Thursday, November 29, 2007

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Bridging the Workflow Gaps in Healthcare

Addressing business and technology pressures

By Margaret Mayer
Boston Software Systems

From TODAY Magazine Archives

At the turn of the last century we finally realized the pundits were right: “all business is e-business.” The rise in use and popularity of electronic transactions has fueled an expectation of faster more accurate service from every business sector, including healthcare. Fulfilling the technology expectations of patients, government, physicians and financial managers becomes a matter of bridging a
multitude of gaps between the data sources that exist behind a transaction or information request. As in life science, where evolving species are most successful
when they are adaptable, those business organizations willing to adapt to new approaches, technologies and solutions will ultimately thrive. The pressures of particular business drivers within healthcare are creating opportunities for organizations to evolve or reinvent processes and workflows through the adoption of technologies that respond to these drivers.

While the goals of each organization define specific mandates,
major business drivers within healthcare can be grouped into three
main categories:

• Regulatory Issues (HIPAA, patient safety initiatives, interoperability
• Technology Demands (new clinical applications, EHR, CPOE)
• Business Issues (faster revenue cycle, reduced FTEs,
Internet/portal connectivity)

The race to handle these pressures effectively requires a careful analysis of existing workflows and processes, as well as an evaluation of how technology is best used in a particular organization. Ultimately, how efficiently an organization can move data and share information determines how well it fills both the information and the process gaps that these business drivers create. The passage of the Health Insurance Portability and Accountability Act (HIPAA) has been the impetus to improve record keeping and has forced organizations to use technology to ensure compliance.

As deadlines approach for the various components of HIPAA, hospitals assume greater responsibility for managing the manual processes still in place and the associated reporting required by HIPAA. While HIPAA has been a great motivator in building a technical infrastructure within hospitals, HIPAA requirements in and of themselves are not revenue-producing activities and do not offer the financial return that enables organizations to hire staff dedicated to compliance.

Understanding Workflow and Tasks

The bottom line is that healthcare organizations will have to evaluate
how the tasks and processes that impact the basic operation of
the organization are completed. The complexity of information gaps in healthcare seems to strangle attempts to automate processes and fill these gaps. Because of the
way healthcare organizations have evolved, individual departments, clinics and physician practices have developed unique workflows to handle information within their specific departments or systems. These workflows are often developed in response to an immediate demand without consideration for how the information is ultimately used or how the process might be automated. These types of paper
or manual workflows may accomplish the initial goal of getting specific
information from one desk to the next, but they lack efficiency and

Every organization has processes or workflows already in place to
manage their business at any particular point. However, the proliferation
of small manual tasks abounds in the hospital environment,
creating points of failure for more strategic information strategies.
For instance, a fully functioning Computerized Physician Order Entry
(CPOE) system must integrate with:

Clinical data repository
• Nursing and physician (and other caregiver) documentation
• Clinical decision support system
• Results reporting system
• Electronic medication administration system
• Pharmacy system

That’s at least six informational gaps which need to be filled, and
within each area, manual tasks that may create points of inaccuracy.
As the demand for CPOE rises, the demand to fill those gaps and
automate tasks intensifies.

Filling Tactical Gaps to Automate Manual Processes

In healthcare, improving business processes may begin by evaluating
areas where paper-driven processes are slowing down workflow, contributing to inaccurate data use, and ultimately, to lost or delayed revenue. One hospital filled this task gap using powerful scripting software. Mount Auburn Hospital in Cambridge, MA. found that attaching accurate patient information to specimens going from clinics and physician offices to the hospital was a problem. In some cases, only handwritten patient information was accompanying a specimen to the hospital lab, creating many inaccuracies including wrong insurance, a wrong address or simply illegible writing. Lab personnel had to take valuable time to register patients using this information, which delayed the ordering of lab work. This ultimately caused billing delays, costly corrections and re-billing issues. The scripted solution allows Mount Auburn Hospital to realize faster turnaround in billing with fewer corrections. Lab work is expedited because personnel aren’t manually performing registrations.

