A Filemaker iPad EMR Database Case Study by ACG Technologies National Ambulatory Hernia Institute Taking FileMaker Pro to the Next Level FileMaker iPad-­‐izaton Success Story Situation / Challenges The National Ambulatory Hernia Institute͛Ɛ (NAHI) Operations Manager, Vicky Vansurksum, was challenged with managing multiple office locations, physicians, patient flow of care and scheduling, complex billing for both workers comp and private patients, Insurance company and adjuster management, patient chart and media management (EMR), data auditing, mobilized accessibility and remote access, PC and Mac compatibility along with many other information related challenges. Assessment Desiring to improve medical outcomes and increase business efficiencies with these highly complex and sophisticated requirements NAHI contacted ACG Technologies to help coordinate and develop a solution that could meet all their needs. Vicky Vansurksum, Operations Manager at NAHI, worked closely with Chris Quinn, president of ACG Technologies, to review their current business processes and in-­‐efficiencies and together as they collaborated was able to identify and solve all their challenges including a fully functional QuickBooks integration eliminating the need for any double entry. Identifying Opportunities Working together, Chris and Vicky set out to identify specific areeas of opportunity where both business efficiencies and patient healthcare could be significantly improved. Dzƒ–‹‡–„‹ŽŽ‹‰ƒ†’ƒ›‡––”ƒ•ƒ…–‹‘• were a laborious effort that required one and a half full –‹‡ƒ†‹‹•–”ƒ–‘”•–Š”‡‡™‡‡•ƒ‘–ŠǤdz Key focus areas were patient billing and transaction management, scheduling and mobilizing patient information. Patient billing and payment transactions was a laborious effort that required one and a half full time administrators three weeks a month to invoice and track many difficult and different types of billing, payment and collection efforts. Phase 1 1 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 Developing an Integrated and Multi-­‐Faceted FileMaker Database Solution dŚƌŽƵŐŚŚƌŝƐĂŶĚsŝĐŬLJ͛ƐĐĂƌĞĨƵůƉƌŽĐĞƐƐĂŶĂůLJƐŝƐĂŶĚƚĂƌŐĞƚĞĚŝŶƚĞŐƌĂƚŝŽŶŽĨƚŚĞ&ŝůĞDĂŬĞƌWƌŽĚĂƚĂďĂƐĞĂŶĚƐŽĨƚǁĂƌĞ
development application the billing and payment process was reduced to less than four hours a month and now only requires one administrator. This process was also enhanced by integrating FileMaker to QuickBooks that quickly and effortlessly pushes all FileMaker transactions directly into QuickBooks. Billing and Payment requirement challenges had to include: x
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Creating a Custom Procedures Library with Unlimited Charges Capability One Click Submission of a Procedure with Multiple Charges to a Patient Record Detailed and Editable CPT Charges HICFA Billing for Pre-­‐Printed and Non-­‐
Preprinted Forms Billing for Multiple Office Locations Professional and Facility Payment Tracking and Check Printing Contract integration for Professionals and Facilities Payment Selection from Multiple Bank Accounts Payments to Practice Partners and other Professionals x
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Multiple Application of Different Adjustments and Discounts e.g. PPO͛Ɛ ƉƉĞĂů͛ƐWƌŽĐĞƐƐĨŽƌInsurance Payment Tracking Unlimited Payments Received on a Charge Unlimited Payments to Professionals and Facilities per Charge A/R Tracking and Collection Follow Up Collection Effort Tracking Log Professional Payment and Ledger Transaction Tracking Data Auditing for Any and All Data Changes
Dzƒ›‡–’”‘…‡••‹‰™ƒ•”‡†—…‡†ˆ”‘‘‡hundred twenty hours per month to less than four hours a monthǤdz 2 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 Image: Payments Received and Processing Dashboard Results and Benefits Automating Payments Received and Payment Processing: To allow for many billing variables ACG Technologies experienced developers created a billing dashboard that conditionally filters by only Professionals and Facilities that are currently owed money, or only charges with remaining balances. As the administrator applies and pays the professionals/facilities the charge falls off the screen leaving only any remaining unpaid charges to process. This filtered process allows the administrator to quickly process their accounts receivables and payables and not have to continually search for outstanding charges. 3 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 Automated payment distribution, discounts, simple write off and contract integration has sharply reduced the process for applying payments received and payments owed across many charges with a single click of the mouse. All accounting is managed within the FileMaker Pro database including the printing and synchronization of checks between FileMaker and QuickBooks. Once transactions have been processed FileMaker then pushes all newly processed transactions to QuickBooks via the custom data connector developed by ACG. When an outstanding charge is paid by the insurance company and the paid amount is NOT correct or up for dispute͕ďLJƐŝŵƉůLJĐůŝĐŬŝŶŐƚŚĞ͞ƉƉĞĂůĞĚ͟ĐŚĞĐŬďŽdžthe item is calendared and sets the charge to the appealed status and put into the collection process. The appealed charge is now available in a collection queue for the collections department to begin the appeals process. Because all these charges are tightly