Dr. Anthony Ingram is a family medicine with a solo medical practice in a large city in California. His peers affectionately call him Dr. AI. Dr. AI has been studying about Automated Pre-Visit Workflow of Patients. He would like his new patients to expect a good healthcare experience.
What can Dr. AI do as a family physician to automate the patient’s pre-visit workflow and eliminate the hassle of information collection?
Also, what can the patients do virtually, at home, by phone, computer or smartphone, if they develop an illness?
Doctor Ingram wanted to know what a virtual receptionist and a virtual medical assistant do to enhance the pre-visit workflow.
His goal is to orchestrate an optimal patient experience and implement an efficient and automated pre-visit workflow.
To that end, Doctor Ingram had a meeting with an IT specialist and asked his prepared questions.
Q: How do I streamline my clinic pre-registration process?
A: You should design a pre-registration process that integrates seamlessly into the practice workflow. This process will save time for both patients and your clinic team workers.
Q: What do you mean by ‘integrate seamlessly’?
A: The concept of seamless integration for patient registration and pre-registration is to streamline the patient registration process by eliminating paper forms and ensuring direct entry into the registration software and Electronic Health Record (EHR). [1]
Seamless integration is beneficial because of:
1. Efficiency by reducing manual data entry, minimizing errors, and accelerating the registration process.
2. Data Accuracy - Direct entry reduces transcription errors and ensures accurate patient information.
3. Accessibility by enabling real-time access to patient data across the healthcare system.
The Implementation Steps of seamless integration include:
Software Integration: Ensure that the registration software and EHR are interoperable. Data entered during registration should seamlessly flow into the patient’s electronic record.
User Training: Train registration staff on using the integrated system effectively.
Workflow Design: Design a streamlined workflow for patient registration, including data collection and entry.
Patient Experience: Consider user-friendly interfaces for patients to provide necessary information.
Security Measures: Implement robust security protocols to protect patient data.
The Pre-Registration Information includes:
Purpose: Collect essential patient details before their actual visit.
Data Elements
Demographic Details: Name, date of birth, address, phone number, emergency contact.
Payment Information: Insurance details, copayments, billing preferences.
Medical History: Relevant medical conditions, allergies, medications, surgeries.
Collaboration with Team:
Work with nurses, administrative staff, and IT professionals to define the required data elements.
Customize pre-registration forms based on specialty (e.g., pediatrics vs. geriatrics).
Successful integration requires collaboration, clear communication, and ongoing evaluation to optimize the process.
Q: What do you mean by collecting ‘necessary information’?
A: You should ensure compliance with the 21st Century Cures Act and the Office of National Coordinator (ONC) Cures Act Final Rule and collect United States Core Data for Interoperability (USCDI), demographics intake, and administrative and clinical PDF forms. (§ 170.315(g)(10)).[2]
You need to know the following about the 21st Century Cures Act and ONC Cures Act Final Rule:
In 2016, the U.S. Congress passed the 21st Century Cures Act to improve access, exchange, and use of health information.
The Office of the National Coordinator for Health Information Technology (ONC) implemented the Cures Act Final Rule to promote patient control over their health information. The goal is to give patients access to their electronic medical records at no extra cost and allow providers to choose the best IT tools for patient care.
Q: What is the United States Core Data for Interoperability (USCDI)?
A: The USCDI is a standardized collection of health data classes and elements. It enables nationwide, interoperable health information exchange. It includes clinical notes, test results, and medication information.
API Certification and USCDI Standard
Your team should use the USCDI standard as part of the new application programming interface (API) certification for “standardized API for patient and population services. This ensures that APIs follow modern computing standards and allow for interoperability.
Q: What happened to the Common Clinical Data Set (CCDS) which I have been using?
A: The USCDI has replaced the Common Clinical Data Set (CCDS) in various certification criteria. The USCDI criteria cover areas like transitions of care, clinical information reconciliation, data transmission to third parties, and more.[3]
Complying with the 21st Century Cures Act and the ONC Cures Act Final Rule involves using the USCDI standard for health data exchange and ensuring interoperability through APIs. The USCDI replaces the older CCDS in certification criteria.
Q: What are New Patient Coordinators (NPCs)?
A: You should appoint dedicated NPCs who will conduct new patient pre-registration virtually over the phone, or in person, before the initial visit. A virtual medical assistant can handle pre-registration 24/7.
The NPCs will capture demographic - including essential information (such as name, date of birth, gender, address, contact details, and insurance and payment information) as well as enter medical details (such as medication lists, allergies, and medical history) directly into the EHR.
By doing this, NPCs reduce the data entry work required of clinicians during the patient’s initial visit. NPCs can also answer, virtually or in-person, any questions the patient may have about the upcoming visit.
Q: What are my Virtual Pre-Registration Options for Patients?
A: You can offer virtual pre-registration options for patients, allowing them to complete necessary paperwork from the comfort of their homes. Patients can:
Schedule Appointments Online: Implement an online appointment scheduling system where patients can choose convenient time slots.
Submit Insurance and Intake Information Digitally: Patients can upload insurance details, medical history, and other relevant documents through a secure portal.
Q: How can a Virtual Receptionist help at the clinic?
A: You can employ a virtual receptionist (an AI-driven chatbot or automated system) to enhance the pre-visit workflow:
Appointment Reminders: The virtual receptionist can send automated reminders via SMS or email, ensuring patients don’t miss their appointments.
