Nextgen_downtime_procedures Sample From Hospital

8/3/2019 Nextgen_downtime_procedures Sample From Hospital

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Attachment DDowntime Procedures

Table of Contents

Definitions: ..................................................................................................................................... 3Downtime procedures for IDX, NextGen, SCC, Quest, Novius, Rosetta, Cloverleaf, Openlink

interactions. ..................................................................................................................................... 3Scenario 1: Rosetta is down and Cloverleaf is up and Openlink is up. ......................................... 3Scenario 2: Cloverleaf Down, Rosetta up, Openlink up. ................................................................ 4Scenario 3: Openlink Down, Rosetta up, Cloverleaf up. ................................................................ 4Scenario 4: IDX up, Nextgen Up, All Interfaces down ................................................................. 5Scenario A: IDX down, NextGen up .............................................................................................. 6Scenario B: IDX down, NextGen down ......................................................................................... 9Scenario C: IDX up, NextGen down ............................................................................................ 12Scenario D: IDX up, NextGen up, LIS (Laboratory Information System) down ......................... 13Scenario E: IDX Up, NextGen Down, LIS (Laboratory Information Systems) up ...................... 14Scenario F: IDX up, NextGen down, LIS (Laboratory Information System) down..................... 15Scenario G: IDX down, NextGen Down, LIS (Laboratory Information Systems) up ................. 16Scenario H: IDX down, NextGen Down, LIS (Laboratory Information System) down .............. 19 Scenario I: IDX down, NextGen up, LIS (Laboratory Information System) down ..................... 22Scenario J: IDX down, NextGen up, LIS (Laboratory Information System) up .......................... 25Scenario K: IDX Down, NextGen up, LIS (Laboratory Information System up, LCR up .......... 28Scenario L: IDX Up, NextGen Up, Quest orders and results are down ....................................... 31Scenario M: IDX up, NextGen is down, Quest orders and results are up. ................................... 32Scenario N: IDX up, NextGen is down, Quest orders and results are down. ............................... 33Scenario O: IDX is down, NextGen is down, Quest orders and results are up. ........................... 34Scenario P: IDX down, NextGen down, Quest orders and results down. .................................... 37Scenario Q: IDX is down, NextGen is up, Quest is down. ........................................................... 40Scenario R: IDX is down NextGen is up Quest is up 43


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Scenario R: IDX is down NextGen is up Quest is up 43

Scenario AI: IDX up, NextGen down, Dermatopathology results down .................................... 77Scenario AJ: IDX down, NextGen down, Dermatopathology results up ..................................... 78Scenario AK: IDX down, NextGen down, Dermatopathology results down ............................... 81Scenario AL: IDX down, NextGen up, Dermatopathology results down .................................... 84Scenario AM: IDX down, NextGen up, Dermatopathology results up ........................................ 87Scenario AN: Faxing Down .......................................................................................................... 90Scenario AO : NextGen up, SureScripts is down ......................................................................... 91Scenario AP: Camera is down at check-in area ............................................................................ 92Scenario AQ: Scanners are down at check-in area ....................................................................... 92Scenario AR: Exam room laptops are down ................................................................................. 93Scenario AS: All Printing is down in the Clinic (i.e. print server) ............................................... 94Scenario AT: One printer is down in the clinic. ........................................................................... 94Scenario AU: Health Center Network is Down ............................................................................ 96II. Recovery Procedures ................................................................................................................ 96

I. Down Time Procedures

Staffing Required for all Scenarios:o Help Desk ext. 4400o Ancillary Department Administrator/Coordinator

1. Radiology: ext. 2784 or 36342. Laboratory: ext. 2498 or 80143. Pharmacy: ext. 7943 or 2782 or 4921

o UMG Informatics team - beeper during normal clinic hours??

Examples of Causes for all Scenarios:o Computer virus, Hardware or Software Failure, Power Surge or Loss

Notification for all Scenarios:

Once the situation is identified, the Ancillary Department will notify the


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Definitions:IDX Registration and Scheduling System used by all UMG clinics.

