New Richmond Clinic Shadow Project
Presented by: Teri Olds, Amy Hanson,
Melissa Traiser, and Melissa Wiederhoft
Introduction
The New Richmond Clinic
We met with Jean, who is the head of the
health information management
department and Lori, who is the head of
the reception department.
Reviewed and signed confidentiality form
and then started our project.
Background
•Division of Western Wisconsin Medical
Associates
– has provided health care for the families in the
greater New Richmond community for more than half
a century
– has grown from a small medical practice into a clinic
that now offers a broad range of medical services for
patients of all ages
– have a highly skilled staff of physicians consisting
of surgeons, family practice professionals,
pediatrician, and a gastroenterologist
Medical Office Reception
Presented by: Melissa Traiser
Process of Receiving Patients
• There are 2-3 providers that still use paper
charts
– can take up to two days to get the paper record
– only pulled if the patient has not been seen
within the last three years
– Pulled for specialist appointments and surgeons
• If patient has been seen in the last three
years their medical records are in the EMR
Patient Registration
•
•
•
•
•
First they are asked their name
Which physician they are seeing
Current address and phone number
Verification of insurance
Charge ticket is then printed and placed in
the folder for that physician
• Billing policy and authorization form
Front desk personnel never asks the patient
what they are there for!
Billing policy and authorization
form
Notifying Staff of Patient Arrival
• After it is verified that the patient has
checked in:
– EMR is then highlighted that they arrived
– Notifies the physician’s nurse
– When nurse views the patients EMR it is
highlighted in green
• Nurse views this from a different side than the
front desk personnel
Communication Process when
Physician is Running Late
• Physician’s nurse will notify the front
desk personnel
• Front desk personnel will relay this to
the patient
– They do not have to go into details why
physician is running late
Communication Process when
Physician is Running Late Cont.
• Then they ask the patient if they want to
continue to wait until physician can see
them
• Or if willing to reschedule with another
physician give them that option
Very important to know how long patients
have been waiting – keep an open line of
communication at all times!
Patient Confidentiality
• There is a sign back several feet from the
registration desk
• Receptionists try to talk in a low voice
– No partitions between each receptionist area
• Receptionist can give patient paper for
them to write on if they do not want to
give information out loud
Patient Confidentiality Cont.
• Patient waiting area is positioned a good
distance away from the front desk
– This helps protect patient confidentiality
Never ask what the patient is being seen for!!
Privacy notice -- HIPPA
Group Assessment of Medical
Office Reception
• Functioned very well
• Staff very friendly and had excellent eye
contact
• Staff greeted patients with a smile, patients
felt very comfortable
• Handled patient confidentiality very well
• Reception desk could handle many patients
at one time – easy flowing
• Staff enjoys their jobs and love to work
with patients
Telephone Procedures
Presented by: Melissa Wiederhoft
Telephone Procedures
Phone Greeting
-
Switchboard
“Good morning/afternoon
New Richmond Clinic”
-
Appointments
“Good morning/afternoon
New Richmond Clinic! This
is Anna.”
Telephone Procedures
1st, 2nd, 3rd ring?
- 1st or 2nd ring, always 3rd ring
- Different department
No more than 3 rings
Telephone Procedures
Script
- No Script
Training
- More Experienced
employee
Telephone Procedures
Putting calls on hold
- Ask permission first
- If yes, go to 2nd caller
- Return to 1st caller & Thank
Telephone Procedures
Check back with callers
- Every couple minutes
- Keep asking what they would like to do
Telephone Procedures
Screening calls
- Switchboard
- Triage
Telephone Procedures
Transferring incoming calls
- Switchboard or Triage
I. Callers name & company
II. Nature of call
III. Call back to identify caller and see if person
available
IV. Plan of action
Telephone Procedures
Taking Messages
- No message pads, electronically
- Messages in patient's charts
I.
Only if medically needed
- Return phone calls
I.
End of the morning, free time, between patients
& end of the day
Telephone Procedures
Taking Messages Cont.
