Chapter 4 Administrative Use of the Electronic Health Record

Using the messaging system built into an EHR application ensures secure delivery of email within the practice and offers a way to communicate with staff regarding confidential patient information. Providers and staff can communicate with patients via secure email using their EHR system or any of several commercially available HIPAA-compliant secure email services. These services also offer web hosting, spam filtering, virus protection, and related accessories, such as shared calendars and address books

. Regardless of the specific use, secure email takes the place of interoffice messages—sticky notes and the like—and postal mail, which may take days to reach its destination.

As Levinson and colleagues discovered in their classic 1997 study of this topic, it is neither the error nor the poor communication alone, but the toxic combination of the two that triggers malpractice suits.

Although such studies have focused primarily on physician-patient encounters, staff interaction is important in making patients feel valued and comfortable. Levinson and colleagues found that patients appreciate being informed, for example, of what to expect. Front office assistants can play a key role in orienting patients during their visits.

Incident Reports Another responsibility for healthcare professionals is the completion of incident reports. Incident reports are used to communicate situations to the risk manager: for instance, falls, injuries, needlesticks, and medication errors. If there is a patient or employee injury, he or she would, of course, be treated for the injury and that care documented in the health record; however, an incident report would also be completed as part of risk management practices. Incident reports are used to help improve the healthcare facility. They are reviewed by the staff to see what caused the incident and what can be done to prevent it from happening again.

An incident report is completed by an employee who witnessed the accident (this may be the actual employee who was injured) and provides complete documentation of what occurred. A description of the accident and the actions taken after the accident become part of the incident report. If medical treatment is involved, it also is included in the incident report. The contributing factors and prevention measures would be documented as well. An accurate and complete incident report is an excellent tool for reducing risks for patients and employees.

HIPAA law states that the patient health record must be kept permanently, not that it must remain in the healthcare facility. When purging, closed records are separated from active ones and stored elsewhere. Some closed records are placed on CDs or computer hard drives or maintained in inactive cloud space by the EHR vendor. Paper charts may be scanned into microfilm.

As discussed in Chapter 2, the retention period is the amount of time, by law, that patient records must be maintained by the medical office. Retention periods vary from state to state. Patient health records must be maintained for evidence of patient care in the event a lawsuit is filed.

In addition, patients have shown little difference in comprehension of letters written in medical jargon compared with those written in lay language. Among the cancer patients interviewed by Krishna and Damato, only 17% said they'd like to have the medical terms explained to them.

As to the other concerns mentioned in the study by Baxter and colleagues, HIPAA allows practitioners to communicate with patients by mail unless they specify otherwise. And finally, studies have shown that copies impose little additional burden on medical assistants and office budgets. But why go to the extra trouble at all? Well, there are several reasons for sending copies to patients. Let's take a quick inventory:

EHR Exercise 4.11 Set-Up Appointment Matrix Complete the following exercise in EHR Exercises found in the Info Panel. In order for everyone to know when the providers are available to see patients, you have been asked to block out the following times for the providers. This will show on the calendar as blocked time so that patient appointments will not be scheduled during that time. a. Dr. Walden takes a 1-hour lunch break at 11:00 a.m. She also likes to have a 30-minute hold on appointments from 3:00 p.m. until 3:30 p.m. for catch-up time. b. Dr. Kahn takes a 1-hour lunch break Tuesday through Saturday at 11:30 a.m. He also does rounds at the Anytown Nursing Home on Thursdays from 4:00 p.m. until 6:00 p.m. c. Dr. Perez is working only mornings for the next 2 months as she recovers from surgery. There should be a hold on the afternoon appointment times Monday through Friday for the next 2 months. 1. Within the Front Office Calendar, click on the Add Appointment button. 2. Select Block as the Appointment Type, Lunch as the Block Type, and Julie Walden, MD in the For field. 3. Using the calendar picker, select today's date in the Date field. 4. For the Start Time select 11:00 a.m., and for the End Time select 12:00 p.m. 5. Click in the box next to Recurrence, select Daily as the Recurrence Pattern, and select End By and, using the calendar picker, select the date 6 months from today. 6. Click on the Save button, and the appointment will display on the calendar. 7. Click on the Add Appointment button. 8. Select Block as the Appointment Type, Hold as the Block Type, and Julie Walden, MD in the For field. 9. Using the calendar picker, select today's date in the Date field. 10. For the start time select 3:00 p.m., and for the End Time select 3:30 p.m. 11. Click in the box next to Recurrence, select Daily as the Recurrence Pattern, and select End By and, using the calendar picker, select the date 6 months from today. 12. Click on the Save button, and the appointment will display on the calendar. 13. Click on the Add Appointment button. 14. Using the steps described above, enter the Block appointments for Dr. Kahn and Dr. Perez. After the appointment matrix has been established, it is much easier and more efficient to schedule patient appointments, as you can now clearly see when the provider is available to see patients. When scheduling patient appointments, it is important to verify the patient demographic information that is in the EHR system. If the patient's address, employment, or insurance information has changed, it is an easy process to correct it, and this will ensure that contact with the patient and that billing for services will go smoothly.

EHR Exercise 4.12 Edit Patient Demographic Information and Schedule an Appointment Complete the following exercise in EHR Exercises found in the Info Panel. Charles Johnson (DOB 03-03-1958) has called in to schedule his annual examination with Dr. Martin. He would like to come in on a Thursday morning before 10:00 a.m. Dr. Martin requires 1 hour for annual examinations. Before scheduling the appointment for Mr. Johnson, you verify his address, phone number, and insurance. He states that he has moved since he was last into Walden-Martin. His new address is 1322 Flagstone Drive, Anytown, AL 12345. Update Mr. Johnson's demographic information and schedule his appointment with Dr. Martin. 1. Click on the Patient Demographics icon (Fig. 4.15), enter Johnson in the "Last Name" field, and click on the Search Existing Patients button. Fig. 4.15 Patient Demographics icon (red rectangle) in SimChart for the Medical Office. 2. From the List of Patients, verify the DOB and click on Charles. 3. On the Patient tab of the Patient Demographics screen, enter Mr. Johnson's new address. 4. Scroll down and click on the Save Patient button and then close the Patient Demographics window. 5. Within the Front Office Calendar, click on the Add Appointment button. 6. In the New Appointment window, select Patient Visit as the Appointment Type and Annual Examination as the Visit Type. 7. Document Annual Examination as the Chief Complaint. 8. Select the Search Existing Patients button to search for Mr. Johnson's record. 9. Enter Johnson in the Last Name field of the Patient Search window, verify the DOB, and select Charles Johnson from the List of Patients. 10. Verify the Provider. 11. Use the calendar picker to select next Thursday as the appointment date. 12. Enter a Start Time of 9:00 a.m. and an End Time of 10:00 a.m. 13. Click the Save button, and the appointment will be displayed on the calendar.

Workplace Applications Using the knowledge you obtained from the chapter and SimChart for the Medical Office Simulation Playground, complete the following activities. 1. Chase Murray (DOB 04-07-1993) is having difficulty sleeping and would like to schedule an appointment with Dr. Martin next Tuesday at 9:00 a.m. Use examination room 2 to schedule this 30-minute appointment. 2. CPR recertification training will be available for the entire staff on November 1 from noon to 4:00 p.m. in the meeting room. All staff who plan to attend must notify Marta at extension 30. Block this time on the calendar. 3. Schedule a wellness examination for Tai Yan (DOB 04-07-1956) with Dr. Walden next Monday at 9:00 a.m. The appointment will last 30 minutes and take place in examination room 4. 4. Truong Tran (DOB 05-30-1991) needs to discuss recent episodes of depression with Jean Burke, NP. Next Monday at 1:00 p.m. will work best for him. Schedule this 30-minute office visit in examination room 7. 5. This Saturday, the Walden-Martin office will be purging health records of patients who have not been seen in the past 3 years. Use the memorandum email template in the Correspondence menu to invite available employees to assist in this process from 8:00 a.m. to 2:00 p.m. Employees will be paid overtime, and lunch will be provided. Those interested should notify Marta at extension 30. Use the office email [email protected] to complete this communication. 6. Maria Hernandez calls the office today for her daughter, Casey Hernandez (DOB 10-08-2000), who was exposed to poison oak while playing in the woods behind their house this weekend. She now has a red rash on her left calf that is seeping clear liquid. Casey complains that the rash is very itchy. Ms. Hernandez is working today and unable to bring Casey in. She wonders if Jean Burke, Nurse Practitioner (NP), could call in a prescription to help with the rash. Casey is not allergic to any medications. The Hernandez family uses Waltman's Family Pharmacy at 123-445-3200. Ms. Hernandez's work number is 123-445-5122. Compose a phone message for Jean Burke, NP, to communicate this question.