NextGen

Outpatient Electronic Medical Record.NextGen Fax Server Fax Server for NextGenLab Information System Uconn Lab system. UCHC Lab andDermatopathology results only will be flowing into NextGen.Quest Lab Outside lab vendor. Orders will be sent via interface toQuest and results will be flowing into NextGen via interface.WINSurge Pathology system interfaces with NextGen for results

only.Siemens Novius- Radiology system at UconnRosetta - interface engine for NextGen which transfers healthinformation using HL7 protocolCloverleaf Siemens interface engine by Quovadx which transfershealth information using HL7 protocol

POLICY: The Disaster Recovery for NextGen Outpatient EMR systemDowntime procedures for IDX, NextGen, SCC, Quest, Novius, Rosetta,

Cloverleaf, Openlink interactions.

Scenario 1: Rosetta is down and Cloverleaf is up and Openlink is up.

Rosetta Down Rosetta Cloverleaf Openlink CommentPatient Registration and Sched data will

not be filing in Nextgen, messages will


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Scenario 2: Cloverleaf Down, Rosetta up, Openlink up.

Cloverleaf Down Rosetta Cloverleaf Openlink Comment

ADT/Sched/Reg data from IDX to

NextGen Up Down UpPatient Registration and Sched data will

not be filing in any ancillary system.

Messages will queue up in IDX.

SCC lab results to NextGen Up Down Up

Lab results will not be posting in Nextgen

or any other ancillary system (LCR,

IBEX). Result messages will queue up inSCC systemNextGen lab orders to Quest Up Down Up Quest orders will queue in Rosetta untilCloverleaf is up and runningQuest lab results to NextGen Up Down Up Quest results will queue on Quest sideDermPath results to NextGen Up Down Up Dermpath results will queue in Winsurgetill Cloverleaf is up and runningRadiology results to NextGen Up Down Up Radiology results will queue in RMSsystem until Cloverleaf is up and running

Scenario 3: Openlink Down, Rosetta up, Cloverleaf up.

Openlink Down

Rosetta

Cloverleaf

Openlink

Comment

ADT/Sched/Reg data from IDX to

NextGen Up Up Down

Patient Registration and Sched data will

file in Nextgen. The departments that are

affected are Invision and Radiology


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Scenario 4: IDX up, Nextgen Up, All Interfaces down

Check-in Process1. Since IDX is up patients are arrived in IDX normally.2. The appointments will not be flowing over to Nextgen since the interfaces are

down.3. The check-in person will have to create a new encounter when patient is arrived.4. If a new insurance has been added in IDX it will not flow to Nextgen. They will

have to make a copy of the insurance card and scan into Nextgen when back up.

Patient Flow1. Since NextGen is up they can document patient visits in Nextgen.2. Lab and radiology requisitions will be printed.3. Any new Radiology, lab, pathology and Dermatopathology results will not be in

NextGen or LCR since interfaces are down.

Checkout Process

1. Checkout report can be accessed since NextGen is up.2. Follow-up appointments can be made in IDX they just will not be flowing over toNextGen.

3. The Superbill will not have the visit number on it. The PSR will have to enternumber on superbill.

Once all interfaces are up:

Encounters will be created. UMG Clinical Informatics will contact Developers todelete empty encounters.

Radiology lab pathology and Dermatopathology results will be sent to the


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Scenario A: IDX down, NextGen up

Check In ProcessRegistration Demographic, Insurance and Case Process

1. If the patient requires a Medical Record Number to be created, front desk personwill call central registration to get downtime number and the update HCH form.

2. Review Patient Visit Profile and verify their demographic information.

a. If the patient has a change in their demographic information, please writethe updates on the PVP.b. If the patient is a walk-in handwrite info on HCH registration update form.

3. If a patient indicates that their visit is case related (Motor Vehicle Accident,Workers Comp, etc.),

a. Give the patient a pen and paper and send them to the phone to callCentral Registration. The patient should return with their case number.

b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,

etc.) and write the number obtained from Central Registration on the PVP.c. Photocopy any case related documents.

4. Scan all Insurance Cards (front and back) even if the patient has provided caserelated documentation into NextGen and the insurance is in NextGen. If thepatient has added new insurance the insurance will not be in NextGen since IDXis down.

