Manage Healthcare Reform With Automated Workflow
By Rob Harding
Healthcare reform legislation lives on, courtesy of the US Supreme Court’s June 2012 decision upholding nearly every provision of the Patient Protection and Affordable Care Act (PPACA). While there was talk of repeal should the presidential administration have changed hands in the November election, most experts believe that, at the very least, the PPACA will be the catalyst for meaningful change to the current healthcare system.
HIT can play a significant role in this transformation, a fact touted by HIMSS in its original healthcare reform policy recommendations. In its position paper, HIMSS stated that legislation should do the following:
• leverage HIT to promote quality improvement, performance improvement, and cost containment, including IT to strengthen patient-provider communications;
• provide for a solid HIT infrastructure that harnesses strong federal leadership and the standardized electronic exchange of health information; and
• apply HIT as a means of increasing consumer and provider access to healthcare services and information, optimizing the efficiency of care payments, protecting the privacy and security of health information, and improving quality and safety.
The healthcare reform package does accommodate many aspects of HIMSS’ vision, including quality improvement initiatives that tie outcomes with reimbursements and provisions that encourage healthcare constituents to focus on quality and safety improvement—activities that are enhanced with the proper application of IT.
At first glance, these capabilities appear to be the domain of EMR systems. But on closer inspection, no single system or technology can accomplish these lofty goals, an indication that administrative workflow technologies will be an indispensable part of the reformed healthcare environment, offering provider organizations significant opportunities to create efficiencies and reap cost savings.
A Complementary Technology
The benefits of HIT typically are discussed in the context of clinical information—and with good reason. EMRs offer great potential to improve quality, facilitate communications, reduce errors, and create efficiencies. But while many organizations deserve commendation on their progressive adoption of clinical technologies, they cannot ignore the importance of automating administrative functions as well.
Unfortunately, many hospitals have overlooked this fact and are still laden with paper-based workflows. Their manual processes depend on legible handwriting, forms accuracy, and the speedy delivery of interoffice mail—activities that are often lacking in busy hospital departments. However, business process and workflow automation tools offer healthcare organizations a significant opportunity to achieve administrative excellence, meet challenging reform-driven compliance requirements, maintain high physician satisfaction, and ensure revenue integrity.
In fact, workflow automation can help lay a foundation for a hospital or health system’s EMR by automating many clinical workflows, including surgical consent forms and checklists. Enabled with intelligent monitoring features, a workflow automation system can produce and track all the forms necessary for an encounter according to parameters designed by the hospital. And when integrated with an EMR, automated workflow solutions allow users to print documents or access reports directly from the clinical platform. If a clinician requires a hard copy of a lab result, for example, it can be sent directly to the nursing station and distributed as necessary.
Workflow automation software also enables hospital staff in any department to enter patient data, electronically sign forms, route electronic documents to multiple departments, and print completed forms to give to a patient. And bar codes attached to the documents assist in automatically routing the file to the correct place in the EMR, helping to complete the vital data population stage of EMR deployment and creating a truly paperless environment that’s more efficient and less expensive.
A Human Resources Asset
From benefits forms to performance evaluations, human resources departments produce an endless stream of documents. When these documents are handled manually, human resources personnel often waste time and energy tracking down additional information for incomplete or misplaced forms. Considering that healthcare reform will make coverage available for more than 32 million Americans and that aging baby boomers are joining Medicare at an unprecedented rate, it’s clear that healthcare personnel resources will be stretched to the limit. Even if providers accomplish the goal of creating a more efficient healthcare system through coordinated care, they still will need to significantly increase their rolls of clinical and administrative staff to accommodate the expected increase in patient volume.
An automated human resources workflow platform can eliminate most paper-based records, effectively removing manual data entry and redundant documentation from the equation. With staff management processes consolidated in a customizable workflow solution, for example, not only will human resources personnel be more effective, staff members who interface with the department will be better organized and informed.
And electronic workflow solutions are easily adapted to incorporate features tailored for healthcare’s expanding and unique staffing needs, such as accommodating clinician licensing, continuing educational credits, and credentialing documentation. Human resources professionals who are not wasting time buried in paper will be better positioned to accomplish more productive activities such as staff development.
Managing the Patient Influx
Just like hospitals must have the appropriate staffing levels to handle the additional administrative burdens promised by healthcare reform, they also need assurances that their workflow processes are an asset and not a liability when it comes to managing the rapid incursion of new patients. The admission process is just one area in which automation will be mandatory if hospitals are to contain costs and maintain efficient practices.
Without a structured workflow, patient access personnel often spend an inordinate amount of time locating and loading preprinted forms, manually embossing or labeling records, and distributing the documents to the appropriate hospital departments. Workflow automation eliminates the need for preprinted forms and embossed cards, saving time and money. With an IT-enabled solution, admission personnel enter patient information into the workflow application. They then have the ability to directly print the forms required to compile an admissions packet, for example, with patient data automatically populating the correct fields.
Providers are afforded many benefits with automated admissions documentation, including reducing printing fees by eliminating the need for preprinted forms, improving documentation quality with patient and facility information imprinted directly on each form, enhancing document imaging workflow with bar-code technology, and increasing admission efficiency and user satisfaction through reduced manual efforts.
Accurate Coding Ensures Revenue Integrity
As patient volume increases with healthcare reform and payer contracts become more restrictive, it will be more important for hospitals to maximize revenue. Automated workflow solutions ensure that clinicians enter charges accurately and at the appropriately coded levels to be fully reimbursed at the appropriate levels. And with the expected rise in the number of claims providers will file, they will need to maximize charge capture efficiency.
Electronic revenue integrity capabilities assist billing staff in submitting claims in a timely manner, leading to a healthier revenue cycle. Enterprise workflow also facilitates hospital and physician interactions to resolve and document coding issues in compliance with Centers for Medicare & Medicaid Services and HIPAA guidelines.
Revenue integrity also can be influenced by chargemaster workflows. With an automated solution, an organization will have greater assurance its chargemaster is well maintained, accurate, and effective. And with increased regulations under healthcare reform, hospitals require the added assurance that they are maximizing operational efficiency, reimbursements, and regulatory compliance.
One not-for-profit community-based healthcare organization comprised of two acute care hospitals and approximately 270 physicians is realizing success with an automated solution for maintaining chargemaster accuracy. Enabled with workflow technology that maintains accurate costs, definitions, and codes that are key to receiving reimbursement for services rendered, the organization could successfully minimize compliance risks, increase revenue opportunities, and lower the number of improper claims that lead to rejections, underpayments, overpayments, audits, fines, and penalties.
Healthcare reform presents hospitals and health systems with a host of challenges that promise to have a material effect on their finances. If they haven’t already done so, healthcare providers must seriously consider how the influx of patients, added regulatory measures, and new reimbursement rules will affect their operations. Not only will they be required to manage greater amounts of patient data, they also will need to bolster their administrative capabilities to handle the additional information that will flow through registration, human resources, compliance, revenue cycle, and other departments.
And while EMRs and other clinical technologies grab headlines as the chief enabler of cost, quality, and access improvements promised by healthcare reform, administrative workflow solutions can play a vital role in not only enabling EMR deployment but also further strengthening the healthcare industry’s commitment to eliminating manual and inefficient paper-based process from the delivery system.
— Rob Harding is president and CEO of FormFast, a provider of electronic workflow solutions that serves more than 850 hospitals internationally with software that helps accelerate their progression from manual processes to fully automated workflows.