Electronic Health Record in Review This is your chance to keep past skills current. Try these activities covering previous content. 1. Interview a fellow classmate to register him or her as a new patient in SimChart for the Medical Office. Remember to first perform a patient search within Patient Demographics to avoid creating a duplicate record. After confirming that your classmate is not registered in the system, use the Add Patient button to begin the patient registration process. 2. Noemi Rodriguez (DOB 11-04-1971) needs a copy of her electrocardiogram (ECG) from January 2014 sent to Dr. Pericardio for review before her appointment. Prepare a Medical Records Release allowing Dr. Martin to send this record. The release will expire in 30 days. Dr. Pericardio is located at 455 Heart Valve Way, Anytown, AL 45582. 3. Chris Miller, father and guarantor of patient Daniel Miller (DOB 03-21-2012), has new contact information. His cell phone number is 123-555-6363, and his work number at the auto shop is 123-540-4774. Update this contact information in the Guarantor tab of Daniel's Patient Demographics.

Truong Tran has stopped in to get all of his medical records. He is going to be traveling in Asia for several months and wants to have a complete copy of his medical records with him. Complete the Patient Records Access Request form. 1. Click on the Form Repository icon, and then under Patient Forms select Patient Records Access Request from the left Info Panel. 2. Click the Patient Search button at the bottom to assign the form to Mr. Tran. The patient name and address are auto-populated. 3. Check the boxes next to all choices except Other. 4. Enter "08-08-2013" in the first field for "Medical record for the period of:" and today's date in the second field. 5. Enter "Travel" in the "Reason for Disclosure" field. 6. Enter "Truong Tran" in the "Releasing to:" field. 7. Enter "123-456-1237" in the "Phone:" field. 8. Enter the date one year from today in the "This request will expire" field. 9. Click the Save to Patient Record button.

Erma Willis (DOB 12-09-1947) has asked to be notified when the next presentation by the dietitian regarding heart healthy eating will be. It has just been scheduled in two weeks on Tuesday at 5:00 p.m. in the Walden-Martin conference room. Compose a letter to Ms. Willis to let her know. 1. Click on the Correspondence icon and select the Blank Letter template from the Letters section of the left Info Panel. 2. Click the Patient Search button to assign the letter to Ms. Willis. 3. Confirm the auto-populated details and enter any necessary information based on the case study. 4. Click the Save to Patient Record button.

The front office assistant, often a medical assistant, must have an?

Exceptional attitude toward patients, providers, and staff, along with the many skills to accomplish the many and varied tasks required by this position.

When communicating patient information with other healthcare facilities, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule allows covered entities to disclose healthcare information via email, fax, or phone without specific patient authorization, provided reasonable care is taken to avoid inappropriate disclosure or use of protected health information (PHI)

If you cannot tell whether the last digit of a handwritten fax number is a "7" or a "2," for instance, a reasonable safeguard might be to call the patient to verify the number before sending the fax.

At the front desk the insurance card is scanned in; when mail is processed, reports from other providers can be scanned, and the information is then uploaded into the health record.

In the clinical area the patient may bring his or her immunization record from the previous provider to be scanned in. All of these integrated devices need to be able to keep the patient information protected to remain HIPAA compliant. Being fully trained on these devices will help ensure that happens.

An attractive alternative to faxing is to send and receive secure fax transmissions via secure email. This system for encrypting fax transmissions and sending them via email makes a fax machine obsolete, eliminating the hassles of changing toner and clearing paper jams.

It also saves the practice the expense of maintaining a fax machine and paying for an additional phone line. The system works by electronically recording fax transmissions and storing them as PDF files. This then establishes the content in an electronic format, which is more compatible with EHR systems. If a hard copy is needed, these faxes can be printed, just like regular faxes.

Scrap your recorded message and get a real person on the line chatting with college kids about their final examinations or asking after Mrs. Millikin's new grandchild. The topic does not matter—showing a genuine interest in the patient's life does. Use a waiting list and walk-ins to fill tables left open by no-shows.

Johnson and colleagues found that practices with low no-show rates are more willing to take advantage of walk-in patients and to use a waiting list to fill slots left open by no-shows and last-minute cancellations.

A variety of correspondence can be created within the EHR, including physician referral letters, patient letters, and patient instructions. Providers may want to write a letter to a patient (for example, to inform the patient of test results or to summarize a plan of care), or they may want to send a letter about a patient (for instance, to provide a consultation report).

Letters in EHR systems can be prepared from standard letter templates. Templates keep providers and medical assistants from having to compose an original letter every time they send correspondence on a topic such as cholesterol results and appointment reminders.

Managing electronic health records The EHR is only as good as its security. It must be monitored daily to ensure the program's integrity. EHRs that are not closely monitored are at risk of vandalism by computer hackers and are vulnerable to destruction by natural disaster or other means. If records are damaged or destroyed, patient care could be compromised.

Maintaining the EHR is the responsibility of the entire office, and each person may have specific responsibilities. The providers, office manager, and system administrator determine which major software updates are necessary and when the changes will be made. Software updates and adding new functionality will require training sessions for all users.

Additional training sessions will restore proficiency in forgotten applications, build competency in executing complex functions, and inform users about new EHR capabilities. In addition to ongoing end user training, technical support must also be provided. Larger organizations may have in-house technical support, especially for hardware issues.

Most EHR software vendors will also offer technical support for their customers. This service may be available over the phone or in an online format.

Patient Letter Providers send letters to patients for many reasons. For example, if the medical assistant is unable to reach the patient by phone regarding normal test results, the patient may be contacted by letter..

New patients are often sent a welcome letter, which outlines the office's general policies and procedures for the new patients. Appointment reminders and discharge letters are also examples of patient correspondence.

Finally, when making the confirmation call, staff should take the opportunity to check for any billing issues or insurance questions that need to be addressed.

Occasionally patients cannot be contacted via phone before their appointment because the phone was disconnected, the number was changed, or the number was entered into the EHR incorrectly. In such cases staff should ask the patient to update contact information during check-in.

A referral is different from a consultation. A consultation, according to the Centers for Medicare & Medicaid Services, occurs when a physician requests advice or an opinion from another physician or other qualified practitioner regarding the evaluation or management of a specific problem.

Only an opinion is offered with a consultation; no treatment is provided. With a referral, treatment of the condition for which the patient was referred is transferred to the specialist physician. (Occasionally one specialist refers a patient to another specialist in a different or more highly specialized field. For example, a gynecologist might refer a patient to a gynecologic oncologist for treatment of ovarian cancer.)

Often a particular physician lacks the expertise or proper credentials to treat a patient with a specific condition. An example would be a family practice provider who has diagnosed a patient with diabetes and initiates treatment.

Over time the patient has difficulty maintaining an appropriate blood sugar. The provider will send the patient to a board-certified physician for specialized treatment, testing, or consultation; in this case the patient would be sent to an endocrinologist. This is called a referral.

Sometimes the only clue that the physician has not is a third or fourth phone call from an increasingly irate patient. Once the request has been dealt with, a message is filed in the patient's paper chart. This small piece of carbon paper may be the only permanent record of the call and its content.

Paper or electronic, it is best to follow some simple guidelines to ensure the patient care is upheld while taking a message: 1. Document the patient name, date of birth, and phone number on the message. 2. Document the date and time of the call. 3. Document all instructions and conversations with the patient. 4. Document the name or initials of the person taking or returning the call on the message.

Staff members must be ready to help with anything the physician asks of them, within the bounds of ethics, law, and common sense.

Primary front office duties usually include: • Greeting patients on the phone and in person • Creating the patient record and managing an electronic health record (EHR) for each patient • Generating patient letters and other correspondence • Maintaining the schedule Providing patients with registration forms and other required documents such as Notice of Privacy Practices (NPPs).

When the number is underestimated, practices and kitchens are overstaffed. Because restaurants must keep perishables on hand, they also lose money by purchasing and prepping too much food.

Privately, restaurateurs have long bemoaned what they see as a scourge on the industry. According to the Operations and Information Management Department at the Wharton School, University of Pennsylvania, the industry-wide no-show rate was estimated to be around 20% for big cities. The rate of absenteeism surges on Saturdays and can be as high as 40% on weekends and during special occasions, such as graduation day in a college town.

