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New Richmond Clinic Shadow Project
Presented by: Teri Olds, Amy Hanson, Melissa Traiser, and Melissa Wiederhoft
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Introduction
The New Richmond Clinic
We met with Jean, who is the head of the health information management
department and Lori, who is the head of the reception department.
Reviewed and signed confidentiality form and then started our project.
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Background
•Division of Western Wisconsin Medical Associates– has provided health care for the families in the greater New Richmond community for more than half a century– has grown from a small medical practice into a clinic that now offers a broad range of medical services for patients of all ages– have a highly skilled staff of physicians consisting of surgeons, family practice professionals, pediatrician, and a gastroenterologist
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Medical Office Reception
Presented by: Melissa Traiser
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Process of Receiving Patients
• There are 2-3 providers that still use paper charts– can take up to two days to get the paper record– only pulled if the patient has not been seen
within the last three years– Pulled for specialist appointments and surgeons
• If patient has been seen in the last three years their medical records are in the EMR
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Patient Registration
• First they are asked their name• Which physician they are seeing• Current address and phone number• Verification of insurance• Charge ticket is then printed and placed in
the folder for that physician• Billing policy and authorization form
Front desk personnel never asks the patient what they are there for!
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Billing policy and authorization form
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Notifying Staff of Patient Arrival
• After it is verified that the patient has checked in:– EMR is then highlighted that they arrived– Notifies the physician’s nurse–When nurse views the patients EMR it is
highlighted in green• Nurse views this from a different side than the
front desk personnel
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Communication Process when Physician is Running Late
• Physician’s nurse will notify the front desk personnel
• Front desk personnel will relay this to the patient– They do not have to go into details why
physician is running late
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Communication Process when Physician is Running Late Cont.
• Then they ask the patient if they want to continue to wait until physician can see them
• Or if willing to reschedule with another physician give them that option
Very important to know how long patients have been waiting – keep an open line of
communication at all times!
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Patient Confidentiality
• There is a sign back several feet from the registration desk
• Receptionists try to talk in a low voice– No partitions between each receptionist area
• Receptionist can give patient paper for them to write on if they do not want to give information out loud
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Patient Confidentiality Cont.
• Patient waiting area is positioned a good distance away from the front desk– This helps protect patient confidentiality
Never ask what the patient is being seen for!!
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Privacy notice -- HIPPA
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Group Assessment of Medical Office Reception
• Functioned very well• Staff very friendly and had excellent eye
contact• Staff greeted patients with a smile, patients felt
very comfortable• Handled patient confidentiality very well• Reception desk could handle many patients at
one time – easy flowing• Staff enjoys their jobs and love to work with
patients
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Telephone Procedures
Presented by: Melissa Wiederhoft
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Telephone Procedures
Phone Greeting- Switchboard
“Good morning/afternoon New Richmond Clinic”
- Appointments“Good morning/afternoon New Richmond Clinic! This is Anna.”
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Telephone Procedures
1st, 2nd, 3rd ring?- 1st or 2nd ring, always 3rd ring
- Different departmentNo more than 3 rings
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Telephone Procedures
Script - No Script
Training- More Experienced
employee
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Telephone Procedures
Putting calls on hold
- Ask permission first- If yes, go to 2nd caller- Return to 1st caller & Thank
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Telephone Procedures
Check back with callers
- Every couple minutes- Keep asking what they would like to do
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Telephone Procedures
Screening calls
- Switchboard
- Triage
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Telephone Procedures
Transferring incoming calls
- Switchboard or TriageI. Callers name & company
II. Nature of call
III. Call back to identify caller and see if person available
IV. Plan of action
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Telephone Procedures
Taking Messages
- No message pads, electronically
- Messages in patient's chartsI. Only if medically needed
- Return phone callsI. End of the morning, free time, between patients
& end of the day
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Telephone Procedures
Taking Messages Cont.
- Telephone logs- Tracking incoming call messages
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Telephone Procedures
Handling certain types of calls Angry caller/complaint
I. Keep clam
II. As much information as possible
III. Manager if needed
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Telephone Procedures
Handling certain types of calls cont. Emergency
I. Triage
Personal callsI. Help patients first
II. As long as they don’t interfere with job
III. Don’t spend a lot of time on phone
IV. To make a personal call – business office
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Telephone Procedures
Handling certain types of calls cont. Calls from Patient's family
I. Can’t give out that information
II. Only with consent
Calls from insurance companiesI. Coding question – business office
II. Patient chart question – Triage
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Telephone Procedures
Professional answering service
Prompts to call 911 if its an emergency Gives office hours Physicians on call Monday through Saturday
6:30 p.m. – 8 a.m.
Saturday through Monday noon – 8 a.m.
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Telephone Procedures
Leaving patient information on
answering machines
House phonesI. Who is calling
II. Appointment time
III. Call back number
Cell phonesI. Who is calling
II. Call back when they get a chance
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Telephone Procedures
Group assessment• Handles scheduling and patient check-in
very efficiently• Switchboard separate room
• Appointment schedules located in two spots in reception area
• More than one receptionist at front desk at a time
• Phone system only takes one call at a time
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Medical Office Scheduling Procedures
Presented by: Amy Hanson
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Scheduling System
The New Richmond Clinic uses a Computerized Scheduling System.
The Software they use is called CERNER
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Scheduling Process
Physician's have their own set of fixed time intervals
Most appointments are 15 minutesPap smears and male physicals are 45
minutesFor longer appointments the receptionist
uses scheduling codes to choose a longer appointment time
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Visit Codes
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Visit Codes Cont.
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Emergency Appointments
For a patient that walks in to the clinic needing an emergency appointment, the receptionist will page a nurse up to assess the situation.
