to the follow up visit requirements. Integrating all the data concerning a given patient is what allows the hospital to provide the highest level of patient satisfaction while, at the same time, meeting your clinical and business objectives.

• Access to Surgery Data allows the hospital the ability to monitor the internal and external customer service processes, as well as the quality of care provided.

Importance: In today's competitive healthcare marketplace, the ability to access, on an ongoing basis, how well you are doing competitively provides the data that will ultimately separate the growing, successful hospitals from the "others".

Access to Charge Entry

Access for both the hospital and the patient often centers on charges.

Unbilled charges can account for up to 20% lost revenue.

From the hospital's standpoint, the crucial area of interest is in ensuring that all the services provided are charged for. The patient requires access to the actual charges for insurance purposes. Therefore you need to provide for processing of charges, recognizing and accounting for all services provided, and creating a complete audit trail between the medical record and the billing system.

Why is integration of this function with Scheduling so important?

• Management can view and monitor billed and unbilled services, exceptions, statistics, revenues, and medical record documentation of daily treatment.

Importance: How would you know what unbilled services were provided unless you knew ALL the services that were scheduled in the first place?

Integrated Scheduling systems know because the Charges are tied back to the originally scheduled event. Once a service is scheduled, the clinician MUST either enter the charges for the service provided, or enter a "reason code" to explain why the service was not charged for. The appointment would then be flagged for charging or canceling/rescheduling.

Insurance Authorization Access to Data and Scheduling

With the advent of managed care, Access to Insurance Authorization  information has become critical. The existence of this data enables you to track authorized visits by patient and to provide only those services that have been approved by a third-party payer.

Why is the integration of case management so important?

• The hospital needs to track authorizations by discipline/service, patient, period of time, or third party carriers and type of contract.

Importance: When it comes time to renegotiate with your managed care providers, you need to know your experience history in order to effectively discuss the next year's reimbursement rates. Access to this data is possible only if ALL the history associated with EVERY patient that is covered by a particular HMO is tracked from the time a referral begins. This data exists only if the systems are tied together (integrated).

• Authorizations can then be maintained and monitored for each patient encounter. Management reports can then provide "authorization status" information on patients approaching authorized limits.

Importance: Did you ever try to get reimbursed AFTER the fact by either the HMO or the patient?

Unauthorized services represent 5-10% of all bad debts. These services occur because the provider does not have access to the authorized limits for the patient.

In an integrated system, the authorization is available because the referral module (way back in the beginning) captured it. Then, as services are scheduled, provided, and charged for, the Insurance Authorization Tracking component  can monitor against authorized limits. Then, and only then, can you reduce lost revenues due to performance of unauthorized services.

Overall Access to ALL the Data

Everyone has a number of reports that can be run from the hospital's HIS System. The challenge in the growing Access movement is that someone wants the information in a different way …regardless of how many reports you have…. That's why it's called Access!

What is the ideal Access solution? The ideal solution is to have everyone who is authorized have the ability to get access all the data without the help of an overburdened IT organization. What attributes would you ideally have with such a system?

Ideally you would want a menu- and parameter-driven system that allows the non-IT user to access and report on the data utilizing "natural" selection. Some of its features would include:

• Straightforward English language selection
• Sorting, grouping, and subtotaling
• Calculation capabilities (select one or more fields, perform calculations, and place into report)
• Print detail or recap reports
• Schedule reporting to run automatically at user-selected times or intervals

Summary -- Flow between Integrated Components

 This paper has dealt with the challenges and opportunities in creating access to the hospital's data. Information must flow among systems in a process that parallels critical tasks in the hospital:

• When a patient is referred or admitted, a user takes the demographic information, records it, and initiates the creation of a medical record. This is managed by a Referral/Admission Management component.
• Then... The user schedules an appointment for the patient. This is managed by the enterprise-wide Patient Scheduling or Surgery Scheduling System.
• Then... The patient receives services, and the charges may be directly submitted from scheduling side. This is managed by a Charge Entry Component.
• All the while... Authorization information is shared to determine whether the patient is authorized for the services. Error inquiry and reports keep as assigned person current on authorization status. This is managed by a Insurance Authorization Tracking component.
• With the result... All data entered through any one system component is integrated into the database, thereby providing extensive analysis and reporting capabilities.

An integrated approach built around scheduling is the ideal way to ensure Access to  pertinent data surrounding a patient's experience for both the hospital and the patient.