5. If brand new patient or patient has added insurance todays visit photocopyinsurance card and fax to Central Registration. Front desk will have to scan

insurance card next time the patient comes in.6. Fax PVP with updates, and any case-related documents to Central Registration

at X1272.7 If brand new patient and patient does not have a T# and T# was received from


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6. For any scheduled or unscheduled patients, the front desk staff must go intoNextGen and manually create a new encounter for the visit, and change patient

tracking to note patient is in waiting room.7. If the patient does not yet have a TOO number, the front desk will contact central

registration and ask for a downtime number to be assigned to the patient as wellas a downtime visit number (see IDX downtime procedures).

8. If no labels were printed for the patient, patients name, TOO, The front desk canprint Nice labels from their workstation. DOB, Date of visit and visit # must be onthe labels so that these can be affixed to all printed documents (requisitions,superbill, specimens, etc).

Patient flow

All subsequent steps should follow normal uptime procedures for NextGen.

Lab labels required would be manually created as needed.

Checkout Process

1. COA will review the checkout report in NextGen to see if follow up is required2. If the patient requires a follow up appointment, tell the patient we are in the

process of upgrading our computer system.3. Ask the patient if they would mind calling back for their appointment or if they

would prefer for the office to call them?4. If they would prefer to have the office call them, fill in the information from the

voucher on the Check Out Follow Up Downtime sheet (see Attachment B).

Telephone Process1. If patient is calling to cancel their appointment and does not wish to reschedule at


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Once IDX comes back up, the front desk must go in and arrive the patient in IDX

using the downtime TOO# and downtime visit # assigned previously.The superbill will not have the visit number on them since IDX was down. ThePSR will have to manually write the visit number on it.

Clinical informatics team will notify Application developers and delete anyunlocked/locked encounters with nothing in them.


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Scenario B: IDX down, NextGen down

An IDX reception list for every office is run nightly so they will need to refer tothe paper reception list for who is coming in for the day.



2. Review Patient Visit Profile and verify their demographic information.c. If the patient has a change in their demographic information, please write

the updates on the PVP.d. If the patient is a walk-in handwrite info on HCH registration update form.



b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,etc.) and write the number obtained from Central Registration on the PVP.

c. Photocopy any case related documents.4. Scan all Insurance Cards (front and back) even if the patient has provided case

related documentation into NextGen and the insurance is in NextGen. If the

patient has added new insurance the insurance will not be in NextGen since IDXis down.5. If brand new patient or patient has added insurance todays visit photocopy

insurance card and fax to Central Registration. Front desk will have to scan


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6. If the patient does not yet have a TOO number, the front desk will contact central



8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down

1. MA will room the patient and then document on the HCH approved visit form allnormal data, including vital signs, reason for visit, allergies, medications etc.

2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders will be handwritten on requisitions and faxed to

appropriate areas. (clinics need to have these on hand)5. Any prescriptions will be handwritten on prescription pad paper.6. Lab or radiology data that is required will be obtained via a phone call if needed.7. If available find patient information in NetAccess LCR.8. A billing voucher needs to be filled out by provider and handed to patient at the

end of the visit. The patient will hand the voucher to the check out person.

Check Out Process1. Review the voucher to see if follow up is required2. Collect Copay if appropriate


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b. If they would prefer that we call them back, complete the Phone ApptTracking Downtime sheet (Attachment C).

3. If patient is calling about medical question and needs to speak to clinical staff.Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to bere-entered or scanned back into the system.

MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX

comes up)MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enterthose medications prescribed as new or stopped during downtime encounter viaMedication Module. Will enter any change in Allergy history via Allergy Module.Completed documented HCH visit form with then be sent to medical records toscan into arrived open encounter. Encounter will auto lock in 10 days.


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Scenario C: IDX up, NextGen down

Patient is arrived normally in IDX and labels are created. Staff will refer to IDX tolook at the schedule for the day and monitor patient arrivals in IDX.

Check in person will attach paper voucher with the labels when the patient isarrived and have it ready for the MA.

MA will room the patient and then document on the HCH approved visit form allnormal data, including vital signs, reason for visit, allergies, medications etc.

