Katherine Bailey
CET 3010 Course Project
Professor Yousef
By
Katherine Bailey
CET 3010 Course Project
Professor Yousef
By

Better Your Small Business Today
Better Your Small Business Today

Contents Introduction: 1 Current Business Process: 1 Patient Arrival 1 Check in Process: 1 Wait in waiting room 2 Urine Sample 2 Wait in waiting room for nurse 2 Nurse takes/records vitals on paper 2 Wait to see Doctor 2 See Doctor 2 Check Out: 2 Data Collection and Analysis: 3 Type of data collected: 3 Recommendation for collecting proper data using information technology: 3 Recommendation: 3 Digitized Form 4 Data and System Security 4 Ethical Issues: 5 Guidelines: 5 System Requirement’s: 6 System: 6 Other Requirments: 6 Conversion 7 Direct Data Entry 7 Idea: 7 References 8

introduction:
I have been called to one of the Atlantic Urological Associates offices to provide recommendations for an efficient information system that will help with the following: * Minimize patient waiting time * Decrease paper work between the office and other healthcare entities * Increase quality of patient care * Optimize the billing and coding process
Upon arriving at the doctor’s office I notice the waiting room is full and there is a line of people waiting to check in. Behind the desk is an overstressed receptionist who is trying to manage checking everyone in, answering the phones, and filing/completing paper work. When it is finally my turn she hands me paper work that I would have to fill out if I was a new patient. I find a chair sit down and start filling them out, and 10 minutes later I am called back to the front desk to verify my insurance information, and pharmacy location. After verifying I finally get to set back down to fill out the rest of my papers, looking at the clock it has already been 15 minutes. After waiting 10 more minutes I am finally called back to see what I thought would be the nurse, behind the door that separates the waiting room from the patient waiting rooms, is more chairs with more people waiting! She tells me this is when they have patients give a urine sample to check for infections, once done they sit on these chairs to wait for a patient room. By this time it has been 35 minutes and I am getting anxious. Finally after 10 more minutes a room has cleared and I am finally able to see the doctor. 15 minutes later and she finally walks in, apologizing for the wait, but they only gave her one room to work with. After the doctor, I have to walk to another desk which has more people waiting in line to pay, reschedule their next appointment, all while another young lady is flipping through mountains of paper work just to find insurance codes to get the patients payments, and having to take phone calls.
Current Business Process:
Patient Arrival * Patient arrives at location
Check in Process: * Check in at front desk * Fill out any new or required patient forms * Documentation such as driver’s license, insurance card, or prescription card
Wait in waiting room * Wait 15-25 minutes
Urine Sample * Lab technician directs you to restroom to give urine sample * Tests urine in back room for infection * Writes results down on patients chart
Wait in waiting room for nurse * Wait 5-10 minutes
Nurse takes/records vitals on paper * Take’s blood pressure * Take’s temperature * Record any new symptoms
Wait to see Doctor * Wait 5-15 minutes
See Doctor * Doctor reviews vitals and information from nurse * Listens to what you have to say * Diagnoses * Makes treatment plan * May give you a paper prescription * Tells you when to reschedule appointment if necessary, gives you a business card with date and time on the back to hand to the check-out person * Documents everything on paper, then walks your chart over to the check-out person who bill’s you for services rendered
Check Out: * Wait in line until it’s your turn to check out * Hand the check-out person the business card the doctor gave you * Check out person makes follow up visit if required in her computer * Check out person goes through stacks of paper to find the medical code to charge your insurance with, then goes through more stacks of paper to find your insurance providers co-pay * Make payment * Get paper receipt of payment * Chart is put in a pile with other charts to be filed later * Finally free to leave or go fill prescriptions if necessary
Data Collection and Analysis:
Type of data collected: * Patient data * Medical data * Insurance data * Payment data * Billing data * Scheduling data
Recommendation for collecting proper data using information technology:
There needs be a database system that allows office personnel to pull a patients file. In this file should be subcharts on: * Patients data – should include name, address, age, sex, social security, contact information, insurance information * Medical data – should include patient’s medical profile, history, diagnosis, and prescription information, allergies, record of prescriptions * Insurance data – should include history of patients insurance and contact information for the insurance provider * Payment data – patients preferred method of payment, payment history, receipts, and any transactions * Billing data – this could include any insurance codes for things such as co-pay amounts, heath codes to bill the insurance company, maybe a hyper link to a list of medical codes to choose from, anything that could create an invoice. * Scheduling data – this subchart, when selected should open and real time calendar of the offices current schedule, when date and time are chosen for an appointment, it will be automatically updated to the server, so it will show immediately on the offices schedule. * Doctor’s data: there should be a computer in each patient room, where a doctor or nurse can log in, and update the patient’s vitals, reason for visiting, diagnosis etc.
Recommendation:
The front desk personnel is in charge with so many different tasks that can result in errors, delay in check-in, overlooking information, or just over looking something simple. You should consider hiring someone just for scheduling appointments. The ivr line could say for example, press one for appointments, and be directed to that person(s). Some doctor’s office even have an after hour answering service for patients, pharmacies, and other medical places, so they can leave messages.
Digitized Form
New patients are normally asked to arrive 10-15 minutes early to have time to fill out paper work. This incurs extra waiting time, which makes them anxious and restless. To minimize stress for the patient we can provide them with a digitized new patient form. This form could be found on the company’s website where they create a username and password, log in, then fill out the new patient form. Once submitted it is securely sent, and updated into the doctors office’s software. The following is an example of a possible digitized form:

