Integrated Patient Managed-Care Information System Identifying a Cost-Effective Integrated Patient Managed-Care System for Concord Hospital: A Managed-Care White Paper

This white paper is provided in response to a request review integrated patient managed-care systems for possible implementation at Concord. Because there are a number of sophisticated applications specifically designed for such purposes today, each with its own attributes, it is important to select the software package that best suits Concord's needs and can accommodate future expansion. To this end, this white paper describes the MedicsElite system components such as registration, appointment scheduling, billing, medical records, and management reporting, including a discussion of how the proposed MedicsElite Medical Practice Management Software can benefit Concord in these areas.

Overview of MedicsElite Medical Practice Management Software.

A review of several software suites for the purposes of this analysis was conducted, including Advanced Data Systems's MedicsElite, MediPro's Lytec's MediNotes Charting Plus Electronic Medical Records Software, and Medical Software Associates' electronic records management (EMR) software, complete practice management software. A qualitative analysis of core product features and additional module requirements was then made, and telephonic interviews with service and customer support representatives from the respective vendors were conducted. The analysis determined that the most cost-effective and appropriate application for our hospital's use is MedicsElite Medical Practice Management Software with the Medical Managed Care module added; these issues are discussed further below.

The company reports that the MedicsElite's product is an integrated, Windows-based practice management software system that has been developed, marketed, and supported by Advanced Data Systems, a reputable company with over 25 years of experience automating medical practices (MedicsElite Overview, p. 2). According to the company's literature, "Individual providers, group practices large and small, hospital billing departments, practice management firms, networked providers, billing companies, and many others trust the automation of their practices to Advanced Data Systems" (p. 3). The software package is highly flexible, with a number of additional components available to help customize it to the hospital's unique needs. The MedicsElite's medical practice management system's primary, optional and specialty functions are listed in Table 1 below.

Table 1. Primary Functions and Options Modules: MedicsElite Medical Practice Management Software.

Primary Functions

1. Patient Information Management

2. Patient and Insurance Billing

3. Financial Ledger

4. Essential System Reports

5. Word Processing

6. Integrated Image Scanning

Optional Modules

1. Appointment Scheduler

2. Electronic Billing (EDI)

3. Online Insurance Verification

4. Medical Practice Management Reports

5. Managed Care

6. Prescription Writer

7. Document Scanning Enhancements

8. Medics On-call for Palm Pilot

9. LaserForms

10. Collections

Specialty Options

1. Immunization Tracking

2. CLIA Updates

3. Mammography Tracking

4. Film Tracking

5. Surgical Scheduling

6. Collection Agency

7. Electronic Medical Records (EMR).

Source: MedicsElite Functions and Modules in MedicsElite Overview, pp. 3-4.

The application's specific technical features are provided in Table 2 below.

Table 2. MedicsElite Technical Features.

1. Microsoft Windows® client-server architecture -- industry-standard and easy-to-use

2. Realtime relational SQL database -- fast, powerful, flexible;

3. Developed with object-oriented C++ code -- consistent Graphical User Interface (GUI), fast, reliable;

4. ODBC and HL7 compliant -- open, extendable;

5. ADS's own unique Extended Multiple Document Interface (XMDI) -- simplified;

6. concurrent access to multiple windows for an individual patient or multiple patients (using linked windows);

7. Windows 98/2000/XP client, Windows 2000/NT server or AIX® server for IBM® RISC System/6000®;

8. All mouse functions have keyboard equivalents.

Source: MedicsElite Functions and Modules in MedicsElite Overview, p 10.

Registration.

There are both internal and external customers involved in our hospital's patient registration process; the internal customers are comprised of the medical records service, of course, but virtually all practitioners who will ultimately come into contact with the patient and/or his or her records during the treatment process as well, and the external customers are the patients themselves as well as any third-party providers and insurance companies that may become involved (Eckes, 2003). In general -- and properly implemented and administered, information systems have been shown to improve the patient registration process across the board (Tuohy, 1999). Registration issues are addressed in a comprehensive fashion by this integrated application. In their segment, "Patient Information Management," the company reports that the MedicsElite Demographics window provides users with the ability to easily access the entire range of patient demographic information by making all pertinent patient data available in the Windows-based environment; however, the company also emphasizes that this information, although easily accessible by authorized personnel, is also completely secure (see further discussion on security below).

Some of the valuable registration functions provided by the MedicsElite's integrated medical practice management system include the...

