1. Copyright © 2009 by The McGraw-Hill Companies, Inc. All Rights Reserved. McGraw-Hill/Irwin Chapter 3 Electronic Health Records in the Physician Office Electronic Health Records for Allied Health Careers Cover goes here when ready

2. 3-2 Learning Outcomes After studying this chapter, you should be able to: 1.List the five steps of the office visit workflow in a physician office. 2.Discuss the advantages of pre-visit scheduling and information collection for patients and office staff. 3.Describe the process of electronic check-in. 4.Explain how electronic health records make documenting patient exams more efficient. 5.Explain what occurs during patient checkout.

3. 3-3 Learning Outcomes After studying this chapter, you should be able to: 6.Explain what two events take place during the post-visit step of the visit workflow. 7.Describe the advantages of computer-assisted coding. 8.List three decision-support tools the EHRs contain to provide patients with safe and effective health care. 9.List four important safety checks that an EHR’s e-prescribing feature can perform when a physician selects a new medication for a patient.

4. 3-4 Key Terms chronic diseases clinical guidelines computer-assisted coding decision-support tools disease management (DM) formulary point-of-care

5. 3-5 Patient Flow progression of patients from the time they make an appointment until they leave the office after a visit. Whether paper-based or electronic health records are used, the basic steps are the same.

6. 3-6 Patient Flow Steps Step 1: Pre-Visit: Appointment Scheduling and Information Collection Step 2: Patient Check-in and Payment Collection Step 3: Rooming, Measuring Vital Signs, and Patient Examination and Documentation Step 4: Patient Checkout Step 5: Post-Visit: Coding and Billing, and Reviewing Test Results

7. 3-7 Step 1 – Pre - Visit Paper 1.Patient Calls for Appointment 2.Front desk staff member schedules and confirms insurance information Electronic 1.Patient Schedules appointment o the Internet 2.Patient completes information forms online

8. 3-8 Step 2 – Payment Check-In and Payment Collection Paper 1.Staff member pulls patient chart and prints superbill for today’s appointment. 2.Patient arrives and signs in 3.Front desk verifies demographics and billing 4.Patient returns to waiting room 5.Front desk checks eligibility by Internet or telephone 6.Patient called to front desk to may copayment 7.Patient returns to waiting room 8.Front desk notifies the MA patient ready to be seen places chart and superbill and labels in tray 9.MA takes information and rooms the patient Electronic 1.Patient arrives and checks in electronically at a computer in the waiting room 2.Patient confirms demographics and billing information on a computer 3.Electronic Health Record checks insurance eligibility. 4.Patient enters copayment via computer or pays at front desk 5.MA sees alert on electronic health record screen that patient is ready to be seen. 6.MA rooms the patient.

9. 3-9 Step 3 – Rooming and Measuring Vital Signs Paper 1.MA checks vital signs 2.MA asks the reason for the visit 3.MA verifies medications and allergies 4.MA documents findings on face sheet in chart 5.MA leaves he room and places patient chart in pocket on exam room door, flips covered flag on wall 6.Physical walks down hallway and notices that the patient is ready to be seen. Electronic 1.MA checks vital signs 2.MA asks for reason for the visit 3.MA verifies medications and allergies 4.MA documents findings in the electronic health record via computer in the exam room 5.Electronic health record sends an alert to physician that patient is ready for exam

10. 3-10 Step 3 Patient Examination and Documentation Paper 1.Provider reviews face sheet in paper chart on door. 2.Provider enters the room 3.Provider review MA documentation 4.Provider examines patient 5.Provider jots visit notes on superbill 6.Provider write needed prescriptions and requisitions for tests 7.Provider hands the patient orders, prescriptions and superbill. Electronic 1.Provider reviews patient record in electronic health record 2.Provider enters the exam room 3.Provider examines patient 4.Provider documents visit in electronic health record 5.Provider enters needed prescriptions and requisitions in the electronic health record