The first concern has not been borne out by research. Krishna and Damato interviewed patients with ocular (eye) cancer who were referred to super specialized cancer physicians called ocular oncologists. The purpose of the study was to see how patients with a particularly stressful diagnosis would react to being given the additional information contained in the referral sent by the ocular oncologist to their GPs and to the referring ophthalmologist.

Rather than finding the referral stressful, the patients remarked that the explanations of their condition helped them accept it. Most used the letter as a jumping off point to discuss the diagnosis with their family and friends. In fact, the researchers found that 97% of patients appreciated receiving copies of the letters.

Communication within the healthcare facility and between patients and healthcare professionals is continually evolving.

Some medical offices now offer patient portals as a way of giving patients the option of viewing open slots on the schedule and making their own appointments online rather than having to call and ask which dates and times are available.

Stop accepting reservations altogether and seat diners on a first-come, first-served basis. This idea has worked well even at high-end restaurants like celebrity chef Rick Bayless's Frontera Grill in Chicago.

Stop accepting appointments and see patients on a total or partial walk-in basis. Some practitioners use online scheduling systems to allow patients to make their own appointments, leaving as many as two-thirds of the slots open on any given day. Other practices operate in tandem a traditional appointment schedule and a fast-track room for walk-ins.

. Automated systems are available for making confirmation calls, but in most small- and medium-size practices, front office assistants are expected to do so. Because many people have several phone numbers, leaving messages at more than one number is advisable, provided the practice has permission from the patient to do so. Text messaging and secure email can also be used to remind patients of upcoming appointments.

The Patient Dashboard in SimChart for the Medical Office (SCMO) displays a record of appointment dates and times. The EHR produces a history of canceled appointments and no-shows for each patient.

Good communication is so important; it actually reduces the likelihood a patient will bring a lawsuit even when a medical error is made.

The explanation for this phenomenon is simple—patients or family members who file lawsuits tend to be upset not so much that a mistake was made but that no one ever apologized for the error and the harm it caused.

Planning for these updates is also important, as it may mean that the software is unavailable for a period of time. Oftentimes the updates occur overnight, but they will require that someone be available in case of a problem with the installation and also to test the software to ensure that it is functional when the staff arrives to use it. It is important to maintain an inventory of the software and hardware assets found within the healthcare facility.

The first reason is to ensure that all assets are being used to their fullest functionality, and the second is to enable replacement of equipment if needed. Staff members (medical assistants, nurses, billing staff, and receptionists) must maintain patient confidentiality, and they may be responsible for backing up the EHR. End user training sessions should be conducted not only during the process of implementing the EHR but also on an ongoing basis throughout the year.

Most of us recall—or perhaps are still using—those pink "While You Were Out" memo pads for transcribing phone messages. Messaging in a paper-based office might also consist of scrawling a few facts on thin little slips of perforated carbon paper no bigger than a sticky note and just as easy to misplace.

These loose message slips are then placed in a bin or a tray on the physician's desk. If the provider needs to view the patient's chart in order to respond, the chart must be pulled. The staff has little way of knowing whether the physician has read a message, reviewed a laboratory result, or returned a call.

The healthcare facility must, by law, have a written backup and recovery plan in place (see Chapter 3). This detailed document should be stored in the office policies and procedures manual and be easily accessible.

This plan should outline what constitutes an emergency and should provide contact information for restoring the EHR (if the vendor is responsible for doing so), the location of the backup copy, instructions for managing patients while the software is down, and plans for inputting the data once the software becomes functional again.

In addition to the date and time, the script might include the following points:

• A reminder that the physician has reserved this time especially for him or her • A request to return the call to confirm the appointment or to reschedule if necessary • A request to bring to the appointment a list of current medications because many patients receive prescriptions from several different specialists • A reminder for the patient to check on his or her referral status if the patient's insurance company requires a referral • A list of forms of payment the practice accepts (for example, "We now accept MasterCard and Visa for your copayment, or you can pay by cash or check if you prefer.")

Occasionally letters are used to address unpleasant matters that must be put in writing for the legal protection of the practice. A request for payment of a delinquent balance is an example.

A less common situation occurs when patients must be formally notified that the patient-provider relationship (contract) is being terminated, usually because they continually miss appointments and disregard providers' treatment plans

We have one opportunity to create a positive first impression. That opportunity can take place when the patient comes into the healthcare facility, but the initial contact between the patient and the healthcare provider's office usually occurs by telephone with the medical assistant.

A telephone conversation, then, gives patients their first impression of the medical office. The medical assistant or staff member responsible for answering the telephone must maintain a professional and pleasant tone.

Paper-based offices have to pull a patient's chart a day or two ahead of time to ensure that the chart can be located and that all recent correspondence received has been filed in it. An EHR eliminates that step. All test results, referral letters, and other important clinical information will already be in the patient's EHR.

However, office staff should check to make sure that the provider has reviewed these items before the patient's visit.

Good communication among providers, patients, and staff is a key component in building patients' confidence in their care and increases their satisfaction with the medical practice.

It also makes healthcare personnel feel better about their jobs, which has been shown to lower staff and clinician turnover. Studies have shown that good communication also prevents many medical errors, thus improving care and reducing the incidence of malpractice lawsuits.

The front office assistant of the referring provider, the family practice provider in the above scenario, will complete a referral form to give the specialist a clear picture of the patient's general health, health history, and the condition for which the patient is seeking care.

The front office assistant should have a basic understanding of terminology and coding systems used to complete this form.

Eliminating Duplicate Charts The EHR should be a complete collection of a patient's health information; however, sometimes a duplicate patient chart is created in error. Perhaps the patient's last name changed due to marriage, or maybe the patient was set up as a new patient when in fact the patient had been seen before. This duplication creates a serious problem because it divides the patient information between two charts. To avoid this, the healthcare facility staff must ask pointed questions during the patient interview:

1. Ask whether the patient has ever been seen by the practice before. If so, use the already established patient EHR. Regardless of whether patients believe they are new to the office, always perform a patient search before creating a new record. 2. Ask established patients whether they have had a name change. 3. Always set up the patient EHR account using the name listed on the insurance card. Claims submitted with names that do not precisely match those on the insurance card may be denied for payment.

It is office policy to send all new patients a new patient welcome letter. Susannah Ling (DOB 01-02-1973) has recently scheduled an appointment with Walden-Martin Family Medical Clinic. Prepare a new patient welcome letter for Susannah Ling. (Susannah Ling was entered as a new patient in Chapter 2.)

1. Click on the Correspondence icon and select the New Patient Welcome template (Fig. 4.3) from the Letters section of the left Info Panel. Fig. 4.3 New Patient Welcome letter template in SimChart for the Medical Office. 2. Click the Patient Search button at the bottom to assign the letter to Ms. Ling. The patient demographics are auto-populated. 3. Confirm the auto-populated details and include any additional information needed. 4. Click the Save to Patient Record button.

Create a Patient Referral Noemi Rodriguez (DOB 11-04-1971) is being referred to a cardiologist to perform an echocardiogram (CPT 99307) for mitral valve prolapse (MVP) (ICD-10-CM I34.1). According to past office notes, the significant clinical information/symptoms include the fact that the patient has experienced palpitations over the past 2 months. There have been no previous treatments for the MVP. Noemi has no known allergies and takes only a multivitamin daily. The echocardiogram will be performed at Cardiology Associates, located at 445 Heart Valve Way, Anytown, AL 12345. This procedure will take one visit and will be done as an outpatient procedure. Dr. Walden is the referring provider and also the family physician. The NPI number is 8788012880, and the authorization number is NNP3234. It expires 30 days from today.

1. Click on the Form Repository icon and then select Referral from the left Info Panel (Fig. 4.2). Use the Patient Search button to link the document to the patient record before proceeding. Fig. 4.2 Referral template in SimChart for the Medical Office. 2. Fill in the blank text fields and save the completed document to the patient record using the Save to Patient Record button. You can access this saved form anytime by using the Patient Dashboard.

EHR Exercise 4.8 Complete an Incident Report Complete the following exercise in EHR Exercises found in the Info Panel. Carl Bowden (DOB 04-05-1954) arrived for his appointment with Dr. Walden, and as he was walking across the waiting room, he tripped on the rug. This was witnessed by the appointment coordinator, who was working at the front desk. Mr. Bowden landed facedown in front of the reception desk. The appointment coordinator, a medical assistant, called for help and went to the patient. Dr. Walden and the medical assistant assisted the patient to the examination room, where Dr. Walden concluded that Mr. Bowden had minor bruising from the fall. Complete the necessary incident report.

