Overview of Patient Scheduling / Pre-Admission & Insurance Verification:

South Fulton Medical Center (near the Atlanta airport), had identified a hospital-wide problem related to outpatient appointment scheduling, the pre-admission process and insurance verification. Like many hospitals, patient scheduling was de-centralized. Each of the departments (Radiology, Surgery, Endoscopy, Cath Lab., Radiation Therapy, Cardio-Pulmonary, Rehabilitation Therapy, etc.) scheduled their own patient appointments in a variety of computerized scheduling applications and manual scheduling books. Several times a day, the information from the individual departments (typically printed copies of future schedules), were faxed or manually collected by personnel from the Admissions department. This information was then utilized by the Admissions department to confirm the appointment, obtain orders, collect/verify the patient's insurance information and conduct the pre-admission process.

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Problems Identified:

Several problems were identified with the process that resulted in less than satisfactory outcomes.

• Patient demographic information collected during the scheduling process was frequently incomplete or incorrect (Name, D-O-B, SS#, Address, Phone, etc.).
• Patient insurance information collected during the scheduling process was frequently unavailable, incomplete or incorrect (Carrier, Policy #, Group #, etc.).
• The referring Physician information was frequently unavailable.
• Printed schedules for each department had to be compared to previously printed schedules to determine the newly scheduled cases. The manual observation method sometimes resulted in patients falling through the cracks.
• Follow-up calls to the physician office or patient had to be conducted to obtain missing information. This process required 2 FTEs and caused frequent delays in the pre-registration and insurance verification processes due to the time required to track down the necessary information.
• On occasion, patients were double booked. Multiple appointments in different departments were scheduled causing a patient conflict. This resulted in the re-scheduling or cancellation of the appointment(s), or worse, long wait times for the patients to be worked in.
• On occasion, the sequencing of multiple appointments in different departments for a patient had been incorrectly or inconveniently scheduled necessitating the re-schedule or cancellation of appointments. This could also result in long wait times for the patient to be worked in.
• A Financial Counselor attempted to contact the patient 72 hours prior to the scheduled visit and many times did not have the necessary information to accurately inform the patient of their financial responsibility.
• The Patient was often informed of their financial responsibility regarding the episode of care on the day of the appointment. This process necessitated cancellations and re-scheduling of appointments.

The first step taken after identifying the problems was to strengthen and improve the policies and procedures regarding patient scheduling and the communication of scheduled appointment data to the Admissions department. The Admissions department met with the clinical departments to better understand their scheduling processes, (and limitations), and to develop a uniform and consistent flow of information. The next step required SFMC put together a "wish-list" of capabilities that would enforce the new policies and procedures that had been developed. The result of this step was a decision to explore the possibility of automating and streamlining the processes through the implementation of a computerized hospital-wide patient scheduling system. A budget for the project based on the availability of capital and the estimated benefits of the system was put together by the hospital CIO, CFO & COO.

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Surgical Services Department:

In preparation for the computerized scheduling system, SFMC established a central scheduling office and moved personnel from the departments into the central scheduling office. Several departments (Surgery, Endo, etc.) remained separate for scheduling purposes.

The list included:

• The ability to quickly determine resource availability (rooms, surgeons, equipment, etc.) and schedule a case without having to be on the phone for an extended period of time.
• The ability for the surgery system to communicate with the hospital Admissions system to select a patient from the Master Patient Index and automatically receive the patient demographic information.
• The ability to schedule individual physicians on a first available basis and the ability to conduct block scheduling for individual surgeons and groups of surgeons.
• The ability to print schedules in different formats for the nurses, anesthesiologists, nursing stations and volunteers with the necessary data by individual day and in multi-day formats.
• The ability to create, copy and edit physician preference cards in a timely and efficient manner.
• The ability to exchange data with the materials management system to maintain accurate preference cards and relieve on-hand inventory levels in the Surgical Services stock location.
• The ability to produce a large variety of statistical and clinical reports without having a degree in computer programming.
• The ability to produce graphs and charts of the system reports for distribution at monthly surgery meetings.
• The ability to electronically send patient charges to the billing system.
• The ability to perform electronic charting to replace the paper forms used for nurses notes.

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Finding a Vendor:

SFMC utilized the Internet, trade publications and word of mouth referrals to identify software vendors with products for hospital wide patient scheduling systems and Surgery Management Systems. The vendors were invited to the facility to discuss the needs of the facility, demonstrate their software and to develop price quotes for the project. The vendor to be chosen for the project must be able to:

• meet the budgetary constraints,
• meet or exceed the desired functionality,
• integrate the software with existing systems in use at the hospital,
• provide project management services,
• provide "on-site" training for hospital staff,
• provide references of customers utilizing the company's software applications.

At the conclusion of the vendor selection process, CQI Solutions, Inc. (www.cqisol.com), was awarded the contract. CQI's application; CARE TRACKER-ENTERPRISE offered a complete scheduling solution for the hospital and included a robust Surgical Services Management component. SFMC decided on the CARE TRACKER-ENTERPRISE product based on its functionality, performance, total cost of ownership and strong customer referrals. In addition to the base package, SFMC also purchased the Nursing Notes module. This application enables each department to create their own custom, electronic, point-of-care documentation.

A "kick-off" meeting was conducted for the SFMC department directors and Administrators. CQI presented a detailed implementation plan that was edited to meet the needs, timelines and roll-out sequence desired by the management team at SFMC. A Project Manager from the I/S department at SFMC, Richard Tucker, was assigned to work with CQI to guide the project, assist hospital personnel in completion of their implementation tasks and to communicate with CQI any "issues" or concerns as the application was implemented across the hospital. A Data Collection Worksheet was developed for each department and was given to the department directors. This worksheet was completed and returned to CQI so that file building could be completed by CQI personnel prior to the system installation at SFMC.

