1. Business Intelligence ( 2 of 3 ): Improving Back Office Workflow and Accuracy PRESENTED BY

2. Objectives Learn how to combine EMR and PM data to creatively solve back office queuing problems and double the X-ray department’s capacity Hear how customized and automated reports are delivered to care teams prior to appointments where there are needs to comply with state regulations See examples of the types of reports created and how adoption to the new workflow has progressed since these tools have rolled out

3. Presenters Rhonda Draper, Patient Care Services Director, Ortho NorthEast (ONE) Mike Baeske, Software Applications Specialist – Team Leader, Ortho NorthEast (ONE) Shawn McLain, DBA, Systems Programmer, Ortho NorthEast (ONE) Nate Moore, Moore Solutions Inc.

5. Why we needed to change Physicians wanted X-rays done before entering the exam room We were expanding our office and considering the need to add a very expensive fourth X-ray room

6. What did we know X-ray rooms were often empty Physicians were waiting on X-ray results at times Appointment duration times were long Physicians were indicating return with X-ray in notes Current workflow contained lots of non-value added tasks

7. Identify the rechecks Physicians indicated need for X-ray at next visit We needed more information / options

8. New Future X-ray Workflow

9. MEL Programming Tips OBSNOW() used to save requests LIST_OBS() retrieves every instance of an observation Can isolate the results toward signed observations or include unsigned ones ORDERS_ALL() pulls all orders associated with the patient, including completed ones Getfield() chops object into an array of values MEL_SIGN_ORDERS() triggers orders to be signed for PACS and X-ray work list MEL_SEND_FLAG() generates a flag that links back to update

10. EMR X-ray desktop

11. X-ray Appointment Type System monitors observations and automatically updates appointment type to X-ray:

12. Routing screen for X-ray staff

13. Automatic Flag from OnTime Board Send_Flag procedure utilized to transmit flags outside of EMR forms based on the appointment type

14. Adjust workflow to eliminate non-value added steps Old workflow All techs watched EMR desktop Assigned themselves a patient Walk to exam room to get patient Go to an empty X-ray room Sometimes had to wait if all rooms full Same tech positioned patient, captured image and charged Walked patient back to room Used a stationary PC so charge entry happened after patient was gone and before getting next patient

15. New workflow 2 techs per room One positions and interviews the patient One captures the images and bills in EMR from console 2 Runners Escort patients to and from X-ray Assign patient to an X-ray room Use tablets so they are mobile Watch EMR desktop and use routing screen

16. Before and After BEFORE 21 exam rooms 75 exams 5-6 Rad Techs 3 x-ray rooms (2 DR 1 CR) Unhappy physicians AFTER 35 exam rooms 150 exams 7 Rad Techs 3 x-ray rooms (2 DR 1 CR) Using BI to identify recheck patients and help balance work loads Happy physicians

17. X-ray Reporting

18. Needs X-ray Report

19. Tracking patient wait time Using data helps us identify opportunities for improvement

20. “Patients compliment us daily on how efficient our process is” - Nikki V. “We have done 50 patients this morning already?!” It didn’t even seem like it! – Amanda E “It’s great knowing I’m staying ahead of the doctors schedule!”- Anna Z “Some patients arrive early, we can get them into the x- ray room and to the exam room before their appointment time. Sometimes they even check out before appointment time!” – Melissa R Quotes from our RAD Techs

22. Why we needed to change New laws in Indiana require specific monitoring and assessments when prescribing opioids for chronic pain Staff struggling to “prep” for office visits and ensure all areas were covered

23. What did we know INSPECT reports are scanned into the EMR Narcotics contracts are tracked in the EMR Prescriptions are created in the EMR Appointments are tracked UDS orders are created in the EMR We would need to add assessments Opioid Risk screening Mental Health screening

24. INSPECT reports

25. Narcotics contracts

27. Programming Tips: Printing Handouts PRINTHANDOUT() MEL function used to automatically print Default printer determines where it will print: Handout header always prints on top Observations, Functions, and Document Objects can be pulled from forms in an update Document object must be setup like this:

28. Video Show how UDS order is created

29. Opioid and mental health assessments

30. Scores show up in document Answers stored in observations, can be pulled into future visits or reported on

31. Chronic Pain Dashboard

32. Q uestions?