Taking an aggressive role in automation can help avoid a million-dollar reboot

The key to success — plan, plan, and plan some more

If at times it seems your kids are more computer literate than you and your staff, you may face hard times ahead. But by embracing technology, admitting managers can carve out a new role for themselves in the future, experts say.

With surveys showing that about a fourth of all health systems expect to increase technology expenditures by 50% or more, there’s a strong likelihood that the systems you’re working with to register, schedule, verify, and bill will change. Taking an aggressive role in those changes is a key to success, experts say.

One of the first questions to ask is, "How is it going to improve things?" That’s what Beverly David at Washington County Hospital in Hagerstown, MD, wanted to know when she faced converting to a new computer system in 1992.

"A lot of people, when changing their computer system, try to figure out how to make a new system just like the old one," says David, RN, director of admissions/registration. "If that’s all they’re going to get out of it, why bother? Say, ‘If I were king, this is what I’d like the system to do,’ and get as close to that as you can."

David’s second piece of advice is to get immediate buy-in from front-line staff. "Ask them right away, ‘What will make your job easier?’ Most systems are kind of vanilla, and the individualization you need to apply has to be analyzed.

"Make sure your staff is involved and participating in how you make that system meet the end result," she adds.

When David changed her system, one of the biggest issues facing registrars involved insurance. "Every managed care organization has a different set of rules, and unless everybody has a book in front of them, or a really good memory, or a terminal that can carry 10,000 Post-It notes . . . .

"We wanted to utilize the computer system to give those kinds of cues to the front-line staff," David says. With that in mind, she made sure the new system included prompts for specific questions for staff to ask during a patient’s registration.

For example, in determining whether Medicare is the primary payer, the system prompts the registrar to ask such questions as, "Have you had an accident?" or, "Do you have benefits through the black lung program or the Veterans Administration?" "We’ve incorporated that information in a computerized record that will never go away," David says.

Plan for a detailed conversion

David also made sure the system included details concerning individual companies with which the hospital had contracts. For example, it reminds registrars that if a patient is coming in for an MRI, precertification is necessary, she says. "Whatever questions are associated with that insurance will pop up every time it’s introduced."

When Mercy Hospital and Medical Center, part of ScrippsHealth System in San Diego, changed computer systems last year, there were 9,000 hours of planning activity before going live, says Jack Duffy, director of patient financial services for ScrippsHealth.

Duffy’s number one tip for a successful transition is to do a detailed conversion, paying attention to "every keystroke we can get our hands on," he says. "It saves millions on the back end."

The short cut, he explains, is to automatically transfer all of the old information into the new system (called a balance forward), run a parallel system, or outsource collections from the old system. Duffy doesn’t like any of those alternatives.

"We’ve done six [computer] conversions in the past few years, and we’ve found that the standard needs to be a detailed conversion," he says. "If there are collection notes on the old system, you want to copy those. If there are detailed charges, you want to keep those, although the tendency is to do balance forward."

Ask to see a work plan

Duffy also advises you to ask your vendor what the company’s best installation has been at a hospital or health care system similar to yours and then go to that organization and ask to see its work plan.

"Work plans are hundreds of pages," he points out. "Ask for a copy of their work plan on a disk, and it gives you a wonderful step up. The tendency is to start from scratch, but if you guess wrong, it can damage your ability to have a successful install. Start with the best install there ever was and make it better."

Duffy says his experience with vendors is that they have a tendency to go back to "square one" with each client. "I’m not sure if it’s a lack of energy or imagination, or if they think the information is proprietary."

In the process of choosing a vendor, he contends, part of due diligence is to find the most successful user of that software and partner with them.

"If you find these partners and ask in an appropriate way, I’d be surprised if they’re not more than willing to share their experiences, plans, and profile decisions," Duffy adds. "But you have to ask — no one’s going to knock on your door."

Like David and Duffy, John Woerly, RRA, MSA, CHAM, stresses staff involvement and planning as keys to a successful computer system installation. Also be aware of the cultural factors that computerization may affect, says Woerly, a veteran access director and currently corporate manager for patient access processes for HealthTask in Atlanta. A new computer system may change job descriptions, training and work performance standards, he says. For example, automating the bed board with your new system — meaning it’s in the computer rather than hanging on the wall — would eliminate a lot of paperwork and change the work flow.

Also as part of computerization, a department might either change registration forms or go to a paperless system, which also would alter work patterns, Woerly notes.

In addition, he suggests that managers installing a new system:

• Be aware of current and future interfaces, such as embossing or label systems, or downloading to another system.

• Realize customization may be beneficial to you in the short term, but in the long term may be expensive and cumbersome. "If a vendor sells 200 systems, and with yours you said, ‘I want page one on page three, and page three somewhere else,’ every time they have a new release you have to remember that and change it to meet your needs,’" Woerly adds. "Determine what truly needs to be customized and what you can live with."

• Look for current hardware and software and not what is known as "vaporware," as in, "We’re going to have that in the next release."

• Document the process, but don’t go overboard. You might want to chart current work patterns vs. future ones, Woerly notes. And keeping notes on meetings with the vendor could help if its representative denies having discussed a certain issue, or in pinpointing specific assignments that have been made.

But you’ve gone too far, he adds, "if you get so lost in documenting that. All you’re doing is documenting instead of seeing or hearing staff needs."

In installations he has overseen, Woerly says, staff members from outside access services were asked to visit every department, observe what went well and what didn’t, and do an evaluation. Their feedback became part of a daily newspaper — published to keep staff updated on the installation process — that included changes being made and key questions and answers, he adds. "We also used [their assessments] to add to the training program and as a tool for getting information back to the board of directors and management staff."

In addition, there was a temporary help desk — manned either by vendor representatives or the hospital’s information systems staff —that employees could call if they were having problems, he adds.

And to supplement that, each department had a resident expert — someone who had received more training than the average employee — to serve as a resource, Woerly says.