The script works like this: When a sample is drawn, the physician’s office sends patient information to a text file in its IDX physician system. The script runs continuously Monday through Friday, from 8:00 a.m. through 6:00 p.m., automatically logging in and checking for new patient files to be registered. When it finds one, it automatically registers the patient into the hospital’s MEDITECH Magic system and produces an audit file detailing the number of records processed and any exceptions that were encountered. In addition, the script formats and sorts an Excel spreadsheet that details all of the actual data sent from the physician’s office. Both files are produced daily, are date stamped and the actual data is backed up. At the end of the day, a copy of the exception report and the Excel spreadsheet are e-mailed to a distribution list for review.

The Value of Automation

Automating specific tasks yields fast returns on investment. Reinventing whole processes, yields beneficial and predictable outcomes with payoffs that are both tangible and intangible. The mandate to make significant changes in hospital processes may come from one of the business drivers described above, but instituting those changes begins with a clear vision of corporate goals and buy-in from the administration and the business users. Ensuring that the
end product of process development lines up with the corporate
vision helps keep the process in focus and the staff fully committed
to its success.

When Credit Valley Hospital in Mississauga, Ontario moved to automate its registration process, they started at the top with the corporate vision and goals. They evaluated areas that would offer the greatest benefit and developed an Information Management Plan that focused on specific areas within the hospital that could benefit from process improvement. There were a number of reasons why Credit Valley chose to reinvent its registration process. With more than 40 registration areas (six areas off-site) and 163 registration users, it was difficult to monitor the accuracy or consistency of captured data. Inaccurate data capture
leads to lost revenue, incorrect patient demographics, inaccurate abstract data sent to the Canadian Institute for Health Information (providing part of the basis for hospital and facility planning and funding, disease surveillance, public health expenditures, physician
referral patterns and other community based services), incorrect contact information (needed for effective disease surveillance) and the inability to standardize for addresses, postal codes and residence codes.

Credit Valley’s IT department had two primary goals: standardize the way patients were registered and improve the quality of data being captured at the point of entry. This would create a proactive, rather than reactive, approach to information gathering. The hospital
began by working with the registration clerks to develop a Project Definition which identified all the fields on registration screens that were misused, misinterpreted or simply ignored. To enforce standardization, they established business rules which monitor users to ensure that no field is improperly filled or ignored. To ensure data quality and recover revenue, the hospital integrated an address validation product into the registration process, providing automated address look-ups. Since completing this project, Credit Valley has experienced an 80% drop in address inaccuracies that slow revenue recovery. They admit that any process enhancement, including this one, requires constant improvement and upgrades, but the financial and strategic rewards are well worth the work.

Developing On-Demand Processes

By closing the information gaps that exist throughout the hospital
environment, organizations reap fast financial rewards. Even the
automation of common manual tasks – such as re-keying data or downloading reports – allows for the reallocation of resources, substantial time savings and may save significant third-party vendor costs. Powerful task automation tools are available that allow hospitals to reinvent or realign processes on an as-needed basis to
develop the workflow that meets the expertise of their end users and supports their overall technology environment. Developing an environment for continuous, on-demand process innovation and workflow automation allows organizations to respond
not only to tactical needs, but also to strategic business requirements.
It bridges the information gaps in healthcare and lays the
foundation future technology demands.

Wednesday, November 28, 2007

Taking Some of the Pain Out of Lockbox Conversions

By Mark Brousseau

To be sure, transitioning to a lockbox provider from an in-house payments processing environment can be a stressful process with lots of hurdles along the way. But taking time early on in the process to evaluate your legacy systems and true business requirements can keep your conversion from getting tripped up, says Craig Bjork (, director, account and business development, Data Capture Services, for CDS Global, a subsidiary of The Hearst Corporation. Bjork provided me with the following tips for corporate billers looking to streamline the conversion to a lockbox provider:

… Evaluate your billing systems capabilities. “A good lockbox provider will want to limit the number of exceptions clients receive by working through all of the transactions a client’s billing system can handle,” Bjork said. “This goes beyond payments to things like change of address requests and requests for information. Knowing what your billing system can handle means you can offload this work to the lockbox provider, freeing your internal staff.”

… Clearly define business rules and expectations, early on. “Moving to a lockbox provider is a good time to evaluate business processes and the value they provide,” Bjork said.

… Don’t get too hung up on the mechanics of how your lockbox provider will process your work (the models of machines, version of software, etc.). The corporate biller’s primary concern should be whether the work is getting done correctly and on time, Bjork explains. In this vein, also be sure to regularly monitor the work being done on your behalf: ask for measurements and appropriate reports (be sure to read them!), and make periodic visits.

… Outline critical times for file and information delivery. But make sure that these times correspond to key deadlines, such as billing cut-offs or customer service postings. Don’t set delivery times solely based on convenience or the way things have been done in the past.

… Assign one individual on your transition team to handle communications and deliverables handoffs. While your transition team should include a cross-section of project stakeholders, having a single point of contact helps ensure timely and accurate project status updates.

… Trust your selected service provider, and let go. “This is why it’s so important that you choose a lockbox provider that is as concerned about your customers as you are,” he said.

Any strategies that your organization found useful? E-mail me at

Monday, November 26, 2007

The Skinny On Trade Shows

By Mark Brousseau

Many vendors wonder about the true costs of exhibiting at trade shows. Now, Exhibit Surveys Inc.'s 2006 Trade Show Trends Report provides some answers. According to the study, exhibitors spend an average of $126 per attendee that enters their exhibit and expresses an interest in their products and/or services. Moreover, exhibitors spend an average of $236 per attendee that engages in conversation with a staff member. How does this compare to your company's exhibit costs? E-mail me at

Friday, November 16, 2007

Remote Channels Drive Growth

By Mark Brousseau

U.S. bank transactions are expected to grow at a compound annual rate (CAGR) of nearly 10 percent between 2006 and 2010, according to Needham, MA-based TowerGroup. Driving this growth are remote channels, with the fastest rates coming from online (27 percent) and the call center (7.1 percent), followed by the branch (still kicking at 1.4 percent) and the ATM (0.5 percent).

Is this what your bank is projecting? E-mail me at

Online Bill Payment Pays Off

By Mark Brousseau

For financial institutions, integrating online banking and bill payment has the potential to reduce operating costs, expand cross-selling and up-selling capabilities, and increase consumers' interactions through the online channel, according to CheckFree Corp.

Online banking customers visit their financial institutions' sites an average of 11.2 times per month, according to the 2007 Consumer Bill Payment Survey, conducted by Harris Interactive with the Marketing Workshop, and sponsored by CheckFree. However, customers who use both online banking and bill payment services visit their financial institutions' sites 13.4 times and those who use electronic bills to receive and pay their bills visit the online banking sites an average of 15.1 times, according to the same survey.

Today, online banking and bill payment exist as separate applications on many financial institution websites -- meaning banks have a ready opportunity to improve their bottom line.

What do you think? E-mail me at

Monday, November 12, 2007

The Secret to RDC Adoption

By Mark Brousseau

Ease of enrollment (implementation and training) is the key to the mass adoption of remote deposit capture, Jane Darga, vice president, product development, at Comerica said during a presentation at TAWPI's Payments Automation: Beyond Capture & Clearing Conference last week in St. Petersburg, FL. What do you think? E-mail me at

Sunday, November 11, 2007

Shifting Online Behaviors

By Mark Brousseau

In a keynote presentation entitled "Thinking Beyond Tomorrow" at TAWPI's Payments Automation: Beyond Capture & Clearing Conference last week in Florida, Sanjiv Sanghvi, president and CEO of Wells Fargo HSBC Trade Bank, noted that megatrends such as electronic payments are accelerating, and provided several examples of shifting online behaviors and interests:

  • 158 billion text messages were sent in 2006
  • 8.4 percent of U.S. households are wireless-only
  • 74 percent of single Internet users in the U.S. have taken part in at least one online dating-related activity
  • More than 100,000 marriages a year result from people meeting on an online dating service
  • 10 percent of cell phone users age 18 to 34 have "texted" someone out of their romantic lives
  • MySpace is second only to Yahoo! in the U.S. market in terms of page views

Against this backdrop, Sanghvi told the audience that in order for financial services providers to survive in the emerging electronic payments environment (where more payment choices are coming), they must listen to their customers, and keep new product offerings simple ("adopt then adapt"). He also advised financial services providers to remember that technology is the enabler, not the end state (just like financial services). What do you think? E-mail me at

Saturday, November 10, 2007

Industry Collaboration Critical For Survival

By Mark Brousseau

Increased industry collaboration will be needed in the future in order for financial services providers to deliver more value to their corporate clients, J.D. "Denny" Carreker, vice chairman, strategic payments initiatives at CheckFree Corporation said during a luncheon presentation this week at TAWPI's Payments Automation: Beyond Capture & Clearing Conference in St. Petersburg, FL. "Some progress is being made, but more is needed to drive costs down and bring additional value," Carreker told the audience.

Driving a more integrated, streamlined payments industry will benefit everyone in the new payments environment, Carreker said. These benefits include:

  • Reduced costs
  • Reduced risk
  • Reduced float
  • Improved funds availability
  • Increased access to, and faster delivery of, consolidated payment information
  • Faster, more efficient delivery of new payment-related services

What do you think? E-mail me at

Management Buy-In Key To Outsourcing

By Mark Brousseau

Whether your organization is a financial institution or a corporate biller, one of the most important things you must do when looking at outsourcing lockbox processing is to get senior management to buy into the process early-on, Serena Smith, senior vice president at Fidelity National Information Services said during a presentation this week at TAWPI's Payments Automation: Beyond Capture & Clearing Conference in St. Petersburg, FL.

"What's also important to know is whether senior management is looking for a vendor or a partner," Smith told the audience. "The service provider needs to know what a customer's plans are five years down the road, to help us with our planning."

Smith's co-presenter, John Mintzer, vice president at Citizens Bank, said companies outsourcing their lockbox operations must be committed to following a formal project methodology all the way through the process. "If you don't follow a project methodology, you will be 'committed' at the end," Mintzer joked. What do you think? E-mail me at

Friday, November 9, 2007

Capture Conference-Imaging to Archive-December 6th to 7th

This is a must attend event for end-users looking strategically at the future of document capture, workflow, back end integration and improving your own image based operation. Whether your company is looking to automate and improve upon your invoice processing or scanning of EOB's, claims, forms, the TAWPI Capture Conference at the Doral Resort December 6th to 7th will be the place to be. Click Here to register.

Partial Conference Agenda:Solutions Overview

Ralph Gammon, Editor, Document Imaging Report
Join us for breakfast and hear a brief overview detailing what products you’ll find in the vendor showcase.

Keynote Address: “The Future of Document Imaging”
Dolores Kruchten, General Manager, Document Imaging, Vice President, Eastman Kodak

Keynote Address: How Intelligent Capture & Exchange Solutions Can Effect Positive Organizational Change and Automate Business Processes Andrew Pery, Vice President of Marketing, Kofax

Strategies for Outsourcing Document Processing
Jan Trevalyan, President, Direct Data Capture
Bob Zagami, General Manager, DataBank IMX;
Devang Thakkar, Senior Product Manager, Enterprise Information Capture Solutions, Anacomp

Case Study: Montgomery County Increases Efficiency and Accuracy with Forms Processing
Dieter Klinger, Enterprise Services Division Chief - Department of Technology Services, Montgomery County
Craig Laue, Eastern Regional Manager, ABBYY USA Software, Inc.

Trends in Invoice Processing
Ralph Gammon, Editor, Document Imaging Report

Case Study: Beyond Claim Processing at Blue Cross Blue Shield of North Carolina
Jay Keogh, IBML
Christina Lane, Operations Manager, Blue Cross Blue Shield of North Carolina

NEW Success Stories in Enterprise Content Management Bill Premier, Chief Operating Officer, Hyland Software

Unstructured Document Processing Panel Discussion
John Craig, Account Manager, ReadSoft North America
Ken Kriz, Product Manager, AnyDoc Software
Jerry Metcalfe, Sr. Director, Captaris
Andy Lawrence, Product Manager, Eastman Kodak

Monday, November 5, 2007

From Transaction Systems To Analytics

By Mark Brousseau

In an article on trends in IT capabilities and advancements in healthcare finance that appears in this month’s issue of HFMA’s magazine, Deb Davis and Jim Adams, both of IBM Global Business Services, identified the move from transaction systems to analytics.

“As advanced clinical systems are implemented, the value of clinical information can be extended beyond the transaction level to be used for risk management, trend analysis, and analytics that include financial and clinical data,” Davis and Adams wrote.

The development of a health analytics roadmap can determine strategic priorities in the analysis and use of data with research, finance, and patient care, they conclude.

Sounds like another example of the convergence of payments and document processing to me. What do you think? E-mail me at