- Telephone logs
- Tracking incoming call messages
Telephone Procedures
Handling certain types of calls
- Angry caller/complaint
I. Keep clam
II. As much information as possible
III. Manager if needed
Telephone Procedures
Handling certain types of calls cont.
- Emergency
I.
Triage
- Personal calls
I.
II.
III.
IV.
Help patients first
As long as they don’t interfere with job
Don’t spend a lot of time on phone
To make a personal call – business office
Telephone Procedures
Handling certain types of calls cont.
- Calls from Patient's family
I. Can’t give out that information
II. Only with consent
- Calls from insurance companies
I. Coding question – business office
II. Patient chart question – Triage
Telephone Procedures
Professional answering service
-
Prompts to call 911 if its an emergency
Gives office hours
Physicians on call
Monday through Saturday
6:30 p.m. – 8 a.m.
- Saturday through Monday
noon – 8 a.m.
Telephone Procedures
Leaving patient information on
answering machines
-
House phones
I. Who is calling
II. Appointment time
III. Call back number
- Cell phones
I. Who is calling
II. Call back when they get a chance
Telephone Procedures
Group assessment
• Handles scheduling and patient check-in very
efficiently
• Switchboard separate room
• Appointment schedules located in two spots
in reception area
• More than one receptionist at front desk at a
time
• Phone system only takes one call at a time
Medical Office Scheduling
Procedures
Presented by: Amy Hanson
Scheduling System
The New Richmond Clinic uses a
Computerized Scheduling System.
The Software they use is called CERNER
Scheduling Process
Physician's have their own set of fixed
time intervals
Most appointments are 15 minutes
Pap smears and male physicals are 45
minutes
For longer appointments the receptionist
uses scheduling codes to choose a longer
appointment time
Visit Codes
Visit Codes Cont.
Emergency Appointments
For a patient that walks in to the clinic
needing an emergency appointment, the
receptionist will page a nurse up to assess
the situation.
If a patient calls in needing emergency
assistance the receptionist will route the
call directly to triage.
Walk-in Appointment
The receptionist will check the days
schedule for the earliest available
appointment.
Double booked Appointment
 On the rare occasion that the receptionist
finds it necessary to double book
patients, they try to fit the double
booking in at the end of a longer
appointment slot.
Late Appointment
 The receptionist will call back to the
physician’s nurse and see if the physician
is still available to see the patient.
 If the physician is unable to see the
patient the receptionist will help the
patient reschedule their appointment.
No-Show Appointments
 If it has been more than 15 minutes and
the patient has not yet arrived for a
scheduled appointment then the
receptionist will pull up the patients chart
and mark them as a no-show.
Extended Appointments
 The receptionist, using her own personal
judgment, can extend the allotted
appointment time by an additional 15
minutes for patients that have several
issues or who are unwilling to share the
reason for appointment.
Canceling an Appointment
 The receptionist will take the
appointment out of the schedule.
Other Appointments
 Laboratory appointments are made at the
clinic’s appointment desk.
 If a patient has a referral from their
physician for an X-ray, the nurse will take
them over to the specialty reception desk.
 Surgery appointments are scheduled through
the hospital.
Visitors
 Drug company representatives and
Vendors are given a pass at the front desk
and allowed to go back into the clinic.
 Only one representative or vendor is
allowed back into the clinic at a time.
Language Barriers
 The clinic has a phone interpretation
system that can be utilized by all staff.
• The system has a 1-800 number that the
receptionist calls
• Interpreter gets information from the patient
• Interpreter relays information to the receptionist
 Translations is available in many
languages, but Spanish is the most
common.
Group Assessment
The New Richmond Clinic has an excellent
patient scheduling system. The receptionists
are well trained and capable of handling
front desk check-in duties while also
answering the phone and scheduling
appointments.
