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Managing physician orders no longer an issue at St. Louis health system
Web-based tool is 'really slick, really simple,' director says
Challenges with handling physician orders abound at most hospitals: Patients may show up without the order, leading to frustration all around and a wasted appointment time. An order coming in on a multiple-use fax machine may be buried under a pile of other faxes, nowhere to be found when the patient soon to be disgruntled customer arrives for her mammogram or MRI.
"If the appointment is at 7 a.m. and the physician's office doesn't open until 9, the patient is waiting a long time [to have the order present]," notes Pam Greenberg, MHA, network director of access management at SSM Health Care in St. Louis.
The physician office staff, meanwhile, is annoyed at being called to redo an order they know they've already sent, she adds. "Sometimes it happens a couple of times and that really irritates them."
Fortunately, such occurrences are now in the past at SSM, where a "really simple, really slick" web-based tool for processing physician orders has been in place since July 2005, Greenberg says.
With the new process, she explains, the physician's office is able to fax the order using the same number, but it comes through the web-based server and is received in a computer inbox.
"Anybody you give access to can go to the Internet and pull up [the tool] and log in," explains Becky Kinsella, director of registration at SSM. "They save it as a 'favorite' and then go to the inbox and click on it. You can see where the message came from, see the caller ID."
Users have the ability to link the fax numbers with physician names, she adds, so that when the message comes over, the caller ID actually reads "Dr. Smith."
The access employee opens the message, sees that it is for an MRI, and then drags and drops it into an MRI folder, Greenberg says. "Rather than hand-delivering a piece of paper that could be lost, we send that folder to the [imaging] department."
If the ancillary department somehow loses the order, the staff there can go back in to the folder and reprint it or can call access personnel and have them reprint it, she says.
"The physician's office receives a confirmation once we receive that fax," Greenberg adds, "so if we call back and ask about [an order], we can search for it by the confirmation number or the patient name."
There is an interface with the registration system, notes Kinsella, so when someone schedules a CAT scan, for example, as soon as the reservation is put into the system, that triggers the interface with Care Ready.
"When the physician's order comes over," she explains, "whoever is processing it finds the order, gets the patient name, does a search through Care Ready, pulls up that appointment and attaches the order to the appointment.
"We have patients who come in for different things and [the program] holds the history of all their orders," Kinsella adds. "With the appointment date attached to it, you know you're picking the right one."
The twist on that, she says, is that when patients aren't scheduled and the physician just faxes over an order for lab work, it still goes into Care Ready. "Once it's interfaced [for a previous order], it's still there. You just add a visit and attach the date when the order came over."
If the patient has not been entered in the system previously, Kinsella says, staff add the name to the master person index (MPI) in Care Ready. "It's a one-way interface," she emphasizes. "Care Ready doesn't send anything back to [the registration system]. It will not add the name to that system's MPI."
By the end of 2007, seven SSM hospitals are expected to be on-line with the physician order management tool, Greenberg says, and the next step will be to bring in 17 outpatient rehab clinics, which are in the process of having registrars brought under the oversight of the access department.
"The [physician order management] process will fold right into that transition," she adds.
An upgrade planned for the beginning of 2008 will enable SSM staff to provide an on-line order form to physicians, who will be offered the option of checking the procedure or service being ordered, adding an electronic signature, and sending the form back to the hospital, Greenberg adds.
In some SSM hospitals, Care Ready also is used by members of SSM's dedicated authorization group (DAG), which calls physician offices on a daily basis to get precertification information and wait for faxes to be returned, notes Kinsella.
SSM also is preparing to expand its use of the web-based tool from orders processing to "any time we need to use a fax," Greenberg says. "When we correspond interdepartmentally if the DAG team, for example, wants to send information to inpatient case management or vice versa we will use the same tool.
"It's not a cookie-cutter product," she adds. "You really can look around and say, 'I think I can use it for this,' and tailor it for what you need."
No capital investment required
The beauty of the tool is that it is "very inexpensive" and requires no capital investment, just operational funds, Greenberg notes. "The budget is just the ongoing monthly fee for service no huge amount for signing up, no big equipment costs."
While other solutions exist for managing physician orders, she adds, those she has researched are more complicated and more expensive. "The capital outlay would have been $25,000 or $30,000 to get started, and then enormously more per month [than the tool SSM is using]."
Part of the reason for the high costs of other physician order management products, Greenberg says, is that they are "folded into other solutions that we didn't need or already had and you had to buy the whole thing."
Before coming to SSM, Greenberg and Kinsella worked at a community hospital with Care Ready creator John Chen and as a result were present for the genesis of the product.
"We were trying to come up with this solution as part of a continuous quality improvement project," Greenberg recounts. "He did it in the basement of the hospital and we were his pilot, [saying], 'We want this. Now we want that.' He learned that nobody was doing this, so he ran with it."