Answer Common Questions: Patients can ask basic questions (e.g., office hours, location, parking) through the virtual receptionist.
Route to Specialists: If a patient’s condition requires specialized care, the virtual receptionist can guide them to the appropriate specialist.
Q: How about Virtual Medical Assistants (VMAs) for Initial Patient Information?
A: VMAs can play a crucial role in obtaining initial patient information during pre-registration or admission.
They can assist with collecting essential details such as patient demographics (name, age, gender), medical history, allergies, and current medications.
VMAs can also guide patients through the necessary paperwork and consent forms.
By automating these tasks, VMAs free up nurses’ time, allowing them to focus on more complex patient care.
Q: How accurate are Large Language Models (LLMs) for Triage?
A: LLMs, such as GPT-4, have shown promise in healthcare applications.
For triage purposes, nurses can use LLMs to:
Assess Symptom Severity: Nurses input patient symptoms, and the LLM provides a preliminary assessment of severity (e.g., mild, moderate, severe).
Prioritize Patients: LLMs can help prioritize patients based on urgency, ensuring timely care for critical cases.
Provide Initial Guidance: LLMs offer general advice (e.g., “Apply ice to reduce swelling”) while waiting for a physician’s evaluation.
Screen for Red Flags: LLMs identify red flags (e.g., sudden chest pain) that require immediate attention.
Q: And how the accuracy of Preliminary Diagnosis Using LLMs?
A: LLMs can assist nurses in generating preliminary diagnoses based on patient-reported symptoms and vital signs. However, it’s essential to recognize their limitations:
o Data Quality: LLMs rely on accurate input data. Garbage in, garbage out—so nurses must ensure reliable symptom reporting.
o Risk of Misdiagnosis: LLMs are not infallible. Nurses should use their clinical judgment and consult physicians for complex cases.
o Ethical Considerations: Transparency about AI involvement and patient consent are crucial.
o Legal Aspects: Liability and accountability need careful consideration.
In summary, VMAs and LLMs can enhance efficiency and patient care, but their integration requires thoughtful planning, training, and adherence to ethical guidelines.
Q: Can you tell me about Integration with Specialist Referrals and the virtual receptionist’s role in arranging visits with specialists?
A: Here are three considerations regarding integration with specialist referrals:
Assess Urgency:
When patients seek specialist consultations, the virtual receptionist evaluates their symptoms.
If urgency is evident (e.g., severe pain, sudden vision loss), the receptionist prioritizes immediate consultation.
Urgent cases bypass regular appointment slots and receive prompt attention.
Provide Information:
The receptionist shares essential details:
Specialist Details: Information about the specific specialist (e.g., cardiologist, neurologist).
Appointment Availability: Available time slots for consultations.
Referral Requirements: If referrals are necessary, the receptionist guides patients through the process.
Coordinate Appointments:
The receptionist assists patients in scheduling appointments:
Booking: Helps patients secure suitable appointment times.
Confirmation: Sends reminders and confirms appointments.
Transition: Ensures a seamless handoff to the specialist’s office.
Remember, an efficient virtual receptionist enhances patient experience and facilitates timely specialist care.
When arranging visits with specialists, the virtual receptionist can:
Assess Urgency: Based on the patient’s symptoms, the receptionist can determine if immediate specialist consultation is necessary.
Provide Information: Share details about the specialist, available appointment slots, and any required referrals.
Coordinate Appointments: Assist in scheduling appointments with specialists, ensuring a smooth transition for the patient2.
Q: What can you tell me about Continuous Improvement in my office?
A: Doctors should regularly gather feedback from patients and staff to fine-tune the pre-visit workflow. They should also monitor the effectiveness of the automated pre-registration processes and make adjustments as needed to optimize the patient experience.
By doing so, a doctor can orchestrate an optimal new patient experience, reduce administrative burden, and enhance patient satisfaction in his solo practice.
The process of continuous improvement for doctors in solo practices is as follows:
Gathering feedback from:
Patients:
Doctors should actively seek feedback from patients regarding their pre-visit experience.
Use patient surveys, post-visit interviews, or online platforms to collect insights.
Ask about registration processes, wait times, clarity of instructions, and overall satisfaction.
Staff:
Engage with administrative staff, nurses, and receptionists.
They interact closely with patients during registration and can provide valuable feedback.
Staff insights help identify pain points and areas for improvement.
Fine-Tuning Pre-Visit Workflow based on feedback. Doctors can:
Streamline Processes: Simplify paperwork, reduce redundant steps, and optimize data collection.
Improve Communication: Ensure clear instructions for patients during pre-registration.
Minimize Delays: Address bottlenecks that cause delays in the workflow.
Enhance Staff Training: Equip staff with the necessary skills to handle patient interactions effectively.
Monitoring Automated Pre-Registration - Doctors should assess the effectiveness of automated processes:
Data Accuracy: Verify that patient information flows accurately into the EHR.
Efficiency: Measure time saved by automating pre-registration.
Patient Experience: Evaluate whether automation enhances or hinders patient satisfaction.
Technology Updates: Stay informed about software upgrades and adapt as needed.
Optimizing Patient Experience by fine-tuning workflows and leveraging automation. Doctors can:
Reduce Administrative Burden: Less paperwork means more time for patient care.
Enhance Satisfaction: Efficient processes lead to happier patients.
First Impressions: A smooth pre-visit experience sets a positive tone for the patient’s journey.
Remember, continuous improvement is an ongoing process. It benefits both patients and the medical practice.
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