1. Click on the Form Repository icon, and then under Office Forms select Incident Report (Fig. 4.10) from the left Info Panel. Fig. 4.10 Incident report in SimChart for the Medical Office. 2. Document today's date, and the time of 2:30 p.m. 3. Select "Patient" for the "Incident Type" and "Staff" as the "Witness." 4. Document "Reception" in the "Department" field and "Waiting Room" in the "Exact Location" field. 5. Document "physician, medical assistant" as the Medical Team. 6. Document "scheduled appointment" as the Patient Reason for Visit. 7. Select the "No" radio button to indicate that this incident is not a Medication Incident. 8. Document "Patient tripped on the rug in the waiting room, landing facedown on the floor" in the "Incident Description" field. 9. Document "Physician and medical assistant assisted patient to examination room. Physician determined that there was minor bruising from the fall" in the "Immediate Actions and Outcome" field. 10. Document "Rug on floor" in the "Contributing Factors" field. 11. Document "Remove rug" in the "Prevention" field. 12. Select the No check box to indicate that the next of kin/guardian has not been notified. 13. Select the Yes check box to indicate that the medical staff has been notified. 14. Document your name in the "Reported By" field. 15. Document "appointment coordinator" in the "Position" field. 16. Document "123-123-1234" in the "Contact Phone Number" field. 17. Document "Dr. Walden" in the "Other Persons Involved" field. 18. Document "physician" in the Position field. 19. Document "123-123-1234" in the "Contact Phone Number" field. 20. Select Julie Walden, MD from the Provider drop-down menu. 21. Document "Self-inflicted" in the "Designation" field. 22. Select the Signature on File check box and document the current date and time in the "Date/Time" field. 23. Click the Save button. To view the completed form, click on the Saved Forms tab and select the Incident Report from the drop-down menu.

Complete a Certificate to Return To Work Complete the following exercise in EHR Exercises found in the Info Panel. Jenny Adams (DOB 02-12-1983) is in for her follow-up appointment with Dr. Perez. Jenny had dropped an ax on her foot while chopping fire wood when camping 8 weeks ago. She has been under Dr. Perez's care for several broken metatarsals in her left foot since that time. Jenny was unable to stand to do her job while the fractures were healing. Dr. Perez has stated that Jenny is completely healed and can now return to work at full duty. Jenny states that her employer is requesting a return to work certificate. Complete the necessary form.

1. Click on the Form Repository icon, and then under Patient Forms select Certificate to Return to Work or School (Fig. 4.9) from the left Info Panel. Fig. 4.9 Certificate to Return to Work or School in SimChart for the Medical Office. 2. Click the Patient Search button at the bottom to assign the form to Ms. Adams. The patient name is auto-populated. 3. Document the date that care started. 4. Document the date that the patient can return to work. 5. Document "Broken metatarsals" in the "Nature of Illness or Injury" field. 6. Document "None" in the Restrictions field. 7. Check the box next to "Signature on File." 8. Enter today's date in the "Date" field 9. Click the "Save to Patient Record" button. You can access this saved form anytime by using the Patient Dashboard.

EHR Exercise 4.10 Block Out-of-Office Appointments Complete the following exercise in EHR Exercises found in the Info Panel. Jean Burke, NP, is attending a training seminar for wound treatment on Monday from 9:00 a.m. to 12:00 p.m. and will not be available for patient appointments during that time. Block this time for Jean Burke, NP.

1. Click the Add Appointment button. Select Block as the Appointment type. 2. Select Out-of-Office as the Block type. 3. Select Jean Burke, NP, to specify who this blocked time is for. 4. Because this time will be spent out of the office, no location is needed. 5. Use the calendar picker to select Monday as the meeting date. 6. Select a start time of 9:00 a.m. and an end time of 12:00 p.m. 7. Document "Wound treatment training" as the Description. 8. Click the Save button. A confirmation message will appear, and this time will be blocked on the calendar for Jean Burke NP.

EHR Exercise 4.9 Block Time for a Staff Meeting Complete the following exercise in EHR Exercises found in the Info Panel. The providers at Walden-Martin Family Medical Clinic want to schedule a staff meeting to discuss opening a new laboratory, new uniform requirements, and professionalism. An hour-long time slot is open this Friday at 3:00 p.m. Coffee and water will be provided. Reserve the meeting room for this meeting.

1. Click the Add Appointment button. Select Other as the appointment type. 2. Select Staff Meeting as the Other Type. 3. Select Meeting Room as the Location. 4. Select All Staff as the Attendees. 5. Use the calendar picker to select this Friday as the meeting date. 6. Select a start time of 3:00 p.m. and an end time of 4:00 p.m. 7. Document the agenda in the "Description" field as "Discussion topics: New laboratory opening, new uniforms, and professionalism. Coffee and water provided." 8. Click the Save button. A confirmation message will appear, and the meeting will be displayed on the calendar.

A fax machine is a device that encodes documents in order to transmit them over telephone lines. The fax, like email, enables quicker message transmission than traditional mail. However, it poses several security and integrity risks:

1. Faxes can be misdirected because of human error or technical glitches. 2. The recipient of a fax cannot be verified because anyone can pick up the printed document if the machine is placed in an unsecure location. 3. It is difficult to verify that all pages were received. 4. You can mitigate these risks by following some common-sense guidelines: a. Inform the recipient before sending any confidential patient information so that it can be retrieved immediately. b. Use a cover sheet when sending a fax (Fig. 4.8). The cover sheet should include the sender's contact information, a confidentiality disclaimer, and recipient information. Fig. 4.8 Example of a fax over sheet. c. Follow up with the intended recipient to ensure that the message was received. d. Document the date and time, and initial the faxed information to create a paper trail. e. File the completed cover sheet in the patient's record.

The increased use of laptops that can run on battery power for a short period of time if the electricity goes out. Some offices may revert to written documentation while the power is off and then input the data once the software is running again. Caution should be taken, however, because rewriting documentation increases the risk of error. It is good practice to input only the data you gathered yourself and not information that a coworker gathered. This kind of backtracking can cost the practice thousands of dollars in paid overtime for office staff.

Backup takes place at a minimum of once daily to every 15 minutes or even as often as every keystroke. It is usually the job responsibility of one or two reliable workers, or the EHR vendor may conduct routine backups. Although having off-site copies of patients' charts is an advantage to patients, security must be monitored closely. Patient confidentiality and security must remain as much of a priority for the backup copies as it is for the primary EHR systems in the medical office. For this reason, backup copies should be stored in a remote location, such as a bank vault, or should be maintained by a separate entity, such as the EHR vendor. The EHR vendor may provide a data recovery package that can guarantee data backup or recovery and virus protection. An EHR vendor based as Software as a Service (SaaS) (see Chapter 2) will remotely provide backups online to minimize the risk of lost information.

In the United Kingdom patients receive copies of referrals sent to their general practitioners (GPs) after hospital consultations. Should physicians in the United States follow the United Kingdom's lead and voluntarily send referral copies to patients?

Baxter and colleagues identified four primary reasons that physicians are uncomfortable copying communication to patients. First, they worry such communication might make patients anxious about their condition. Second, they believe patients may have difficulty understanding medical terminology and do not wish to translate the information. Third, they worry that misdirected communication might violate the patient's privacy rights. Fourth, providers cite the additional workload and associated copying costs.

When using an electronic appointment book, the medical assistant simply can search for specific appointment times, specific providers, and/or specific examination rooms (therefore ensuring the appropriate equipment is available) for the patients. At the same time, coworkers can be setting up appointments for other patients or viewing provider appointments.

Before an established patient's appointment is scheduled, his or her demographic information should be reviewed and verified. If there is change in that demographic information, it should be updated in the EHR system. When the appointment is scheduled, the demographic information is auto-populated in the schedule.