11. 3-11 Step 4 – Patient Checkout Paper 1.Patient hands superbill to front desk staff member. 2.Staff member verifies the charges and collects any payment due 3.Staff member schedules follow up appointments 4.Patient leaves office Electronic 1.Patient stops at front desk to pick up copies of orders, prescriptions, and educational materials 2.Front desk staff member reviews electronic health record and collects any payment due 3.Staff member schedules any follow up appointments 4.Patient leaves the office

12. 3-12 Step 5 – Post visit Coding and Billing Paper 1.Provider dictates notes 2.Outside agency transcribes notes and sends to physician 3.Physician reviews 4.Patient chart and superbill forwarded to billing staff 5.Coder reviews and assigns codes 6.Coder writes codes on superbill 7.Billing staff enter information and submits electronic claim. Electronic 1.Coder reviews codes assigned by electronic health record and automatically sends to billing 2.Billing staff reviews and submits electronically.

13. 3-13 Step 5 – Post Visit Reviewing Test Results Paper 1.Locate patient’s chart 2.Attach lab results to top of chart 3.Route chart to physician 4.Physician reviews, sigs and adds notes 5.Chart placed in physician outbox 6.MA phones patient with follow up instructions 7.MA documents phone call in patient chart 8.Chart with added lab results and physician's notes filed Electronic 1.Alert appears on MA screen lab results have arrived, if abnormal physician sent immediate alert 2.Physician review results, electronically signs and forwards to MA 3.MA telephone patient with follow up instructions 4.MA documents phone call.

14. 3-14 Coding and Reimbursement Documentation and coding plays a major role in whether a payer approves claims and reimburses the physician. Computer-assisted coding uses software to facilitate claim processing. http://www.youtube.com/watch?v=twYcAo378eo

15. 3-15 Computer Assisted Coding To minimize problems and paper based coding offices are using software that automates coding. Some assign codes based on keywords that are included in the template Other programs analyze words, phrases, and sentences in the electronic document to determine the proper code. Once codes have been suggested that are reviewed and verified by a professional coder

16. 3-16 Clinical Tools in the Electronic Health Record Contain features that aid clinicians in providing patients with safe, effective health care. Some of the common features are Access to current clinical information Identifying patients at risk for a specific disease Monitoring a patient’s compliance

17. 3-17 Clinical Tools in the EHR Decision-Support Tools - Computerized based programs that make the latest clinical information available Tracking and Monitoring Patient Care – Sending electronic report to the physician Screening for Illness and Disease – Search records to determine if patients are current with wellness screenings Identifying At-Risk Patients – Potential risk to a certain disease Managing Patients with Chronic Diseases – Such as diabetes and monitor course of disease Improving the Quality and Safety of Patient Care with Evidence-Based Clinical Guidelines – Make sure that their care follows recommended guidelines

18. 3-18 Field Trip The National Guideline Clearinghouse – evidence based guidelines that is updated on a weekly basis. www.guideline.gov

19. 3-19 E-Prescribing According to Preventing Medical Errors: Quality Chasm Series (Institute of Medicine, 2006) errors in prescribing or taking medication harm 1.5 million Americans each year. Institute of Medicine recommends the use of e-prescriptions by all providers and pharmacies by 2010. Keeping Current with Electronic Drug Databases

20. 3-20 E-Prescribing Benefits Increasing Prescription Safety Drug-Allergy Conflict Drug-Disease Conflict Incorrect Dosage Incorrect Duration Drug-Pregnancy Conflict Drug-Age Conflict Drug-Gender Conflict Drug-Drug Interactions Saving Time and Money

21. 3-21 Field Trips Lets go to the following web site and read about recalled medications. www.fda.gov/cder/index/html Lets go to the Certification Commission for Healthcare Information Technology (CCHIT) and read about criteria for certification of ambulatory electronic health records. www.cchit.org/choose/ambulatory/2007/index.asp