Comprehensive patient information including demographics, insurance, appointments, contacts, referrals, notes, case management details, and more
2. Fast patient registration with alert messages including duplication warnings

3. Case specific records: insurance plans, hospital stays, A/R classes

4. Patient and guarantor account retrieval by numerous search criteria including patient and/or guarantor name, date of birth, social security number, phone number, insurance policy number, account number, transaction number, medical record number, and user-definable fields

5. Procedure and diagnosis code tracking with auto recall for immunizations, mammography, annual check up, etc.

6. Patient and insurance company balances displayed in every patient-related view

7. Budget billing plan specific to the individual patient

8. Custom fields available for user-defined information MedicsElite -- Detailed Feature & Function List, pp. 2-3).

Appointment Scheduling.

Any improvements that can be made to Concord's existing appointment scheduling approach would be well worth the investment. Studies have shown time and again that waiting times are an important component of patient satisfaction; patients perceive the quality of the care they receive to be superior when their appointments are handled in a timely fashion and they are treated with respect and consideration by medical staff members (Peterson, 1998). The important features from the "Appointment Scheduler Module" (this is included with the primary application) include the following:

1. Numerous views and reports available including schedule printouts by provider/room, daily/weekly schedule report, monthly density report, and reports for no-shows, cancellations, and reschedules;

2. Search by day, time, place, provider and appointment type;

3. Simultaneous display of up to six different dates/providers/rooms;

4. Effortless modifications to existing appointments in one or two mouse clicks

5. Extensive customization: customized screen settings, user-defined appointment types, appointment durations, overbooking features, time slot intervals by provider/room, etc.;

6. Separate office and surgical schedules;

7. Automatic recall reminders for recurring procedures;

8. Wave scheduling;

9. Charge slip and label printing for chart preparation; and,

10. Integrated with Managed Care Module (MedicsElite -- Detailed Feature & Function List, pp. 6-7).

Billing.

The hospital stands to gain time-saving and revenue-generating benefits by implementing this integrated software package; these features will improve our existing collection rates by automating the fundamental processes involved. According to Wright (2004), today, computers can "transmit and share billing information real-time from the patient's bed, removing the time-intensive and error-prone manual data-capture process that was traditionally used" (p. 45). In this regard, some of the core billing features provided by the MedicsElite package include:

1. Fast and flexible electronic claims submission and Electronic Data Interchange (EDI) can handle the most sophisticated billing requirements;

2. Quick reimbursement on electronically submitted claims;

3. Eliminate the need for paper forms, HCFA and other forms;

4. Dramatically reduced insurance company rejections due to error-free electronically submitted claims; and,

5. Electronic reconciliation for automatic posting of payments, eliminating the need for manual keyboard entry (MedicsElite -- Detailed Feature & Function List, pp. 7-8).

Medical Records.

Ensuring the privacy of patient records is more important than ever; in this regard, all of the integrated medical management packages reviewed were HIPAA compliant. According to Pincock (2003), the Department of Health and Human Services (HHS) has published its final rule for the Health Insurance Portability and Accountability Act (HIPAA) security standards. "Large healthcare plans and providers have until April 21, 2005, to comply, while small healthcare plans and providers must be in compliance by April 21, 2006" (p. 111). any organization that handles electronic protected health information (PHI) now faces some challenges in how to get into and main in compliance-or face the penalties, which include fines up to $250,000 and even imprisonment. Following is an analysis of the standards that comprise the rule, as well as the implementation specifics that outline how each of those standards is to be addressed in practice.

In fact, the new security rule is even more comprehensive and complex in terms of compliance than the HIPAA patient privacy rule that was finalized in 2002 and which went into effect in April 2003. Pincock points out that although the privacy rule provided patients with the right to control the disclosure of their health-related information, the new security rule requires healthcare organizations to proactively protect the confidentiality, integrity, and availability of "all electronic protected health information the covered entity creates, receives, maintains, or transmits" (p. 112).

Furthermore, compliance is complicated by the fact that there will the security rule consists of 18 standards that in some cases overlap; these standards are grouped into three areas: 1) administrative, 2) physical, and 3) technical safeguards (Pincock, 2003). Because of the tertiary nature of Concord's services, it is a covered entity for HIPAA purposes and must therefore be in compliance with the new security rule by April 21, 2006. In this regard, the MedicsElite's integrated medical practice management system will help Concord meet these requirements by allowing the medical records service to collect, integrate, and organize patient information to create continuous records that are easily…