integrated with different departments, errors and lost revenues have been significantly reduced. There are many more integrated and automated procedures that have been implemented into the solution in order to reduce inefficiencies, human error, improve data entry to help ensure correct and accurate data impute. The administrator also has the ability to toggle between any charge in the receivables/payment dashboard and any patient information they might require during the Accounts Receivables and Accounts Payables process. Patient Scheduling, Electronic Medical Records (EMR)/Document Management and Actionable Flow of Care: Managing and monitoring Patient Flow of Care was a big concern for Vicky. Her objective was not only to automate this process but also put all the patient information in one place and at the fingertips of her staff. From the patient record the administrator has instant access to: x
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Patient Detail and Assigned Physician Patient Referral Bill Type and Method Office Location Nurse Case Manger Patient Appointment History Patient Individual Calendar Patient Notes History of Injury Unlimited and Server Based EMR Records Patient HCFA Records Exam Information x
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Prescriptions Data and Electronic Prescription History Patient Family and Personal Insurance Information Patient Charges Web Integrated Map with the Patients Location and Directions to the assigned Clinic or Hospital Location that is Easily Emailed to the Patient Data Auditing that Tracks all Field Changes to a Patient Record Patient Ledger And Much DŽƌĞ͙ Patient and professional ƚĂƐŬƐĂƌĞĐĂůĞŶĚĂƌĞĚĂŶĚǁŝƚŚŽƵƌĂůĞƌƚŝŶŐŵŽĚƵůĞŝŵƉŽƌƚĂŶƚƚĂƐŬƐĚŽŶ͛ƚŐĞƚŵŝƐƐĞĚ͘ The flexible calendar module is a unique calendar in that it allows you to filter by Professional at any location, Patient, and of course by day, week or month. Because of FileMaker Pros excellent plug-­‐in architecture integrating our calendar to Outlook is easier than ever. 4 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 Our Monthly Calendar view summarizes the types of appointments by day, who type and by name. Filter the calendar by: x
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Office Location Type: o Patient o Professional o Staff o Referrer Name (Conditional by Type) Very granular giving the administrators great flexibility and many choices when scheduling or reviewing schedules 5 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 The Daily Schedule allows the administrators to, for example, filter by all professionals or one professional. 6 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 The Appointments Dialog is also easy to use and assisted with conditional menus for filtered lists making data entry a breeze. 7 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 EMR and Document Management Module The full featured EMR ŽĐƵŵĞŶƚDĂŶĂŐĞŵĞŶƚDŽĚƵůĞǁĂƐĚĞƐŝŐŶĞĚƚŽĞĂƐŝůLJĂĚĚĂŶLJĚŝŐŝƚĂůŵĞĚŝĂĨƌŽŵW&͛Ɛ͕
Word Documents, Spreadsheets, and Video etc. to any patient specific record. Another advantage is that all digital media is located to a single server location in a patient directory for multiple reasons. The advantage of localizing the digital media in one location is as follows: x
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Media Security ʹ All patient records are organized at the server in one location for easy security and backup management All EMR and Attached Media is NOT embedded in the database but rather organized and located in one directory location The administrator can open any digital media right from the FileMaker ͞ZĞĐŽƌĚƐ͟ portal in the application it was developed in Organizing patient related digital content right on the patient record makes chart and x
other media easily available to the Administrator Completely Automated EMR and Document Management is Secure, Organized by Patient, Not Embedded into the record unburdening the database, Open media right from the patient record 8 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105 Phase 2 iPad-­‐ization iPad-­‐ization of the FileMaker Medical Database Mobilizing the NAHI Medical Database ǁĂƐ Ă ďƌĞĞnjĞ ǁŝƚŚ &ŝůĞDĂŬĞƌ͛Ɛ 'Ž ĨŽƌ ƚŚĞ ŝWĂĚ and iPhone. The new FileMaker Go for the iPad application is simple to deploy, just go to the online Apple App Store, download the FileMaker Go app and open it on your iPad, connect to your local network and open the database right to your iPad or iPhone. zĞƐ͕ŝƚ͛ƐƌĞĂůůLJƚŚĂƚĞĂƐLJ. In our initial testing FileMaker Go performed well beyond our expectations and gives our doctors the ability to carry critical patient information with them right into the exam room. Accessing any patient record is easy, quick and convenient. Having that information at their fingertips improves patient care. FileMaker iPad Go makes mobilizing patient data simple and without the high cost of developing a separate unique application. ACG Technologies is an innovative software development services company, providing a comprehensive offering of custom application development consulting, IT Support, e-­‐commerce, web design and e-­‐marketing services. For more than a decade, companies have used ACG products and services to automate, streamline and promote their businesses. 9 Vicky VanSurksum Phone 714.446.6670 Chris Quinn Phone 949.713.5162 Ext. 105