Hospital Outpatient Departments (HODs) are often a pain point in an otherwise excellent EHR go-live. They all seem to have unique workflows. Each department may have a different way that they like to organize their front office staff and the various staff that handle their revenue cycle. The transition to any new software can be disruptive.
When planning an Epic go-live for your hospital outpatient departments, take into consideration the workflows that will need to be reviewed:
- Referrals/Authorization/Certification
- Scheduling
- Check-in
- Payments
- Insurance updates
- Charging procedures/supplies
- Professional charges
Everything starts during appointment conversion prior to go-live. Critical pieces of data from the legacy system are transcribed into the new system. Patients, appointments, and insurance information are all transcribed. Typos can occur. All involved strive to enter the correct information, but everyone needs to be prepared for issues at go-live. Once the manual conversion is done, the system is maintained and is live.
Staffing Considerations
One of the highest needs for a successful HOD go-live is ensuring that you have enough trained staff and support for all the changing workflows. Do you have enough staff for:
- Handling auth/cert/referral workflows
- Contacting insurance companies
- Validating insurance
- Updating referral information
- Front desk support
- Checking in patients
- Collecting payments
- Scheduling next appointments
- Checking out patients and delivering AVS summaries as needed
- Monitoring workqueues and making corrections
- Multiple workqueues for insurance
- Workqueues for errors
Referral Management
Epic has a very integrated approach to handling referrals and how those feed into scheduling appointments. Staff will need to deal with the workload of contacting insurance companies for authorization for appointments and validating the insurance. This is key to making sure that you can schedule all future appointments. Many departments find that they get a bottleneck of patients during this process so having additional people available ahead of time to help handle this load will be critical to having a smoother go-live.
Scheduling and Check-Ins
Scheduling future appointments hinges on the referral information being updated in the system. When patients check out is another potential bottleneck. They want to schedule their next appointment. The same clerk may be checking in patients too. You will want to ensure that patients are not lined up waiting. Some organizations have had to redesign their staffing structure in order to have adequate staff for their HOD departments. This could be a go-live issue but could also mean a permanent change in the workflow.
Check-in is an important step to validate that the correct spelling of names and insurance is updated. A simple mistake can lead to errors which can impede billing. This is an opportunity to also collect outstanding payments.
MyChart and Kiosks
A potential way to help reduce the burden on your staff is to utilize some of the tools that Epic provides to streamline these processes. MyChart has a way for patients to complete their insurance information prior to their appointments. You can have them pre-register for their appointments, take photos of insurance cards, etc. If you enable it, they can also do self-scheduling for your department. A robust MyChart setup can enable your patient portal to receive payments, send out alerts for future visits, and host educational materials.
Some departments utilize a kiosk approach to check-in with Epic’s Welcome product. A kiosk can handle the check-in, validation of insurance, and other tasks to allow your staff more time to deal with other complicated issues.
The Power of the Mock Walk-Through
Prior to go-live, it is not a bad idea to host a mock walk-through of patients so that each member in the team understands their part of the process. This could be done in your training environments. In addition, for your go-live, plan to have super users and at-the-elbow support staff at all locations for your front desk staff, referrals staff, and any insurance verification staff. It is very helpful to have specialized staff who understand the referrals/auth/cert process to aid your staff. A seasoned person with Cadence/Prelude experience will be very helpful when dealing with any uncommon workflow.
Workqueues and Charging Considerations
Workqueues always seem to be forgotten prior to go-live. There isn’t a great way to train on them. But these workqueues are important to monitor and to address immediately in order for your revenue cycle to be unhampered. Have analysts available to help build out new workqueues or to redesign as needed for each HOD area. There should be Epic trainers or analysts who can help the users in each department know which ones to monitor daily and how to resolve issues. Sometimes workqueue issues are simply an insurance number missing a digit or a misspelled name. Often the departments don’t know who should be monitoring the workqueue. This is probably a new workflow for them because the EHR is different. Involve the practice managers prior to go-live in order to help make these decisions.
We have been focusing on the front desk and the revenue cycle for the HODs. But another pain point for your HOD can be charging. This will feel different for them. Who will be monitoring charges and potentially lost charges during your go-live? All charges should have been tested prior to go-live, but you may find that new charges may need to be created during actual practice. Again, ensure you have a way to communicate with your build team for these issues. Someone should be assigned to review charges daily during the go-live.
Professional billing charges may occur depending on the type of HOD. Do you need to export data for a non-hospital provider? Consideration of these workflows should be made prior to your go-live. Is everyone in the practice employed by the hospital? If not, then workflows may need to be designed to help pull that data.
In Conclusion
There are a lot of workflows to consider for your hospital outpatient departments. Protecting your revenue cycle and ensuring accurate reporting of all charges is very important for a smooth go-live. Having those assist you who are familiar with the complexities will be very important.
More Epic resources
If you are preparing for an EHR initiative, we are here to help — whether transitioning to a different EHR, getting ready for cutover, or needing to optimize your existing EHR investment. Check out these resources to learn more:
