Northeast Georgia Health System (NGHS)
Gainesville, GA
Physician Liaison Provides Medical Practices the Limitless Benefits of SCI Solution’s Order Facilitator® at Northeast Georgia Health System
Ensures reliable electronic orders, easy referrals, improved workflow and new time-savings
The Challenges
Until March 23, 2009, physician offices faxed their orders to multiple departments in separate locations across the multiple facilities of Northeast Georgia Health System (NGHS). Departments had their own staff to process and track their orders—and each was troubled by lost orders. Physician offices complained about hospital interruptions requesting orders they had already sent, about having to re-fax them and about the amount of time they spent on the phone. Yet despite departments’ best efforts, some patients still arrived for outpatient appointments before their orders did.
Any initiatives to eradicate lost orders would be hampered by the nightmare of a former attempt to provide electronic orders through a Patient Access model. According to Physician Liaison, Amy Sperrazza, her new position was specifically designed to interact with offices about issues relating to ordering, scheduling, registration, and financial counseling. Her new role, however, quickly morphed from problem researcher into problem solver. She became the advocate, trainer, implementer, and code maintainer for Order Facilitator, SCI’s comprehensive solution that streamlines patient order processing.
The Goal
NGHS wanted to create a higher level of service for all its customers—physicians, internal staff and patients. “‘Exceptionally Responsive’ became our mantra,” says Sperrazza, “with the goal of obtaining the order prior to scheduling, which allows the completion of pre-registration and financial liability processes before every patient visit as well as notifying the patient.” Clearly, that meant instituting electronic orders.
The Solution
“People ask me how I got so many physician offices to use electronic orders,” Sperrazza says, “and I tell them I let the benefits of Order Facilitator speak for themselves.” After one day of SCI training and the implementation of seven initial practices, she started visiting physician practices armed only with a page of Order Facilitator benefits. Orders are instantly accessible to every access point throughout the system as well as the ordering physician’s office. No re-faxing. The orders are complete, legible, signed and recorded. “I show the offices how Order Facilitator allows orders to be built in two minutes or less from scratch without searching through an entire ICD 9 Book, and then how to create unique templates so the complete process is compressed to 35 seconds or less every time an order is submitted by any physician within their specialty.” Sperrazza added, “The use of Order Facilitator favorites builds an ICD 9 book specific to their specialty, while the templates allow a CPT 4 and ICD 9 to be linked together. Search and build it only once and use it forever!”
Initially Sperrazza implemented Order Facilitator for only seven practices and one initial department in conjunction with a migration to a Patient Access Service Center (PASC), something she does not recommend. It meant staff had to also handle the old processes for all other physicians and departments at the same time. Quickly implementing electronic orders for another 16 hospital-networked practices eased the workload. PASC simplified processing further by building a fax repository in Order Facilitator, immediately creating a readily accessible centralized record of all orders, regardless of how they were submitted. SCI became the ONE source for all ancillary testing for the PASC modalities.
Now when PASC receives an electronic order, staff schedules the visit in the scheduling system based on the SCI Order, in addition to scheduling, PASC offers a complete process which includes insurance verification, pre-certification and pre-registration, and financial liability. Medical Necessity checks are performed as the order is being reviewed in Order Facilitator so the office has the ability to code to a higher level of specificity or add additional codes to warrant the procedure. As soon as an applicable diagnosis code is entered in Order Facilitator, the Alert Message will disappear from the Review/Submit tab. Since offices are able to see when codes meet medical necessity, the offices are scheduling tests, assuring patients are scheduled and notified appropriately without picking up the phone, which is a time savings to the physician’s office. Within 24 hours of the appointment request, PASC calls the patient to relate the appointment date, time, location, financial responsibility and prep instructions. Two call attempts are made before the information is mailed. PASC takes all this work off of departments and physician offices, which provides increased patient care.
For the rollout’s second stage, Sperrazza identified community practices of all sizes that were having trouble with lost faxes, and introduced them to Order Facilitator. “I told them it’s not mandatory, SCI’s Order Facilitator is a service that the health system has adopted and offers as a free service to our customers.” Small practices, she reports, are grateful and recognize the increased efficiencies immediately following a short training session; while the larger practices require additional training for all areas to recognize the full benefit of Order Facilitator. Regardless of the practice size, the benefits and time savings are shared by all.
Sperrazza trains office staff in two hours, presenting an Order Facilitator overview and leading hands-on sessions creating patient orders, adding favorites and building shortcuts. Sometimes she uses a train-the-trainer approach.
Looking back, Sperrazza recognizes ways to simplify the Order Facilitator rollout:
- Have a solid internal process for electronic orders in place before you implement
- Train your Patient Access staff thoroughly on new processes
- Roll faxed orders into a single, centralized SCI repository from the start
- Use department liaisons (if centralizing orders during Order Facilitator rollout) and during migration phases
- Secure management support for staff accountability for processes
The Results
Hospital statistics. Starting with 7 practices, they have now rolled out Order Facilitator to over 60 practices (an increase in total users of over 88 %.) Currently, NGHS is using SCI for Radiology, Cardiology/Vascular, Respiratory, Neurophysiology, and Sleep Study scheduling, with the addition of ER diagnostic ordering and referral/follow up scheduling coming next.