Filing and Health Information
Management
Presented by: Teri Olds
Type of records used
Paper
• Some physicians and specialists
• Surgeons
• Length of time since last visit
Electronic
• Cerner – 3 years ago
Observation of the EMR in Use
Home page
• messages/items in queue
Summary Page
• diagnoses, last visit summary, alerts,
insurance info.
Orders/Lab
• May enter and review results
Seemed very similar to Medisoft
Security Measures to protect patient
confidentiality within EMR
•
•
•
•
•
•
Automatic log-off after three minutes
Security screens
Monitor positioning
Change passwords/logins every 90 days
Certain areas require dual sign-on/log-ins
Restricted access – need to know basis
Process of converting to an EMR
“Very painful process”
• Extensive training required
• Whole new way of doing things
Training to prepare staff to use
EMR
Extensive
• Webinars
• Super users/trainers
• On-site for two weeks once live
• Specialized per department or unit
Costs associated with converting to
an EMR system
Very expensive
• More comprehensive/popular system
available
• Penalties in future for non-compliance
Benefits of EMR system
•
•
•
•
Multiple users can access
Quicker/more efficient flow of information
Critical access for emergencies
Decreased loss of
documentation/misplaced files
• Capability to dictate directly into the EMR
• Multi-functional – billing, lab orders,
progress notes, etc.
Disadvantages of the EMR
• Need to change screens to access different
data
• Incapable of having two sections of a chart
open at once
• Constantly changing – updates and
upgrades
• A “work in progress”
• Scanning is very time consuming
Patient Health History Cont.
(Scanning Example)
Paper Records
Open Shelving
• 35,000-40,000 on shelves
• Active/most current records
• Filed alphabetically
• Color coded by letter
• Each file – year sticker, first two letters of
last name, first two letters of first name
• Name alert stickers – refer to M.I./DOB
• Use of Out folders
Out guide used for paper records in
filing room
Paper Records
Lateral File Cabinet
• Charts of people from out of town
Banker’s Boxes
• Organized alphabetically and by year
• Inactive & Deceased
• Boxes labeled and lists maintained
Off-Site Storage
• Retain 10 – 12 years or longer
• 25 years worth of deceased
• Process of getting rid of records
Organization of the Medical
Record
Source-oriented
• Divided into sections on right side
• Left side contains summary documents
Maintaining patient confidentiality
when the record is stored
Storage
• Room always locked, building locks
after hours
• Cleaning people supervised
• Only Health Information Department
can access
• Location of file storage room
Maintaining patient confidentiality
when the record is checked out
• Kept in staff possession
• Physical control over or visual
Process of correcting record
Paper
• Place a line through error
• Write correct information above or below
• Date and initial correction
• Never use white out or remove things
Electronic
• Create addendum
• EMR is “stamped” with date and author’s
name
How records are locked after hours
• Record room is always locked
• Building locked after hours
How to find misplaced files and
occurrence rate
• Check for out guide
• Check with physicians, business office,
etc.
• Look at color coding
Rarely have misplaced records
Fairly easy to locate, small facility
Process for records retention
Paper
• Active kept on open shelving indefinitely
• Inactive moved to banker’s boxes after five years
• Deceased moved to banker’s boxes, on-site one to two
years, then off-site. Currently have 25 years worth.
NR Clinic does not use microfilm
Electronic
• Any paper records are scanned in
• Kept indefinitely
• Take up less storage space
Handling employees who breach
patient confidentiality
Varies based on severity
• Suspension
• Termination
Utilize co-workers
• Files of relatives/friends
Group Assessment of Medical
Records Function
• Well organized
• Scanning is very time consuming
• Benefits of copier in medical records
room
• Inconvenient access to records
Conclusion
We really enjoyed the opportunity to
shadow the New Richmond Clinic.
Everyone was very nice and more than
willing to show us what their job entails.
Recommendations
Our only recommendation is that the New
Richmond Clinic invest in a computer and
copy machine for the filing room.
There is a significant distance between the
filing room and the HIM department and the
women who work in the HIM department
are in the filing room approximately 4 times
a day.