NACRS - The Impact on TEGH Patient Registration Presented by: Dave Walker Manager, Central Patient Registration & Bookings Toronto East General Hospital May 7th, 2004.

Impact of NACRS on: Technology Process People Information System Changes Process Changes to Patient registration People Changing their behaviours and practices Lessons and Opportunities

Technology Cerner Person Management Systems involved: Med2020. OMNI Scheduling Information System Changes Exercise in mapping and linking the FC / MIS Codes to the treatments administered in the various centres. Addition of new fields and rules to Cerner Service Category field containing MIS functional code.

Technology Information System Changes (continued) Interfaces built from Cerner ADT to the Med2020 system Modification of procedure codes in scheduling system to include MIS description. To assist registration staff in selecting correct MIS code

Registration Process Pre-NACRS Instances of ‘Batch registration’ (ex. Oncology) Patients registered shortly after midnight or first thing in the morning, then cancelled if necessary leaving potential for errors Visits not coded previously, registration data inconsistencies were not well known

Registration Process NACRS requirements “real time “ registration Timely and accurate capture of data elements in Cerner ADT Timely and accurate documentation Opportunity to enforce chart integrity and accountability

Registration Process Solutions: Pre-registration (ex. Oncology) Pre-register the patient for the scheduled date and assign the correct MIS Functional Centre code, location, physician, etc (no interface with Med2020). Convert Pre-registered encounter to the appropriate patient type and date / time when the patient arrives (Interfaces to Med2020).

Registration Process Solutions: Assign MIS code at time of Registration Cerner rules based on registration location Only relevant code sets available for selection MIS code defaults where possible (Cath Lab, Dialysis)

People NACRS brought changes to day-to-day responsibilities Staff guided through changes by use of training documentation - easy to read quick guides and reference tables for areas required to select correct MIS code. Other registration staff cross-trained to assist in pre-registration. Balance struck between new process and patient flow requirements

People (Continued) Changing behaviours was key: Knowing the implications of “not doing it properly”, how it affects other systems, how it impacts on coding and reporting. Help them to understand why the change is needed and ‘what’s in it for them’ Regular feedback to the registration and clinic staff Review problems with them before corrections Open the lines of communication- having a more participative and involved approach to registration with the clinic staff

Lessons and Opportunities Chart review revealed chart management and documentation challenges (Oncology) NACRS gave the opportunity to take a closer look and improve clinic documentation processes People will not always do things the way we planned - sometimes we forget that our staff is dealing with patients not just people- different needs Training and process documentation helps to enforce accountability

Lessons and Opportunities Timely audits and feedback are required Registration data problems should be reported at the time of coding to Data Quality Coordinator for follow-up Correction process cannot be performed by front-line registration staff Designated staff are required to make and manage the corrections - accountability, reliability, integrity of the record Flexibility as part of the process Patients who come in unscheduled, “just to see the doctor” – How to capture registration? (ex. Dialysis) Ability to capture other visits/ treatments done in one of the Centres. (ex Urology procedures)

Questions?