Calendar Views In a paper system an appointment book can be viewed only two ways: open or closed. The SCMO scheduling system offers many different views, accessible from the blue tabs on the left side of the screen: Calendar View, Examination Room View, and Provider View (Fig. 4.11). Users can also view a patient's next scheduled appointment using the Search field (Fig. 4.12). Fig. 4.11 Calendar View (red rectangle: top left) and Exam Room View and Provider View (red rectangle: bottom left) tabs in SimChart for the Medical Office. Fig. 4.12 Search field (red rectangle) in SimChart for the Medical Office. Scheduling in SCMO is done by clicking on the orange Add Appointment button from the Calendar View (Fig. 4.13) or by double-clicking within the calendar. The New Appointment box appears (Fig. 4.14). SCMO allows the user to enter three different types of appointments. 1. Patient Appointments—new and established patient visits with any of the providers in the practice 2. Block Appointments—indicates times that a provider is unavailable due to lunch, out-of-office time, office hours, or holidays 3. Other Appointments—time for staff, sales, and pharmaceutical meetings

Block an Appointment Time Appointment slots might be blocked for a variety of reasons, such as the following: 1. To set up the appointment matrix to show when the provider is available for patient appointments. 2. To account for routine days off, such as holidays. 3. To schedule provider vacations, business travel, or personal time off. Some offices block out more time during the last several days before a trip and then open up the slots for urgent care patients as the need arises. During the provider's absence, the offices may also block out time on his or her partners' schedules so that they can cover urgent care visits while the physician is away. 4. To schedule provider maternity or paternity leave, family medical leave, sick leave, or other leaves of absence. 5. To block out time before and after lunch or just before closing, ensuring that the staff and providers actually get to eat lunch and perhaps leave the office by quitting time. Appointment slots should be blocked out as soon as you know the time has become unavailable. Holidays and other office closings should be blocked at the beginning of the year. To block out time in the calendar, use the block appointment type.

What the Restaurant Industry Can Teach Us About No-Shows Anyone would be excused for thinking that the owner of Eddie's Steak and Chop has little in common with Edmund Newland Pierpont III, MD. But for restaurant owners and healthcare providers alike, no-shows are a continual annoyance and a financial drain. Oftentimes when patients, or others who wish to speak with the provider, call with a nonurgent concern, the medical assistant in the front office will have to take a message. It is important that all of the pertinent information is obtained and documented concisely and accurately in that message. If the message is recorded in a paper format, it is best to use a product that will provide a copy of the message in case the original gets misplaced. When using an electronic system, often part of the EHR, a template is provided (Fig. 4.1), and all necessary fields must be completed. The following is the basic information needed for all phone messages: • Name of the caller • Date and time of the call • Who the message is for • Who the patient is (if it is regarding a patient situation) • Patient's date of birth (to ensure that the proper health record is referenced) • A concise and accurate documentation of the message • For prescription refills the medication name, pharmacy name, and number are needed Phone contact with or about a patient needs to be documented in the health record. With an EHR this will likely happen automatically when creating the phone message. In a paper record the medical assistant should record the fact that the call has been received. (Pepper, 092019, pp. 62-63) Pepper, J. (092019). The Electronic Health Record for the Physician's Office, 3rd Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9780323642651 Always check citation for accuracy before use.

Both medical offices and restaurants routinely overbook in anticipation of no-shows. When the number of no-shows is overestimated, disgruntled patients and diners are subjected to long waits.

EHR Exercise 4.13 Schedule a Patient Appointment Complete the following exercise in EHR Exercises found in the Info Panel. Susannah Ling (DOB 01-02-1973) calls Walden-Martin to set up a new patient appointment with Dr. Martin next Wednesday at 10:00 a.m. Dr. Martin requires 30 minutes for appointments with new patients. Schedule an appointment for Ms. Ling. 1. Within the Front Office, Calendar, click the Add Appointment button. 2. Within the New Appointment window, select Patient Visit as the appointment type. 3. Select New Patient Visit as the visit type. 4. Document New Patient PE as the Chief Complaint. 5. Susannah Ling was added as a Walden-Martin patient in Chapter 2, select the Search Existing Patient radio button to search for Susannah's record. 6. Select James A. Martin, MD, as the provider. 7. Use the calendar picker to select next Wednesday as the appointment date. 8. Select a start time of 10:00 a.m. and an end time of 10:30 a.m. 9. Click the Save button, and the appointment will be displayed on the calendar.

Chase Murray (added as a Walden-Martin patient in Chapter 2) called complaining of a rash on his lower extremities. The first available appointment with Dr. Martin is next Wednesday at 1:00 p.m. Dr. Martin requires 15 minutes for urgent office visits. Schedule an appointment for Mr. Murray using examination room 4. Prison guard Miles Green (added as a Walden-Martin patient in Chapter 2) was bitten by the drug-sniffing canine during training this morning and will need sutures. Schedule an urgent appointment with Jean Burke, NP, for 30 minutes at 4:00 p.m. Al Neviaser needs to schedule a follow-up appointment with Dr. Walden to check his high blood pressure. Mr. Neviaser is available next Wednesday at 11:00 a.m. Dr. Walden requires 15 minutes for follow-up appointments and likes to perform these types of visits in examination room 6. (Pepper, 092019, p. 80) Pepper, J. (092019). The Electronic Health Record for the Physician's Office, 3rd Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9780323642651 Always check citation for accuracy before use.

Incident Report

Click Form Repository Document Day and Time Select which person for incident type Staff and witness Document where it happened Document the physician, medical assistant or whoever helped out Document details for for immediate action and details Document what caused it in the Contributing Factor Filed Document how to prevent Select no on next of kin Select yes for medical team has been notified Document your name by the reported field Document your position Document phone number and address Document persons involved Self inflicted Select signature Select save

Phone contact with or about a patient needs to be documented in the health record. With an EHR this will likely happen automatically when creating the phone message. In a paper record the medical assistant should record the fact that the call has been received.

Compare the efficiency of electronic messaging systems to that of a paper-based system. Some offices use a time and date stamp to log incoming messages.

EHR Exercise 4.14 Edit an Appointment Complete the following exercise in EHR Exercises found in the Info Panel. Susannah Ling calls back and states that her car will not start. She would like to reschedule her appointment. Move her appointment to this Friday at 10:00 a.m. 1. Click on Ms. Ling's existing appointment on the calendar. 2. Within the Saved Appointment window, use the calendar picker to select this Friday as the appointment date. 3. Click the Save button. A confirmation message will appear, and the appointment will be updated on the calendar.

EHR Exercise 4.15 Delete a Patient Appointment Complete the following exercise in EHR Exercises found in the Info Panel. Chase Murray calls Walden-Martin later in the day and reports that his rash turned out to be dry skin. Cancel his appointment. 1. Click on Mr. Murray's appointment on the calendar. 2. Change the status to Canceled using the Status drop-down at the bottom of the Saved Appointment window. 3. Document the reason for cancellation and click the Save button. 4. A confirmation message will appear, and the appointment will be removed from the calendar.

Compose a Phone Message Complete the following exercise in EHR Exercises found in the Info Panel. Dr. Pericardio has called at 1:15 p.m. today to discuss patient Noemi Rodriguez (DOB 11-04-1971). Her echocardiogram was positive for mitral valve prolapse (MVP), and Dr. Pericardio requests that Dr. Walden return his call when he is free. Dr. Pericardio can be reached after 4:00 p.m. today at 123-545-8912. Compose a phone message to communicate this information to Dr. Walden. 1. Click on the Correspondence icon and then select the Phone Message template from the left Info Panel (Fig. 4.1). 2. Click the Patient Search button to perform a patient search and assign the phone message to Ms. Rodriguez. 3. Confirm the auto-populated details and enter any necessary information based on the case study. 4. Click the Save to Patient Record button.

EHR Exercise 4.2 Compose a Phone Message Complete the following exercise in EHR Exercises found in the Info Panel. Consumer Pharmacy called today at 10:00 a.m. to inform the Walden-Martin office that it has a shortage of Abilify. The pharmacy expects to get its shipment Saturday but will not be able to fill a prescription for Noemi Rodriguez (DOB 11-04-1971) until then. Compose a phone message to inform Dr. Martin of this shortage using the same workflow provided in EHR

EHR Exercise 4.5 Patient Email Correspondence Complete the following exercise in EHR Exercises found in the Info Panel. Mora Siever (DOB 01-24-1964) had a normal left ankle x-ray last Wednesday. It is Walden-Martin policy to email patients normal results. Mora's email address is [email protected]. Use the Correspondence menu to create a Normal Results email for Mora. 1. Click on the Correspondence icon and select the Normal Test Results template (Fig. 4.6) from the Emails section of the left Info Panel. Fig. 4.6 Normal Test Results template in SimChart for the Medical Office. 2. Click the Patient Search button at the bottom to assign the letter to Mora Siever. Confirm that the correct email address has populated the "To:" field. 3. Enter "x-ray Results" in the "Subject" field. 4. Confirm the auto-populated demographic details and document "left ankle x-ray" in the field with the "Test Name" watermark. 5. Document last Wednesday's date in the field with the "Date of Service" watermark. 6. Click the Send button. You can access this saved email anytime by using the Patient Dashboard.