HCH Form will be placed outside the exam room for the care provider.

Provider will document visit on all HCH approved forms.Any lab or radiology orders will be handwritten on requisitions and faxed toappropriate areas. (clinics need to have these on hand)

Any prescriptions will be handwritten on prescription paper.Any Lab or radiology result can be found in LCR or by calling the Lab at x2498orRadiology department at x2784.

A billing voucher needs to be filled out by provider and handed to patient at theend of the visit. The patient will hand the voucher to the check out person.


MA will access arrived encounter from IDX in NextGen (after Nextgen and IDXcomes up)

MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enter

those medications prescribed as new or stopped during downtime encounter viaMedication Module. Will enter any change in Allergy history via Allergy Module.

Completed documented HCH visit form with then be sent to medical records toscan into arrived open encounter. Encounter will auto lock in 10 days.


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Scenario D: IDX up, NextGen up, LIS (Laboratory Information System)

down

IDX and Nextgen are functioning and all staff are documenting visits in NextGen.The Laboratory Department will notify the Help Desk in the InformationTechnology Department (X4400) who will notify the UMG informatics team thatSCC is down. Informatics team will notify UMG departments of the downtime.

All requisitions will continue to print in clinic areas.

Results will not transmit from the lab system to NextGen until the LIS system is

functioning again.Departments can call laboratory to get an urgent result at x2498. Results will notbe in LCR.

Critical results will continue as protocol.

Once LIS is back up all lab results will flow into NextGen. The notification will bein the providers inbox and providers PAQ.


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Scenario F: IDX up, NextGen down, LIS (Laboratory Information System)

down




HCH Form will be placed outside the exam room for the care provider.Provider will document visit on all HCH approved forms.Any lab or radiology orders will be handwritten on requisitions. (Clinics need tohave these on hand)

Any prescriptions will be handwritten on prescription paper.Any Lab or radiology results can be found by calling the Lab at x2498 orRadiology department at x2784. Results will not be in LCR.

Critical results will continue as protocol.




MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enter


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Scenario G: IDX down, NextGen Down, LIS (Laboratory Information

Systems) up

An IDX reception list for every office is run nightly so they will need to refer to

the paper reception list for who is coming in for the day.



2. Review Patient Visit Profile and verify their demographic information.e. If the patient has a change in their demographic information, please write

the updates on the PVP.f. If the patient is a walk-in handwrite info on HCH registration update form.





related documentation into NextGen and the insurance is in NextGen. If thepatient has added new insurance the insurance will not be in NextGen since IDX

is down.5. If brand new patient or patient has added insurance todays visit pho tocopy

insurance card and fax to Central Registration. Front desk will have to scani d t ti th ti t i


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5. Mark the Reception List to indicate the patient has Arrived.6. If the patient does not yet have a TOO number, the front desk will contact central






2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders will be handwritten on requisitions. (Clinics need to

have these on hand)5. Any prescriptions will be handwritten on prescription pad paper.6. If available find lab results in NetAccess LCR.7. Lab or radiology data that is required will be obtained via a phone call if needed.

(lab results will not be in NextGen since it is down)8. A billing voucher needs to be filled out by provider and handed to patient at the


Check Out Process1. Review the voucher to see if follow up is required


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MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enterthose medications prescribed as new or stopped during downtime encounter viaMedication Module. Will enter any change in Allergy history via Allergy Module.


The lab results will start coming over to the providers inbox and PAQ.


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Scenario H: IDX down, NextGen Down, LIS (Laboratory Information

System) down





2. Review Patient Visit Profile and verify their demographic information.g. If the patient has a change in their demographic information, please write

the updates on the PVP.h. If the patient is a walk-in handwrite info on HCH registration update form.





related documentation into NextGen and the insurance is in NextGen. If thepatient has added new insurance the insurance will not be in NextGen since IDXis down.

5. If brand new patient or patient has added insurance todays visit photocopy


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4. Collect Copay if appropriate5. Mark the Reception List to indicate the patient has Arrived.

6. If the patient does not yet have a TOO number, the front desk will contact centralregistration and ask for a downtime number to be assigned to the patient as wellas a downtime visit number (see IDX downtime procedures).





