A network of multi specialty physician group practices in over 40 locations had made a series of acquisitions and affiliations with other groups over a period of years. The network that now consisted of approximately 1,200 physicians, nurse practitioners and physician assistants recognized the need to implement a single Electronic Medical Record (EMR) and clinical system that would unite the groups in their ability to transfer and standardize patient medical histories and procedures between various offices and specialists.
In order to implement the EMR system, the network had to deal with several distinct but related issues. First, a large number of patient encounters resulted from referrals made by physicians outside the network in a multi state area. Since all patient information originated with the physician who utilized an internal clinical system, there were numerous errors, omissions or delays in identifying the referring providers. And the clinical system was not fully integrated with a separate billing system. One aspect of the problem was that internal providers, as well as acquired practices, developed their own databases of referring physicians.
The EMR implementation highlighted acute discrepancies between the multiple provider databases. Past work-arounds and simmering grievances from the clinical staff over the time consuming and often stressful situations in which clinical information was entered in the clinical system conflicted with the exact information requirements of the billing system. Clinicians requested accurate referring physician information be available in the system when providing patient care and entering orders. Billing requested accurate referring data so that claims were not rejected and re-work was not required in obtaining correct provider information.
FolioMed Problem Solving
FolioMed was asked to review the current provider databases and processes of the network. FolioMed implemented a solution that consisted of the following elements.
Existing databases were rationalized using FolioMed’s proprietary software tools to normalize and eliminate all duplicate, inactive and out of area providers.
The databases were then matched to FolioMed’s reference database of all active practicing providers within the network’s multi state region.
After rationalizing the databases, the next challenge was to maintain its integrity over time and this was accomplished in a multi stage process:
Biweekly the network uploads its entire databases of internal and external providers.
FolioMed matches the files for differences with the prior files and identifies changes and additions/deletions
FolioMed validates and enhances (adds additional information) to the network’s file
FolioMed generates its own bi-weekly change file for the entire region from its reference database
FolioMed’s uploads the change files to the network in the network’s file structure
FolioMed maintains the crosswalk tables between the network’s provider identifiers and national and proprietary identifiers
The network was able to pre-populate their systems with referring providers and eliminated the substantial cost and time consuming efforts required of clerical, billing and clinical staff to capture referring provider information. Billing re-work declined with accurate information and the elimination of duplicate providers. The implementation of the EMR went smoothly and Clinicians accepted the integrated data within the common EMR. The network achieved significant cost savings with the common EMR versus multiple disparate databases and the integrated EMR greatly benefited patient care. With ongoing provider database maintenance the EMR and billing systems are always current and up-to-date with changes in the healthcare environment.