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System Implementation:

Once the plan was in place, the Care Tracker Enterprise system was installed. The Care Tracker Enterprise product is a multi-tiered client/server application built on a Microsoft SQL Server 2000. A dual-processor Dell server with 2 gigs of RAM was installed and brought up the hospital's network. The CQI staff worked with and trained the Information System representatives on how to install the application client. CQI had provided a data collection worksheet which was used to pre-populate the system to meet the hospitals planned implementation. This allowed for user training to begin the day after the server was installed. The interfaces to ADT (Admissions), patient billing and material management were implemented on the same server and on the same day. The application client is self-updating and no I/S support is required when updates are issued. CQI Solutions provides direct support for the application, database and interfaces via a secure VPN connection.

The implementation plan laid out by the hospital called for Surgery and GIDU (Endo), to be brought up first, followed by other departments. At the end of the first week, both Surgery and GIDU were scheduling cases into the system. GIDU was able to configure a single preference card to meet their inventory utilization reporting and patient billing requirements, while surgery began creating their preference cards by surgeon and procedure. When the materials interface was connected, the complete inventory file from the hospitals materials management system, including manufacturer catalog number and charge codes was imported into the CT-E application. This made the process of building out preference cards quick and efficient. The first department to enable the patient charge interface was GIDU. Surgery required approximately 150 days to build out their preference cards. SFMC has built more than 1,000 Preference Cards into the system. During that time frame, several meetings were conducted to design their Peri-operative nursing record. SFMC began utilization of their electronic Peri-Operative Nurses Notes and began to send patient charges electronically to the patient billing system in November 2004. The department is utilizing wireless terminals in the OR suites to connect with the File Server. The CT-E system is interfaced to the materials management to decrement on-hand inventory values by stock location.

After the success of the first two departments, the facility quickly began to bring on the other clinical departments including; Radiation Therapy, Breast Health, Outpatient Services, Radiology, Cath Lab, Education Services, Outpatient Rehab and Respiratory Services (the CT-E system client has been loaded on 218 separate workstations and has 197 Users defined in the application). Each department has their own graphical scheduling grid to view schedules and custom designed printed formats of patient schedules to meet their specific needs. The CT-E system contains an integrated and advanced reporting tool. The CT-E system is used to provide statistical reports, logs and marketing information without the need to have a third party (Crystal Reports), and software application.

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Positive Results:

Patient registration personnel have immediate access to patient information for all scheduled appointments. The CT-E system enables hospital pre-registration personnel to view patient data and verify insurance information as soon as the appointment is scheduled. Tools built into the system provide a checklist for all scheduled patients to ensure that insurance has been verified, orders have been received, and the patient has been pre-registered prior to their arrival. The insurance verification and determination of the patient's financial responsibility are communicated to the patient 72 hours prior to the scheduled appointment by the Financial Counselor. Through "central scheduling" and streamlining of the pre-registration process, SFMC has reduced several FTE's that were previously required for these processes.

Patient scheduling at SFMC has been standardized to a single system. The system is operated through a combination of a central scheduling office and several distributed scheduling areas. The system is patient centric, meaning that no matter where the appointment is scheduled, the system checks for conflicts across all hospital departments and will schedule multiple appointments for the same patient in the most efficient and convenient timeframe available. The efficiency of the CT-E scheduling module has reduced patient cancellations, re-schedules and work-ins.

Surgical Services, GIDU, Radiation Therapy, Outpatient Rehabilitation and Respiratory Therapy are sending patient charges electronically to the patient billing system. This HL7 interface enables charges to be sent throughout the day as the episodes of care are completed. This process saves FTE utilization, reduces the potential for keying errors, captures all charges per episode of care and enables charges to post to the patient's account as soon as care is delivered.

Surgery now gets end of month statistics on the day the month ends! Inventory utilized in surgery is automatically decremented from their stock location. Charges are sent to billing as soon as the case is finalized. Nurses notes are complete (due to required fields), and can be printed in a legible format for each case. A large library of reports provides Connie the tools to effectively manage her department.

Inter-departmental communication has been positively affected. The ability to view schedules for other departments and to see a multi-departmental care path for an individual patient has improved workflow and reduced conflicts.

Management reports and activity monitors provide information at the department level as well as system wide including administrative reports that provide a heads-up view for each department of the hospital.

Improved statistical reporting is now available across the hospital. The CT-E system provides SFMC more statistical information than they can use. Data classified by Cases, Procedures, Minutes, Physicians, Payers, Cancellations, Delays, Utilization, Turn-times, etc. can be printed and graphed by date, date range or in a comparative year-to-date format.

Increased flexibility; through the annual maintenance and support contract, SFMC has the flexibility to change the CT-E system as the hospital changes. Adding services to the scheduling system, adding functionality to improve workflow or adding system reports are all available through the maintenance and support contract.

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About South Fulton Medical Center:

South Fulton Medical Center, part of Tenet, Georgia, is a 392-bed acute care community medical center located off I-85 South at 1170 Cleveland Avenue, appx. five miles from Atlanta Hartsfield International Airport in East Point, Georgia. Established in 1963, South Fulton Medical Center has been at the forefront in meeting the medical and health care needs of residents of South Fulton, Coweta, Fayette, Clayton and Douglas counties for more than a decade. Specialties include cardiac services, an emergency services trauma center, outpatient surgery services, rehabilitation services, women's health and a sleep disorders center. South Fulton Medical Center is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency. www.southfultonmedicalcenter.com

South Fulton Medical Center
1170 Cleveland Ave.
East Point, GA 30344
404-305-3500