If a patient calls in needing emergency assistance the receptionist will route the call directly to triage.
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Walk-in Appointment
The receptionist will check the days schedule for the earliest available appointment.
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Double booked Appointment
On the rare occasion that the receptionist finds it necessary to double book patients, they try to fit the double booking in at the end of a longer appointment slot.
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Late Appointment
The receptionist will call back to the physician’s nurse and see if the physician is still available to see the patient.
If the physician is unable to see the patient the receptionist will help the patient reschedule their appointment.
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No-Show Appointments
If it has been more than 15 minutes and the patient has not yet arrived for a scheduled appointment then the receptionist will pull up the patients chart and mark them as a no-show.
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Extended Appointments
The receptionist, using her own personal judgment, can extend the allotted appointment time by an additional 15 minutes for patients that have several issues or who are unwilling to share the reason for appointment.
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Canceling an Appointment
The receptionist will take the appointment out of the schedule.
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Other Appointments
Laboratory appointments are made at the clinic’s appointment desk.
If a patient has a referral from their physician for an X-ray, the nurse will take them over to the specialty reception desk.
Surgery appointments are scheduled through the hospital.
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Visitors
Drug company representatives and Vendors are given a pass at the front desk and allowed to go back into the clinic.
Only one representative or vendor is allowed back into the clinic at a time.
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Language Barriers
The clinic has a phone interpretation system that can be utilized by all staff.• The system has a 1-800 number that the
receptionist calls• Interpreter gets information from the patient• Interpreter relays information to the receptionist
Translations is available in many languages, but Spanish is the most common.
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Group Assessment
The New Richmond Clinic has an excellent patient scheduling system. The
receptionists are well trained and capable of handling front desk check-in duties while also answering the phone and scheduling
appointments.
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Filing and Health Information Management
Presented by: Teri Olds
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Type of records used
Paper• Some physicians and specialists• Surgeons• Length of time since last visit
Electronic• Cerner – 3 years ago
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Observation of the EMR in Use
Home page • messages/items in queue
Summary Page • diagnoses, last visit summary, alerts,
insurance info.
Orders/Lab• May enter and review results
Seemed very similar to Medisoft
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Security Measures to protect patient confidentiality within EMR
• Automatic log-off after three minutes• Security screens• Monitor positioning• Change passwords/logins every 90 days• Certain areas require dual sign-on/log-ins• Restricted access – need to know basis
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Process of converting to an EMR
“Very painful process”
• Extensive training required• Whole new way of doing things
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Training to prepare staff to use EMR
Extensive• Webinars• Super users/trainers• On-site for two weeks once live• Specialized per department or unit
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Costs associated with converting to an EMR system
Very expensive• More comprehensive/popular system
available• Penalties in future for non-compliance
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Benefits of EMR system
• Multiple users can access• Quicker/more efficient flow of information• Critical access for emergencies• Decreased loss of
documentation/misplaced files• Capability to dictate directly into the EMR• Multi-functional – billing, lab orders,
progress notes, etc.
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Disadvantages of the EMR
• Need to change screens to access different data
• Incapable of having two sections of a chart open at once
• Constantly changing – updates and upgrades
• A “work in progress”• Scanning is very time consuming
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Patient Health History Cont.(Scanning Example)
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Paper Records
Open Shelving• 35,000-40,000 on shelves• Active/most current records• Filed alphabetically• Color coded by letter• Each file – year sticker, first two letters of last
name, first two letters of first name• Name alert stickers – refer to M.I./DOB• Use of Out folders
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Out guide used for paper records in filing room
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Paper Records
Lateral File Cabinet• Charts of people from out of town
Banker’s Boxes• Organized alphabetically and by year• Inactive & Deceased • Boxes labeled and lists maintained
Off-Site Storage• Retain 10 – 12 years or longer• 25 years worth of deceased• Process of getting rid of records
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Organization of the Medical Record
Source-oriented • Divided into sections on right side• Left side contains summary documents
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Maintaining patient confidentiality when the record is stored
Storage• Room always locked, building locks
after hours• Cleaning people supervised• Only Health Information Department
can access• Location of file storage room
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Maintaining patient confidentiality when the record is checked out
• Kept in staff possession• Physical control over or visual
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Process of correcting record
Paper• Place a line through error• Write correct information above or below• Date and initial correction• Never use white out or remove things
Electronic• Create addendum• EMR is “stamped” with date and author’s
name
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How records are locked after hours
• Record room is always locked• Building locked after hours
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How to find misplaced files and occurrence rate
• Check for out guide• Check with physicians, business office,
etc.• Look at color coding
Rarely have misplaced records
Fairly easy to locate, small facility
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Process for records retention
Paper• Active kept on open shelving indefinitely• Inactive moved to banker’s boxes after five years• Deceased moved to banker’s boxes, on-site one to two
years, then off-site. Currently have 25 years worth.
NR Clinic does not use microfilm
Electronic• Any paper records are scanned in• Kept indefinitely• Take up less storage space
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Handling employees who breach patient confidentiality
Varies based on severity• Suspension• Termination
Utilize co-workers• Files of relatives/friends
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Group Assessment of Medical Records Function
• Well organized• Scanning is very time consuming• Benefits of copier in medical records
room• Inconvenient access to records
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Conclusion
We really enjoyed the opportunity to shadow the New Richmond Clinic.
Everyone was very nice and more than willing to show us what their job entails.
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Recommendations
Our only recommendation is that the New Richmond Clinic invest in a computer and
copy machine for the filing room.
There is a significant distance between the filing room and the HIM department and the
women who work in the HIM department are in the filing room approximately 4 times
a day.