NGHS has improved physician loyalty and its patient experience, and has the numbers to show it:
- On track to double the number of orders received in Order Facilitator compared to 2009
- Improved patient pre-registration rate from 35% prior to Order Facilitator to 95% by June 2010, with total monthly cumulative average running 87% to 88%
- Number of electronic orders in first 12 months of Order Facilitator was 51% of scheduled tests, rising to 66% monthly average for 2010
- POS collections are up significantly over prior year since the inception of Patient Access Model and Order Facilitator Implementation
- Scheduling administration shifted from departments and offices to PASC
“Additionally, our internal processes have also vastly improved,” says Sperrazza. “All the different departments with their variety of requirements now use one consistent, “guidelines-driven” standard patient access process with documented accountability.”
Positive Feedback. “Physician offices constantly tell me how much they love SCI,” says Sperrazza, who gets unsolicited calls requesting set-up or complimenting NGHS’ excellent customer service. She actually heard from three offices who admitted giving Order Facilitator demos to fellow practitioners because they thought it was so great. Once in response to Sperrazza’s “How can we help you?” a scheduler wished there was a way to schedule online versus calling in each order and do it today. And of course she granted her wish! The very same office had an unexpected absence of the scheduler shortly after training, and had a staff member who had never been trained on SCI pick up her training material and send in orders in her absence. PASC only found out when the trained scheduler got back to the office and called to apologize for the staff just sending in orders. “We would have never known she was out if she hadn’t called to let us know – the orders were perfect!”
What do the physician offices love about Order Facilitator?
- Better overall workflow and streamlined order processing
- Keeps nurses off the phone allowing more time for patient care
- NGHS’s extremely fast follow-up with patients, often before they get home or out of the physician office
- Notification of patients’ pre-registration process, eliminating office time to notify the patients
- Knowing what patients are scheduled in SCI for result tracking
- No lost order tracking, rework to re-send, or increased patient wait times at registration
- ORDER IS ALWAYS THERE BEFORE THE PATIENT – EVEN IF A STAT PROCEDURE
- Fewer follow-up calls for correct coding with Medical Necessity Checking
- Traceable process for documented due diligence for physician or facility up to 18 months
- Very easy to learn and fast to use
Creative solutions. For departments outside of Patient Access, Order Facilitator provides creative solutions to address other challenges:
- The Rehab Institute of NGHS uses Order Facilitator to schedule therapy at their seven locations throughout Northeast Georgia.
- Rehab receives Order Facilitator Referrals from physicians throughout the15-county area--giving the Rehab Institute a competitive edge from their competitors within the region.
- For specialty departments, doing their own scheduling, SCI’s fax repository serves as an accessible scheduling record and processing hub.
- Offices scheduling Special Procedures within the department also have the option to schedule via phone and fax the order into SCI faxes OR they can submit an electronic order in Order Facilitator which contains and meets all of the signature requirements. By utilizing SCI’s Order Facilitator, offices are assured complete orders are received and processed versus additional calls placed to offices for all incomplete or missing faxed orders.
- Surgery is exploring the use of Referrals to capture ’Patient Status’, collect demographics and history, and send additional reports electronically to provide one complete document for Pre-surgical testing, Registration and Peri-op areas.
- NGHS Medical Records personnel can access Order Facilitator to resolve billing or coding questions before or after any visit. Coding staff can access patient records remotely 24/7.
- Named among Thomson Reuters Top Hospitals in the country and given its 2009 Everest Award for top performance and accelerated improvement
- Named #1 in Georgia and top 5% in nation for cardiac care; top 6% in nation for cancer care; and an American Society of Bariatric Surgery Center of Excellence
- Founded in 1951 in Gainesville, Ga., the not-for-profit health system serves residents in 15 counties
The Future
“The Physician Liaison may be the prime mover,” Sperrazza notes, “but the Order Facilitator rollout takes on a life of its own.” NGHS is in the midst of training its ER department, where referrals to area physician groups and revenue cycle functionality are large motivators. The ability to order tests for ER patients on a 24/7 basis is key to keeping revenue within our system. The ER team will soon be able to order a diagnostic test and patients will be contacted the following morning from PASC with the appointment information. By allowing our ER physicians to schedule electronically, we are contacting patients with a schedule appointment time and providing exceptionally responsive service to our patients and physicians. When using SCI automation, follow-up care becomes more likely since physician offices are provided the patient information along with the appropriate documentation for the follow up appointment.
“Just as Order Facilitator’s Referral module was an awesome incentive for resistant offices,” Sperrazza predicts, “our currently under-construction EMR electronic interface will be my Golden Carrot.”
About Northeast Georgia Health System
>“There is no limit to what Order Facilitator can do. SCI allows NGHS Patient Access to better serve our customer's (physicians, patients and departments) by meeting their workflow requirements with 24/7 access via any internet equipped device. With Order Facilitator, accurate and automated order, referral and pre-registration processing,improved customer satisfaction, and increased revenue are simply a Click Away!”
Amy S.
Physician Liaison
Northeast Georgia Health System
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