Administrative Use of the Electronic Health Record Chapter 5 Administrative Use of the Electronic Health Record Copyright © 2011 by Saunders, an imprint of Elsevier Inc.

Chapter Objectives Explain the importance and typical duties of the front office assistant. Discuss the necessity of respectful communication among providers, staff, and patients when answering the telephone, sending e-mail, messaging, faxing, and scheduling appointments. Outline the procedure for the management of electronic health records, including eliminating duplicate charts, the proper way of purging closed patient records, and the importance of backing up the EHR.

Chapter Objectives (cont’d.) Create and manage patient appointments in the electronic health record. Discuss the role of the front office in maintaining patient flow throughout the waiting room and check-in process.

Role of the Front Office Assistant Positive attitude Greeting patients on the phone and in person Creating and managing an EHR for each patient Generating patient letters and other correspondence Providing patient education material The front office is usually where patients get their first impression of the medical office, so a great attitude toward patients, providers, and other staff is critical.

Communication in the Medical Office Telephone Etiquette Studies have proven good communication also prevents many medical errors, thus improving care and reducing the incidence of malpractice lawsuits. But here’s the astonishing part: Good communication is so important, it actually reduces the likelihood a patient will bring a lawsuit even when a medical error is made.

Appointment Confirmation A reminder that the doctor has reserved this time especially for him or her A request to return the call to confirm the appointment or to reschedule if necessary A request to bring to the appointment a list of current medications, since many patients receive prescriptions from several different specialists A reminder for the patient to check on his or her referral status if the patient’s insurance company requires a referral It’s helpful to develop a script for making confirmation calls. This script should become part of the office procedures manual. In addition to the date and time, the script might include these points.

Secure E-mail Encryption technology HIPAA disclosure statement Figure 5-1 HIPAA disclosure

Messaging in Practice Partner Accessing the messaging system in Practice Partner Viewing a message in Practice Partner Sending a new message in Practice Partner Replying to a message in Practice Partner Forwarding a message in Practice Partner Saving a message in Practice Partner Deleting a message in Practice Partner Figure 5-2 is a sample e-mail agreement for the medical office.

Advanced Features Linking messages Using message templates A patient’s chart or specific chart sections can be linked to a message in Practice Partner. Using templates saves time by allowing you to construct similar messages quickly.

Guidelines for Handwritten Notes Document the patient name, date of birth, and phone number on the message. Document the date and time of the call. Attach the message to the patient chart before giving it to the healthcare provider. Document all instructions and conversations with the patient.

Guidelines for Handwritten Notes (cont’d.) The initials of the person taking or returning the call should be documented on the message. Once the message is complete and the documentation sufficient, file the message in the patient’s chart.

Faxing Faxes can be misdirected because of human error or technical glitches. The recipient of a fax cannot be verified, because anyone can pick up the printed document if the machine is placed in an unsecure location. It is difficult to verify that all pages were received. A fax machine is an output device that encodes documents in order to transmit them over telephone lines.

Guidelines for Fax Inform the recipient before sending any confidential patient information so that it can be retrieved immediately. Use a cover sheet when sending a fax. The cover sheet should include the sender’s contact information, a confidentiality disclaimer, and recipient information. Follow up with the intended recipient to ensure that the message was received. Figure 5-9 is a sample cover letter for faxes.

Guidelines for Fax (cont’d.) Document the date and time, and initial the faxed information to create a paper trail. File the completed cover sheet in the patient’s chart.

Managing Electronic Records Eliminating Duplicate Charts Ask whether the patient has ever been seen by the practice before. If so, use the already established patient EHR. Ask established patients if they have had a name change. Always set up the patient EHR account using the name listed on the insurance card.

Purging Patient Records Patients are Active Inactive Closed Retention period Purging Process of removing inactive and closed patient health records from those that are active Active records are those of patients who have been seen within the last 3 years. These records are easily accessed and used frequently. Inactive records are those of patients who have not been seen by any provider in the medical office within the last 3 years. Closed records are those of patients who have terminated their relationship with the medical office—some have moved away, others have been asked to leave the medical office because of bad debt or failure to follow doctor advice, and some have died.

Backing Up the Electronic Health Record Secondary offsite location Charged portable laptop Purchased through a vendor Offices must have a written backup and recovery plan in place. Backup takes place at least once daily, to as often as every keystroke. The medical office must, by law, have a written backup and recovery plan in place. This detailed document should be stored in the office policies and procedures manual and be easily accessible.

Patient Scheduling Electronic appointment book is the key to efficient time management. Several users can access the electronic appointment book at once. Can be printed out daily so that the doctors, medical assistants, nurses, and receptionists are all aware of the patient load for the day. Patients can be easily rescheduled, and appointment availability can be searched based on patient preferences. Practice management software is typically used to populate the electronic appointment book with a master patient index. In Practice Partner, this list is called the patient registration database. It’s shared by the three software applications that make up Practice Partner: Patient Records, Appointment Scheduler, and Medical Billing.

Patient Flow Waiting Room Ensure that the waiting room is well lit, clean, and safe. Reading material in the medical office should not include potentially offensive topics. Use the waiting room as an opportunity to promote healthy lifestyles. Define patient flow. (The efficient movement of patients through the medical office)

Patient Flow (cont’d.) Patient check-in EHRs allow you to record the flow of a patient’s visit from beginning to end. Document patient’s check in Note how long they wait to see a provider Which examination room they are placed in When actual visit begins How long it lasts and when they leave 1. Select the Check-In icon on the Tool Bar. 2. Search the patient name to be checked in. Let’s use Susannah Ling. 3. A window opens for you to select the slot for check-in (Figure 5-20). Highlight the appointment on the list and click OK. 4. The Patient Check-in box for Susannah will appear (Figure 5-21). You may leave this window open to follow the patient throughout the course of their visit by entering a time for check-in, time in examination room, time provider starts, finishes, and patient checkout. 5. When finished, click OK.