EHR Exercise 4.6 Compose a Patient Email Message Complete the following exercise in EHR Exercises found in the Info Panel. Norma Washington (DOB 08-01-1944) has been waiting for the smoking cessation program to begin at Butler Hospital, and you received word today that 6:00 to 8:00 p.m. classes will start this Monday in the Lawson meeting room. Compose an email message for Ms. Washington informing her of this program. Her email address is [email protected]. 1. Click on the Correspondence icon and select the Blank Email template (Fig. 4.7) from the Emails section of the left Info Panel. 2. Click the Patient Search button to assign the email message to Ms. Washington. 3. Confirm the auto-populated details and enter any necessary information based on the case study. 4. Click the Save to Patient Record button.

Backing Up the Electronic Health Record With the use of paper-based records, protecting patient records consists of little more than storing charts in filing cabinets that are locked at the end of the day. Charts are at risk of damage from wear and tear, weather, and accidents (such as the occasional spilled cup of coffee). Paper records can be irrecoverably damaged or lost in a fire or flood, as there is no other copy of the record.

EHRs eliminate this concern if the records are backed up at a secondary, off-site location. When the software is working, the healthcare facility can run smoothly and efficiently. But no matter what precautions the medical office takes, trouble can still arise. For example, the power may be lost during severe weather, disabling computers and other electronic equipment (including the EHR). Virus attacks, hardware or software failures, and simple human error can bring a healthcare facility to a standstill.

Integrated Devices In most healthcare facilities, the EHR system has to talk to other devices used within the organization. Scanners are used in several ways in a healthcare facility.

Faxed information needs to be documented in the EHR as well, and many machines can be integrated into the EHR so that this is a seamless process. Obtaining the patient signature electronically can be accomplished by having patients sign on a signature pad so that there is documentation of receiving the NPPs, for example. Cameras are also used to help establish patient identity at check-in and to perform certain procedures within the healthcare facility.

Common Types of Telephone Calls in the Medical Office • Appointment requests • Inquiries from prospective patients about the practice • Requests for medical advice from a physician or nurse • Prescription refill requests • Insurance and billing questions from patients • Information requests from insurance companies • Questions from pharmacists, medical supplies vendors, and other medical offices

Following are some guidelines for telephone etiquette in the medical office: • Do not use office telephone lines for personal conversations. Keep your cell phone conversations short and private and take such calls only while on break. • Greet the caller by the third ring, if possible. • Answer the call with a professional, pleasant greeting, such as, "Good morning, Walden-Martin Family Medical Clinic. This is Amber. How can I help you today?" The greeting should include your name so that the caller can ask for you again, if necessary, or can mention the call to another staff member (as in "I spoke to Amber yesterday about being placed on your waiting list"). • Smile as you answer the telephone. Callers will hear the cheerfulness in your voice. • Speak slowly and clearly, adjusting your volume if you know or suspect the caller has a hearing deficit. • Obtain the caller's full name, a return telephone number, and the reason for the call. Verify any spelling and contact numbers for accuracy and summarize the reason briefly and precisely. • If it is necessary to place the caller on hold, do so only after asking the patient's permission and awaiting a response. Few patients, if any, will refuse to be placed on hold when you make a polite request. Limit the hold time to less than a minute, if possible. • Document your conversation with the caller, along with the time and date and your initials. • To ensure that all of the caller's questions have been answered, allow her or him to end the conversation. Appointment Confirmation

Many EHR systems also have functionality that enables the staff members to create their own letters from the clinical documentation in the chart using macros—embedded instruction codes that automatically gather information from the patient's demographics, case information, encounter information, orders, provider's history and examination notes, healthcare professionals' documentation, prescribed medications, future appointments, referral orders to specialists, and aftercare instructions.

For example, if you work for a specialist who treats burn patients and you write letters to the referring physicians to update them about a patient's progress, you can enter the term [body_surface_area] into a letter template, and the EHR will automatically use the patient's height and weight to calculate the patient's body surface area and enter it into the letter.

Patients can request that their information be shared with others for a number of different reasons. They may want their spouse to be able to call in and get their test results. They may want to obtain a copy their own records. They may want to have records sent to another provider. In each of those situations the patient would need to complete a form and sign it. The form then becomes part of their record.

HIPAA is very specific about the information that must be on a release of information form including; patient's name and date of the request, the person or facility that is releasing the information, the person or facility that is receiving the information, what specific information should be released/disclosed, an expiration date, and a statement to notify patients of their right to revoke the release. Within SCMO you will find a Patient Records Access Request, a Medical Records Release, and a Disclosure Authorization form in the Form Repository.

This haphazard method can cause stress for both medical assistants and patients. In addition, poor scheduling leads to longer patient wait times, a key factor in determining patient satisfaction. Patients should be seen within 5 to 10 minutes of arrival, but absolutely no more than 15 minutes of wait time should occur.

In the medical office, an electronic appointment book is the key to efficient time management. Several users can access the electronic appointment book at once. Patient appointment sheets can be printed out daily so that the physicians, medical assistants, nurses, and receptionists are all aware of the patient load for the day. Patients can be easily rescheduled, and appointment availability can be searched based on patient preferences.

Purging Patient Records Patient health records can be classified into three different groups: active, inactive, and closed. Active records are those of patients who have been seen within the past 3 years (see Chapter 2). These records are easily accessed and used frequently.

Inactive records are those of patients who have not been seen by any provider in the medical office within the past 3 years. Closed records are those of patients who have terminated their relationship with the medical office; some have moved away, others have been asked to leave the healthcare facility because of bad debt or failure to follow the providers' advice, and some have died.

Callie Rose Barneson is a new patient to Walden-Martin Family Medical Clinic. She would like to schedule an annual exam with Dr. Perez. Callie has Wednesdays off from work and would like to get an appointment early in the day on any available Wednesday. You can find Callie's Patient Information form posted in the Content Updates on the companion Evolve website. 1. Click the Patient Demographics icon. 2. Attempt a patient search by entering the first couple of letters of the patient's last name in the "Last Name" field. Click the Search Existing Patients button. 3. If no patient record exists, the Add Patient button will appear under the search field. Click on the Add Patient button to create a new record. 4. Enter the Patient information. 5. Click on the Guarantor tab and complete. 6. Click on the Insurance tab and complete. 7. Scroll to the bottom of the Patient Demographics window and click the Save Patient button. 8. Click the Add Appointment button. 9. Within the New Appointment window, select Patient Visit as the appointment type. 10. Select New Patient Visit as the visit type. 11. Document New Patient PE as the Chief Complaint. 12. Select the Search Existing Patient radio button and click the Save button to search for Callie's record. 13. Select Angela N. Perez, MD, as the provider. 14. Use the calendar picker to select next Wednesday as the appointment date. 15. Select a start time of 10:00 a.m. and an end time of 10:45 a.m. 16. Click the Save button, and the appointment will be displayed on the calendar.

It is Walden-Martin's policy to send a New Patient Welcome letter to all new patients after they have scheduled their first appointment. Prepare and send this letter to Callie Barneson. 1. Click on the Correspondence icon and select the New Patient Welcome template from the Letters section of the left Info Panel. 2. Click the Patient Search button at the bottom to assign the letter to Ms. Barneson. The patient demographics are auto-populated. 3. Confirm the auto-populated details and include any additional information needed. 4. Click the Save to Patient Record button.

Perhaps a compassionate industry like healthcare cannot borrow the most punitive of these strong-arm tactics, but many restaurant-industry solutions are adaptable to healthcare.

It is helpful to develop a script for making confirmation calls. With the implementation of technology, offices are using email and text messaging to confirm patient appointments. This script should become part of the office procedures manual.

Ken Thomas is checking in for his appointment with Dr. Kahn and he mentions that his insurance has changed. He recently got a new job and now has insurance through Aetna. His new employer is Anytown Construction and their phone number is 123-983-6065. He is still the policy holder, the Policy Number is AC559922345 and the Group Number is 773J998. Update Mr. Thomas' demographic information. 1. Click on the Patient Demographics icon, search for the patient by clicking on the Search Existing Patient button. 2. Verify that you have the correct patient by checking the DOB, click on the patient's name (in blue). 3. On the Patient tab enter Mr. Thomas' employer information. 4. On the Insurance tab enter the new Primary Insurance information. 5. Click on the Save Patient button.

