Electronic ordering halts misplaced, missing orders

No more unnecessary rework

After an electronic ordering process was implemented at Bon Secours Hampton Roads Health System in Marriottsville, MD, the central scheduling department stopped "pulling their hair out" looking for misplaced or inaccurate orders.

The department takes very seriously its goal of providing excellent customer service 100% of the time, says Dee Sutton, manager of central scheduling. Previously, central scheduling received about 250 to 300 hard copy faxed documents every day. Staff would take each document to the assigned scheduler's desk to verify it for accuracy, where the scheduler would either enter a code indicating a stamp of approval or follow up if there was an error.

Then, each document was batched by facility and/or department for five facilities and manually faxed to the appropriate area. The document was then filed in large crates by facility, month, and date.

"We kept all hard-copy orders on file for 90 days. If an order was misplaced, central scheduling had to go through the many papers trying to find it, and then fax it again to the necessary area," says Sutton.

This was easier said than done, due to appointments being rescheduled several times, requiring a lot of research to locate each document. "Not only was it extremely time-consuming, but it often caused unnecessary rework," says Sutton. "This led me to look for a solution. My team was pulling their hair out."

The problem was so common that the team even created a "next day missing order" document that each facility's admitting office would fax to central scheduling each afternoon around 4:00 pm. "This helped us begin searching for orders that had been misplaced before we closed at 6:00 pm," says Sutton. "Usually, missing orders were due to patients' rescheduling or not showing for their exams."

Sutton set out to improve all-around physician, patient, and employee satisfaction. She also wanted a method that would give the necessary staff members the ability to view and/or print the document at the press of a button.

Staff go live with new process

"Our goal is to ensure a physician's order is on file for every outpatient ancillary exam scheduled," says Sutton. "The only exception is an annual routine screening mammogram, which does not require a physician's order for the patient to receive services."

To address this, the department implemented QuadraMed's Inbound Fax Viewer solution. This is the new process:

Central scheduling staff members begin their call by introducing themselves and reviewing the basic patient demographic information.

A window appears, reminding the scheduler to ask if the patient is to bring the physician's order or if it will be faxed to the central scheduling department.

The scheduler then notes the caller's reply in the proper fields on the questionnaire.

If the ordering physician's office has chosen to fax the patient's order to central scheduling, the following process takes place:

The physician's order/document is received in the fax server and is automatically assigned a file name/number.

The document is then viewed in the inbound fax viewer.

If a document requires rotation or extraction, this process is handled in the inbound fax viewer.

After ensuring the document has been positioned correctly or extracted to become a stand-alone document, it is viewed for accuracy.

To ensure the appointment has been scheduled correctly, the order is compared to the scheduled study in the system.

"There are six subjects we carefully view to ensure accuracy," says Sutton. These are the patient's name, the ordering physician's name, the ordering exam, the facility where the exam has been scheduled, the appointment date and time, and any additional notes, such as ICD-9 codes, that may be on the order but not shared at the time of scheduling

Once the scheduling staff member confirms the scheduled appointment is 100% accurate, he or she enters a code indicating approval. The document is renamed in the fax server under the patient's last name, then first name. The document is then attached to the scheduled appointment in the system. Lastly, the document is electronically filed in the appropriate scheduled facility/month folder.

Better satisfaction all around

"The ability to electronically receive, attach, and store documents has benefited our organization while improving physician, patient, and employee satisfaction," says Sutton.

All users have the ability to view and print documents from any workstation. "It has also reduced supply cost considerably by decreasing the need to print documents, which in turn decreased the need for other office supplies," says Sutton.

Physician and patient satisfaction has improved, due to the substantial reduction of lost and missing orders.

By attaching the physician's order to the scheduled exam in the QuadraMed system upon receipt, the order is always available. Rarely is a physician contacted because an order cannot be found.

Central scheduling verifies the scheduled appointment with the physician's orders to ensure it is 100% accurate, and follows up if it is not.

"If there is a discrepancy, our goal is to have it resolved before the patient's arrival," says Sutton. Employee satisfaction has improved due to all users within the organization, including revenue cycle, having the ability to search for a document within the application without leaving their workstation or contacting another department for a copy.

"There were very few challenges when implementing this electronic ordering process," says Sutton. "Our biggest challenge was in deciding how to set up the Biscom fax server to meet our needs."

Once that decision was made, the necessary fax line was added and testing began. "Thanks to our dedicated department staff members, the program was tested, employees trained and 'go live' was virtually seamless," says Sutton.

[For more information, contact:

  • Dee Sutton, manager, central scheduling, Bon Secours Hampton Roads Health System, 1505 Marriottsville Road, Marriottsville, MD 21104. Phone: (757) 398-4228. E-mail: dee_sutton@bshsi.org.]