2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders will be handwritten on requisitions. (clinics need to

have these on hand)5. Any prescriptions will be handwritten on prescription pad paper.6. Any Lab or radiology data that is required will be obtained via a phone call if

needed. To obtain lab results call x3601.7. Any results will not be in NetAccess LCR since all systems are down.8. A billing voucher needs to be filled out by provider and handed to patient at the




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a. Ask them if they would mind calling back to reschedule their appointmentor if they would prefer that we call them back?

b. If they would prefer that we call them back, complete the Phone ApptTracking Downtime sheet (Attachment C).3. If patient is calling about medical question and needs to speak to clinical staff.

Call Center Staff will fill out Telephone Encounter form and fax to clinic.




Laboratory Information System procedures for downtime

All requisitions will be handwritten in clinic areas.

Results will not transmit from the lab system to NextGen until the LaboratoryInformation System is functioning again.Departments can call laboratory to get an urgent result at x2498.

O th l b t i f ti t i b k ll l b lt ill fl i t


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Scenario I: IDX down, NextGen up, LIS (Laboratory Information System)

down

ADT/registration information will not be coming over to NextGen.

Scheduled/arrived appointments will not be coming over to NextGen.

Follow current IDX downtime procedures and SCC downtime procedures





2. Review Patient Visit Profile and verify their demographic information.i. If the patient has a change in their demographic information, please write

the updates on the PVP. j. If the patient is awalk-in handwrite info on HCH registration update form.




c. Photocopy any case related documents.4 S ll I C d (f d b k) if h i h id d


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Appointment Arrival Process1. Confirm Scheduling and Billing Provider

2. Confirm PCP and Referring MD information3. Review Reception List Referral and Financial Comments information. Obtainnecessary Referral Authorization information if not listed on reception list

4. Collect Copay if appropriate5. Mark the Reception List to indicate the patient has Arrived.6. For any scheduled or unscheduled patients, the front desk staff must go into

NextGen and manually create a new encounter for the visit, and change patienttracking to note patient is in waiting room.



Patient flow with IDX down, NextGen up, LIS and LCR down.

1. For any scheduled patients, the front desk staff must go into NextGen andmanually create a new encounter for the visit, and change patient tracking tonote patient is in waiting room.

2. MA will room the patient.

3. Visit will be documented in NextGen since it is up.4. Lab results will not be flowing to NextGen. If they need a result they can call thelab at x360.


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The superbill will not have the visit number on them since IDX was down. ThePSR will have to manually write the visit number on it.

Once IDX comes back up, the front desk must go in and arrive the patient in IDX

using the downtime TOO# and downtime visit # assigned previously.


SCC procedures for downtime.:

All requisitions will continue to print in clinic areas out of NextGen.Results will not transmit from the lab system to NextGen until the LaboratoryInformation System is functioning again.

Departments can call laboratory to get an urgent result at x2498.

Critical values will still use current protocol.

Once SCC is back up all lab results will flow into NextGen and providers PAQ.Notifications will be sent to the providers inbox.


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Scenario J: IDX down, NextGen up, LIS (Laboratory Information System) up




k. If the patient has a change in their demographic information, please writethe updates on the PVP.l. If the patient is a walk-in handwrite info on HCH registration update form.










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tracking to note patient is in waiting room.7. If the patient does not yet have a TOO number, the front desk will contact centralregistration and ask for a downtime number to be assigned to the patient as wellas a downtime visit number (see IDX downtime procedures).


Patient flow with IDX down and NextGen up1. For any scheduled or unscheduled patients, the front desk staff must go into


2. If the patient does not yet have a TOO number, the front desk will contact centralregistration and ask for a downtime number to be assigned to the patient as well

as a downtime visit number (see IDX downtime procedures).3. If no labels were printed for the patient, patients name, TOO, DOB, Date of visit

and visit # must be written on plain labels so that these can be affixed to allprinted documents (requisitions, superbill, specimens, etc).

4. All subsequent steps should follow normal uptime procedures for NextGen.5. All results will be in NextGen.6. Results will not be in LCR.

7.