Jana Green (DOB 05-01-1936) has called to schedule a follow-up appointment with Jean Burke NP, Mrs. Green was diagnosed with polymyalgia rheumatica and is coming in for another sedimentation rate test and a quick chat with Jean. Mrs. Green has a ride available on Thursday afternoon. Schedule the appointment for Mrs. Green. 1. Within the Front Office, Calendar, click the Add Appointment button. 2. Within the New Appointment window, select Patient Visit as the appointment type. 3. Select Follow-up/Established Visit as the visit type. 4. Document "Follow-up on polymyalgia rheumatic with sed. rate" as the Chief Complaint. 5. Click on the Search Existing Patient radio button to search for Susannah's record. 6. Select Jean Burke, NP as the provider. 7. Use the calendar picker to select next Thursday as the appointment date. 8. Select a start time of 1:00 p.m. and an end time of 1:15 p.m. 9. Click the Save button, and the appointment will be displayed on the calendar.

Another responsibility for a front office assistant working a medical office is the completion of a variety of forms. These forms can be for the patient, for internal use, or a combination. Forms such as a return to work/school form provides that patient with the information required by their employer or school. Incident reports are used internally used to document risk factors and make appropriate changes to policies. The completion of these forms is essential to providing the best possible care for our patients.

Many employers require a statement from an employee's provider if they miss work due to illness or injury. The employer wants to be sure that provider feels that the employee will be fully able to do their job. If they are not fully able to do their job, what restrictions are there. The employer may be able to find other work for the employee to do or adjust their schedule to fit those restrictions. Some schools also require this type of documentation.

Reducing No-Shows Restaurant Industry Tactic Adaptation for the Medical Practice Require diners to supply their credit card number to make a deposit that is forfeited if they do not honor the reservation.

Many medical offices now notify patients that they will be charged either a percentage of the cost of a procedure or the full cost of a visit if they do not show up or cancel.

Demographics. All in a day's work Let us take a look at some of the typical activities in day of using an Electronic Health Record (EHR) for administrative tasks. Complete the following exercises in EHR Exercises found in the Info Panel. Brad Waldorf (DOB 12-14-1978) has called to update his address. He and his wife have recently moved. His new address is 916 Maryland Ave. Anytown AL 12345-1234. Update Mr. Waldorf's address. 1. Click on the Patient Demographics icon and perform a patient search for Brad Waldorf. 2. Click on Brad's name to open the Patient Demographics - Edit Patient window. 3. Enter the new address. 4. Click the Save Patient button.

Maude Crawford (DOB 12-22-1946) stops at your desk after her visit with Dr. Walden. She would like to allow her son to have access to her health information and to be able to speak to Dr. Walden about her health. Her son's name is Jonathan Crawford and his address is 2409 Livingston Lane Anytown AL 12345-1234. Complete the Disclosure Authorization form for Mrs. Crawford to sign. 1. Click on the Form Repository icon and select Disclosure Authorization under Patient Forms in the Info Panel. 2. Perform a Patient Search for Maude Crawford. Verify the auto-populated information. 3. Enter "Walden-Martin Family Medical Clinic" in the "Discloser" field. 4. Enter "all of my health concerns" in the "Related to" field. 5. Enter "Jonathan Crawford" in the "Representative" field. 6. Enter "2409 Livingston Lane Anytown AL 12345-1234" in the "Representative's Address" field. 7. Enter "Family concerns" in the "Purpose" field. 8. Check the box next to "Signature" on File. 9. Enter today's date in the "Date" field. 10. Enter "Son" in the "Authority or Relationship to Individual, if Representative" field. 11. Enter that date one year from today's date in the "This authorization will expire on" field.

A twist on confirming reservations is calling no-shows the following day to ask why they were not able to come. This is a bit of a guilt trip, but it educates diners that the restaurant missed their business and was inconvenienced by their absence.

Medical offices can call patients to ask why they missed their appointments (incidentally, the most common reason is "I forgot"). Patients can be gently reminded that the physician had reserved the appointment time especially for them and can be given the option of rescheduling. Keep callers on the phone longer. This eats up staff time, but it pays off because diners quickly develop a personal connection with the restaurant.

Call to remind diners of their reservation by saying, "I'm calling to confirm that you still plan to join us." Then—and here is the key—wait for an answer. Research has shown that diners who have given their word are less likely to blow off a reservation.

Medical offices can do the same—that is, call to confirm patient appointments and wait for patients to give their word that they will either show up or call in advance to cancel.

• Promotes respect and trust between patient and provider • Better informs patients about why they are being referred, which improves follow-up and compliance with the specialist's recommendations • Allows patients to become more involved in their healthcare and to take responsibility for making informed choices • Improves documentation both for the provider who copies the referrals to patients and for the specialist physician who sends patients a copy of the plan of care he or she shares with the patient's GP • Encourages accuracy because patients have an opportunity to review the practitioner's notes, in effect, and thus correct any misinformation, such as dates of surgery and medication dosages • Promotes a two-way exchange of information rather than an authoritative, top-down communication process • Gives the provider an additional chance to communicate information about health promotion and healthy living Remember, it is fairly easy to craft communication in an electronic health record because you can design templates that populate automatically with information from the patient's chart.

Of course, providers in the United States are not required to share their correspondence with patients. Meaningful use stage 2 requirements do require physicians to provide visit summaries, which can be helpful in improving the communication process as well.

Current Procedural Terminology (CPT) codes are used to designate procedures and services being requested of the specialist. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are used to designate the diagnosis that the patient is being referred to the specialist for.

Once the specialist has seen the patient, he or she will contact the referring physician by phone or letter to outline the treatment plan.

An excessive no-show rate will inhibit the functioning of the office. It is important for the healthcare facility to determine the most common reasons for no-shows and implement policies to help limit the number of no-shows.

Patients should be encouraged to call and cancel if they cannot make their appointment so that the slot can be made available to other patients. Oddly enough, healthcare facilities might be able to learn a thing or two about no-shows from the restaurant industry, for which no-shows are a perpetual problem

It is Walden-Martin's policy to notify patients when they have missed an appointment. This can be done by either email or letter, whichever the patient prefers. Frank McDouglas (DOB 01-27-1965) missed his 10:00 a.m. appointment this morning with Dr. Martin. He has indicated that he prefers to get his correspondence via email. His email address is [email protected]. Complete the Missed Appointment email for this appointment. 1. Click on the Correspondence icon and select Missed Appointment under Email in the Info Panel. 2. Perform a patient search for Frank McDouglas. Verify the auto-populated information. 3. Enter Mr. McDouglas' email address in the "To:" field. 4. Enter "Today appointment" in the "Subject" field. 5. Enter "Dr. Martin" in the "Provider Name" field. 6. Enter today's date in the "Date" field and 10:00 a.m. in the "Time" field. 7. Click on the "Send" button.

Pedro Gomez (DOB 07-01-2007) fell while riding his bike after school yesterday. Pedro's mother Maria has brought him because he is favoring his right wrist. Dr. Kahn has examined Pedro and determined that he has a sprained wrist and does not want him to participate in his physical education class at school for two weeks. Ms. Gomez has asked for note for Pedro's school. Complete the Certificate to Return to Work or School. 1. Click on the Form Repository icon, and then under Patient Forms select Certificate to Return to Work or School from the left Info Panel. 2. Click the Patient Search button at the bottom to assign the form to Pedro Gomez. The patient name is auto-populated. 3. Document the date that care started. 4. Document the date that the patient can return to school. 5. Document "Sprained right wrist" in the "Nature of Illness or Injury" field. 6. Document "No physical education class for two weeks" in the "Restrictions" field. 7. Check the box next to "Signature on File." 8. Enter today's date in the "Date" field 9. Click the "Save to Patient Record" button.

Guidelines for Sending Professional Email Email sent from your office email account should reflect a high level of professionalism. Remember that email is a form of documentation. Accordingly, much of the email you send and receive will end up in a patient's permanent legal medical record.