Data and System Security
All the medical information that will be updated into the new database, there has to be an internet connection with secure networks to have real time results while keeping you system secure. With medical information using internet access we have to make sure the office is protected from external and internal threats. * The office should hold a meeting in where someone can go over system procedures, and the importance of internet security. * In order to access the database system, there needs to be a username and password. The password needs to include at least 8 characters, have an upper case letter, lower case letters, and numbers. The username will be prompted every 3 months to be changed to a new password that cannot contain any previous characters. * All computers should be located in an area where patients or outside vendors do not have any access to. The computers should also be facing away from any patients, or by-standers eyes. The computers need to have up to date anti-virus protection and firewall enabled at all times. * Network access should be a limited hidden network. By law the router access point must be encrypted. * It is always a good idea to have a backup idea for when systems crash or go down. One method for backing up files is cloud computing. Since the information that needs to be backed up are sensitive the cloud needs to be just as secure as the computer. * The office should have an IT specialist who comes in once every 3-6 months to make sure files are being backed up properly, check on software and operating maintenance, anti-virus protection, firewalls, and internet speed. * The office needs to determine what personnel is allowed to see certain patient information in their computer systems. An example could be, the scheduling department not have access to PHI. If the office is to keep current practices, then every employee needs to be trained on HIPPA standards and oaths, on what can and cannot be done with PHI.
Ethical Issues:
The office needs to hold a meeting for training purposes to remind the employees of the rules and regulations. Working in a doctor’s office means that almost every employee is dealing with patient sensitive information. Persons found violating PHI (patient health information) for unethical purposes could be held reliable with a fine, and or time in jail. It is very important that each employee know what is and what isn’t acceptable.
Guidelines:
* An employee may only access or disclose a patients PHI when the access is part of the employee’s job duties. * It is not acceptable for an employee to look at PHI just out of curiosity, even if no harm is intended. It makes no difference if it for a close friend or family member. All information is protected the same and must be kept private. * They need to know their roles and responsibilities in safeguarding PHI and complying with HIPAA rules. HIPAA requires written security policies and procedures, training, and sanctions for security violations. (David C. Kibbe, 2005) * Shall not permit one’s private conduct to interfere with the ability to fulfill one’s professional responsibility. (Guide To Privacy and Security of Electronic Health Information, n.d.) * All HIPAA related policies * Your procedures, including the process to monitor security and steps for breach notifications as regulated by HIPAA * The only time appropriate to discuss a patient’s medication or PHI is if it pertains to you job. It is not ok to discuss a patient’s prescription medication with another staff member, unless that staff member needs to know it. * Even though a staff member might have access to a patients prescription medication list, or other medical information, it is still unethical for that information to be read, or accessed unless it pertains that that employee’s job. This is why there should be limited access on who can access certain data. * Employees need to be advised of proper internet use, which should only be job related issues. Internet browsing might be thought of as innocent and not malicious, but the anti-virus protection that is installed on the computer can only protect so much. It is only designed to scan for certain definitions it is programmed with. With the rate of new virus’s being created each day, a safe practice needs to be implemented when searching on the internet.
System Requirement’s:
System:
The office needs to purchase an electronic health record (EHR) system. A certified vendor can be found at this website: http://oncchpl.force.com/ehrcert?q=chpl (ONC Health IT Certification Program, n.d.) (Certified Health IT Product List, n.d.)
Other Requirments: * In order to operate your new EHR, you will need high speed internet. An internet service provider can offer you a business internet and phone plan that will have the high speed available in your area, along with faster dispatch times if a technician needs to come out. * For types of different internet I would recommend either cable, or fiber optic. These provide you the fastest speed in mbps, while less interference from telephone or twisted pair wiring, such as DSL. If you do choose DSL ask for VDSL2, if that is not available make sure it is 10mbps or higher, most internet companies only guarantee a certain percentage of download speeds such as 60% or even 80%. * With your high speed internet you can choose to get the modem from you ISP (Internet Service Provider) or choose to purchase or own, either way, make sure you have a wireless router that has at least a WEP encryption on it. * You will also need an anti-virus protection on every single computer. Some ISP will let you pay for a security program through companies such as Norton or Mcafee at a lower cost. Either way you need to decide and let your IT specialist download it and maintain it for you. * Your operating systems and databases should have Windows, and SQL * Reporting tools * Charting support
Conversion
Direct Data Entry
The office needs to consider how much information is going to be converted. What information can be interfaced, scanned, or entered directly. You also need to consider how long the conversion might take.
Back-entering data is one way to input patient information into your new EHR system. When entering items such as medications, allergies, or other medical information, you can select from a drop down menu that allows for the data to be used in clinical decisions and other patient required fields. You need to organize a select group of employees who are allowed for back-entering data only. Clinical staff, medical students, or other staff who understand medical terminology and health information can be used to ensure the quality of the data entered.
You might consider having your most recent patients records entered first into the system, then at a later time enter patients you haven’t seen in a while, but are still required to keep record of. idea: I had an idea that I wanted to suggest. When a patient gets lab work done somewhere, the lab results have to be sent back to the referring doctor to be evaluated. I often find it frustrating that they make you schedule another doctor’s appointment just to go over the lab work, which I believe could have been solved with a simple phone call. I think the doctor’s office should hire a physician’s assistant who can have a day to call patients with the pending lab results, charge them half of their co-pay, and talk to them about the lab work and what needs to be done. This can make patient satisfaction higher, patient time and effort a breeze, open up more waiting rooms for the doctors.
I personally would have saved a lot of time, and gas money if someone could have called me just to talk about my own lab results. According to HIPAA it is legal for a doctor to discuss medical information over the phone.

References
Certified Health IT Product List. (n.d.). Retrieved from The Office of the National Coordinator for Health Information Technology : http://oncchpl.force.com/ehrcert?q=chpl
David C. Kibbe, M. M. (2005, April). Family Practice Management. Retrieved from AAFP: http://www.aafp.org/fpm/2005/0400/p43.html
Dental Web Sites . (n.d.). Retrieved from dds.com: http://www.dds.com/dental-websites/Features/Secure-Patient-Registration-Forms/
Guide To Privacy and Security of Electronic Health Information. (n.d.). Retrieved from The Office of the National coordinator for Health Information Techhnology: http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf
HIPAA FAQs. (n.d.). Retrieved from The Official Website of the First State: http://dhss.delaware.gov/dhss/dph/morefaqshipaa.html
Managing Existing Patient Records in the Transition to EHRs in Physician Practices. (n.d.). Retrieved from AHiMA HIM Body of Knowledge: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047676.hcsp?dDocName=bok1_047676
ONC Health IT Certification Program. (n.d.). Retrieved from healthit.gov: http://www.healthit.gov/policy-researchers-implementers/certified-health-it-product-list-chpl