Hospitals

Software-as-a-service model sends data electronically to multiple facilities, easing case-management staff workload.

At Falls Church, Va.-based Inova Health System, up to two full days were needed to process and receive a reply on a simple nursing home referral: gathering, copying and collating paper records, faxing them to the facility, playing phone tag with facility staff, talking with staff, relaying information to patient and family, responding to requests for more information from the facility– and doing it all again for the next facility.

Program at Methodist Healthcare starts after an in-depth evaluation of printing needs, outsourcing costs and use of technology.

An outdated paper-based system creates roadblocks in the flow of patient data. Overhauling this system is a major project for any healthcare facility, requiring the careful selection of appropriate systems, proper implementation, and the understanding and cooperation of staff members.

BayCare Health Systems implements palm-vein recognition technology to streamline and secure patient processing.

The first step in patient safety is correctly identifying patients at the point of entry to the healthcare facility (including matching them to the correct medical record). As the increasing number of cases of medical identity theft have shown, however, conventional identification processes are no longer adequate and present numerous issues that continue to put a patient’s safety at risk. These include simple clerical errors, technological failures and even dishonest patients misrepresenting their identity.

The continued use of manual processes raised a real concern for program changes and tracking with newer and more robust state and federal regulations.

Community Health Plan (CHP) in Washington faced several challenges that needed to be addressed in order to achieve its goal of deploying a patient-centric delegated care-management system. For years, care managers at CHP used multiple, disparate systems for case management (CM), disease management (DM) and utilization management (UM) – resulting in information silos. Without an integrated system, there
was a lack of evidence-based clinical pathways to ensure consistent care planning and management of patients. As a result, data collection was not robust, tracking was inadequate and reporting was not streamlined.

The ultimate challenge was balancing two fundamental regulations – a requirement that drugs in the OR be immediately and readily available, and another necessitating medication security at all times.

One of the most logistically challenging areas of the hospital for medication distribution is the operating room (OR). This is particularly true for institutions such as the Erie County Medical Center (ECMC), with service lines that necessitate 24/7 OR capabilities.

Many providers have found that content management lends itself to automating transactions and managing content in a single location.

Healthcare providers are used to processes. From billing to patient registration to accounts payable, they operate under rules and regulations, policies and procedures. Audits are processes, too. The recovery audit contractor (RAC) program, for example, is an audit. It starts with a record request from the auditor. Upon receipt of the request, the provider has a strictly enforced 45-day deadline to respond. Once the response is received, the RAC can deem an overpayment occurred. Then, the provider has the option to appeal the decision.

Memorial Hermann is one of the largest not-for-profit healthcare systems in Texas, serving the greater Houston area through 11 acute-care hospitals, a large network of affiliated physicians, and numerous specialty programs and services. Its system-driven centralized model involves the coordination of several work processes and products, including billing, coding, pricing and contracting.

"We use a monthly operations review process, designed to identify performance variances and define preemptive actions," says Helen Powers, system executive for revenue operations, decision support and Medicare profitability for Memorial Hermann. "All business operations are reviewed on how well they achieve the health system’s overarching goals of quality, operational excellence, customer satisfaction and growth. Under this model, the revenue-operations department carefully manages cash flow and days in accounts receivable."

CAC does not eliminate the need for medical-coding professionals to be involved in the coding process, but it can make them more productive and accurate.

Technology has finally arrived that is radically changing the process of medical coding in health-information management. Computer-assisted coding (CAC) automatically generates medical codes directly from clinical documentation. With CAC technology, healthcare organizations can streamline their revenue-cycle processes while becoming more compliant with the increasingly complex payer and quality reporting requirements.