The following are guidelines to help ensure that your email messages meet the highest professional standards. • Ask yourself whether sending an email is the best way to communicate in a given situation. The tone of an email message can easily be misinterpreted, especially when addressing touchy subjects. Reread your email before sending and consider asking a staff member for a second opinion. • Never send an email to anyone immediately after an unpleasant incident, when you are still upset about it. If you must write it, save a draft of the message and review it when you have a cooler head. You can always send it later, but you cannot take it back later. • Triage messages as you receive them, expediting those that are urgent. You may need to refer to the patient's electronic health record (EHR) to determine how to prioritize a message. • Avoid the temptation to offer a diagnosis or treatment advice in response to a patient's email; leave clinical tasks to the provider. • Use a descriptive, specific subject line (for example, Mandatory Staff Meeting, 11/15, 4:30). • Proofread your message carefully for typographical and grammatical errors. • Avoid using all-capital letters in the body of your message or in the subject line. • Keep your messages brief and use a formal but conversational style. • Never send jokes, stories, chain letters, or other inappropriate content. • After forwarding or replying to an email, file or archive it in the correct part of the EHR. A backlog of unfiled messages creates confusion that may lead to critical errors, such as missed test results.

Oftentimes when patients, or others who wish to speak with the provider, call with a nonurgent concern, the medical assistant in the front office will have to take a message. It is important that all of the pertinent information is obtained and documented concisely and accurately in that message. If the message is recorded in a paper format, it is best to use a product that will provide a copy of the message in case the original gets misplaced. When using an electronic system, often part of the EHR, a template is provided (Fig. 4.1), and all necessary fields must be completed.

The following is the basic information needed for all phone messages: • Name of the caller • Date and time of the call • Who the message is for • Who the patient is (if it is regarding a patient situation) • Patient's date of birth (to ensure that the proper health record is referenced) • A concise and accurate documentation of the message • For prescription refills the medication name, pharmacy name, and number are needed

Secure email is an inexpensive, efficient system for exchanging messages through the Internet using secure encryption technology. This versatile means of communication has many different uses in the medical office. The office accountant may email an insurance company to obtain an authorization.

The office manager may email other staff regarding changes in office procedures. One practice may email another to request a referral for a patient office visit. Other common message topics include patient orders, notification of schedule changes, and patient education.

The no-show rate among medical practices, curiously enough, falls within the same range. Unfortunately, those specialty practices that are already difficult to get into can sometimes see no-show rates of as high as 50% in a single week. The no-show rate tends to be higher among practices with a large proportion of new, self-pay, or Medicare patients. The proportion is lower among practices with a large proportion of patients 46 to 64 years old and among clinics that treat more chronically ill, rather than acutely ill, patients.

The restaurant industry has become remarkably aggressive and creative in combating truant diners. One restaurateur sued a would-be diner who reserved a four-top and failed to show. The court sided with the merchant, awarding him $200 in lost revenue plus the $400 that he had paid a private eye to track down the person. Another disciplinary tactic has been to embarrass deserters by listing their names on public reservations websites such as opentable.com.

Appointment reminder letters that are generated by the EHR system can be used to send a reminder letter about a week in advance of the appointment; it can be followed up with a confirmation call the day before.

The text of the letter can provide directions for the patient to cancel or reschedule the appointment if he or she is not able to make it. A template for a letter to inform a patient of normal test results can provide information on how to have any questions answered that he or she might have.

A recent Medical Group Management Association study has shown that the no-show rate for healthcare facilities can be anywhere from 1% to 28%. This can mean a lot of wasted time for the healthcare facility, which can in turn mean a lot of lost revenue. If the medical office sees 100 patients a day with an average charge of $125 and has a 15% no-show rate, there would be a loss of $37,500 per month.

This same study mentions that the longer the time between scheduling the appointment and the actual appointment date, the more likely there will be a no-show. Calling a day or two ahead to confirm appointments reduces the likelihood that patients will fail to show up, thus improving continuity of care for patients, increasing practice revenues, and helping the facility run more smoothly and productively

Calendar Traditionally patient appointments have been maintained using paper desk calendars or appointment books; of course, the appearance is unorganized. Scribbled names and scratched-out, overwritten, or double-booked appointments make the schedule hard to decipher. It is often difficult to reschedule appointments and find available time slots. Another disadvantage is that only one person can use the appointment book at a time.

This system has the medical assistant flipping back and forth, searching for availability within a specified time slot while perhaps one or two coworkers wait to schedule other patients.

• The front office assistant must be well trained, versatile, and positive toward patients, providers, and other staff. Front office duties include greeting patients on the telephone and in person, taking accurate phone messages, creating and managing an EHR for each patient, scheduling appointments, and generating correspondence. • Good communication among providers, patients, and staff improves patients' confidence in their care, increases their satisfaction with the medical practice, makes healthcare personnel feel better about their jobs, and prevents many medical errors. • Proper telephone etiquette includes answering calls promptly, using a professional greeting, asking for the caller's full name and reason for calling, writing down a return phone number, documenting the conversation, and allowing the caller to terminate the conversation. • Secure email is an inexpensive, efficient system for exchanging messages through the Internet using secure encryption technology. • A fax machine is a device that encrypts and decodes documents so that they can be quickly transmitted over telephone lines. Fax transmissions can also be sent via secure email. • Patient health records can be classified into three different groups: active, inactive, and closed. Inactive or closed medical records are purged when the retention period expires or when the patient transfers to a different practice or dies. Patients' health information stored in the EHR must be protected from destruction by computer hackers, natural disasters, terrorist attacks, and other untoward events. • Establishing an appointment matrix is the first step in developing an efficient schedule for the healthcare facility. This clearly shows when the provider is available to see patients. • SCMO allows the medical assistant to schedule, block, or change appointments. Using an EHR to organize appointments makes it easy to search for available slots, edit or delete appointments, keep track of patient no-shows, and double-book as needed.

True/False Indicate whether the statement is true or false. 1. _____ First impressions are created only when the patient enters the healthcare facility for the first time. 2. _____ The HIPAA Privacy Rule allows medical practices and other covered entities to disclose some healthcare information via email, fax, or phone without specific patient authorization, provided reasonable precautions are taken to protect privacy. 3. _____ Use of a script is a helpful way for patients to understand that the physician has reserved specific time for them. 4. _____ HIPAA-compliant secure email services may also offer web hosting services, spam filtering, virus protection, and related accessories, such as shared calendars and address books. 5. _____ Always set up the patient EHR account using the name listed on the insurance or ID card. 6. _____ Several users can access the electronic appointment book at once. 7. _____ Electronic health record users should find the scheduling view that works best for their office and ask the administrator to program it in permanently. 8. _____ Appointment slots should be blocked out for trips, holidays, or out-of-office time using the Block Appointment type.

Double-Booking Double-booking is a type of scheduling that may be done for any or all of the following reasons: 1. The practice expects a certain number of no-shows. 2. The practice expects certain patients to arrive early and others to arrive late, which staggers their appointment times even though the schedule shows them as being double-booked. This is an especially good scheduling strategy if patients' appointments are expected to be brief. 3. The two patients being booked in the same slot are being seen for different reasons that require different rooms and resources. For example, one patient might be scheduled for an annual physical. While the medical assistant is taking his or her vitals, another patient might be having a mole removed for evaluation by a pathologist. 4. A patient with an urgent medical problem, such as acute fever, needs to be accommodated.

You can insert a second appointment at a time you choose, or you can search for an appropriate slot by date and time, type of visit, or other criteria by following the same step for inserting a patient appointment described earlier. Keep in mind that physicians will have specific preferences as to when double-booking may occur. For example, some may allow double-booking only during the first appointment of the day, whereas others prefer double-booking slots directly before their lunch hour. The goal of efficient scheduling is to optimize patient flow through the practice. An efficient flow requires an accurate estimation of patient volume. Scheduling must be realistic given the provider's general pace. Habitual overbooking and ineffective scheduling techniques will lengthen wait times and leave providers alternately swamped or idle.

However, it must be used properly to prevent the unauthorized disclosure of confidential patient information. Messages must be encrypted and sent via a secure server, and a HIPAA disclosure should be attached to each message (Fig. 4.4).

• Verify the email address of the recipient to ensure your message reaches the correct person, particularly if you have trouble reading an email address handwritten on a form. • Inform the recipient of the sensitive nature of the email. • If you do not receive a reply to a message in which a reply was requested, follow up by phone, mail, or fax to make sure the message was received. Do not simply resend the message to the same email address. • Do not "cc" messages to others unless asked to do so, and obtain authorization when necessary. • Develop an office policy and a related patient handout specifying what types of communication may be exchanged by email, who has access to the patients' confidential email messages, what the expected response time is, whether minors may exchange email with the office, and so on. • Remember that your email message may end up being read by recipients other than the person for whom it was intended. A good rule of thumb is never to write anything in an email message that you would not write in a letter.