Check Out Process


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3. Telephone call center staff in the clinic will follow normal processes for messagesto the clinic since NextGen is still up. They need to make sure that the patient onthe phone is in fact a patient in NextGen since there will be no ADT feed fromIDX to NextGen.

4. If they are a new patient calling up and not in NextGen yet they need todocument the call on the HCH form.

Lab results will be flowing into NextGen since NextGen is up.


Once IDX comes back up, the front desk must go in and arrive the patient in IDXusing the downtime TOO# and downtime visit # assigned previously.

Clinical informatics team will notify Application developers and delete any

unlocked/locked encounters with nothing in them.


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Scenario K: IDX Down, NextGen up, LIS (Laboratory Information System

up, LCR up




a. If the patient has a change in their demographic information, please writethe updates on the PVP.b. If the patient is a walk-in handwrite info on HCH registration update form.










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tracking to note patient is in waiting room.7. If the patient does not yet have a TOO number, the front desk will contact centralregistration and ask for a downtime number to be assigned to the patient as wellas a downtime visit number (see IDX downtime procedures).


Patient flowAll subsequent steps should follow normal uptime procedures for NextGen.

Lab labels required would be manually created as needed.Laboratory results will be flowing into NextGen since NextGen is up and the LISsystem is up.

Check Out Process1. COA will review the checkout report in NextGen to see if follow up is required2. If the patient requires a follow up appointment, tell the patient we are in the



voucher on the Check Out Follow Up Downtime sheet (see Attachment B).5. For any emergencies staff can call X2784 to order radiology tests.


this time,


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Once IDX comes back up, the front desk must go in and arrive the patient inIDX using the downtime TOO# and downtime visit # assigned previously.



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Scenario L: IDX Up, NextGen Up, Quest orders and results are down

IDX and NextGen are functioning and all staff are documenting visits in NextGen.

All Quest lab orders will be placed but not sent. (The user will receive anotification in their inbox that the result did not go through.)All Quest requisitions will continue to print in clinic areas.Orders and results will not transmit from the Quest to NextGen until the Questsystem is functioning again.

Departments can call Quest at 800-982-6810 or look in the Care 360 website tofind the result they are looking for.

Once Quest is back up all lab orders will be sent and results will flow intoNextGen. The notification of the results will be in the providers inbox andproviders PAQ.


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Scenario M: IDX up, NextGen is down, Quest orders and results are up.





Provider will document visit on all HCH approved forms.

Any lab (including Quest) or radiology orders will be handwritten on requisitionsand faxed to appropriate areas. (clinics need to have these on hand)

Any prescriptions will be handwritten on prescription paper.Any Lab or radiology results can be found in LCR or by calling the Lab at x2498or Radiology department at x2784. Any Quest result can be found in Care 360 orby calling Quest at 800-982-6810.

A billing voucher needs to be filled out by provider and handed to patient at the


Once NextGen comes back up staff will be notified by Clinical informatics viaemail. The lab results from SCC and Quest will start flowing into the providersPAQ and inbox.The Quest lab results will also flow into the providers inbox and PAQ.

Once IDX and NextGen come back up, the data from the HCH forms needs to bere-entered or scanned back into the system.MA will access arrived encounter from IDX in NextGen (after Nextgen and IDXcomes up)


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Scenario N: IDX up, NextGen is down, Quest orders and results are down.






Any lab (including Quest) or radiology orders will be handwritten on requisitionsand faxed to appropriate areas. (clinics need to have these on hand)

Any prescriptions will be handwritten on prescription paper.Any Lab or radiology results can be found in LCR or by calling the Lab at x2498

or Radiology department at x2784. Any Quest result can be found in Care 360 orby calling Quest at 800-982-6810.


Once NextGen comes back up staff will be notified by Clinical informatics viaemail. The lab results from SCC and Quest will start flowing into the providersPAQ and inbox.


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Scenario O: IDX is down, NextGen is down, Quest orders and results are up.





2. Review Patient Visit Profile and verify their demographic information.c. If the patient has a change in their demographic information, please write

the updates on the PVP.d. If the patient is a walk-in handwrite info on HCH registration update form.


a. Give the patient a pen and paper and send them to the phone to callCentral Registration. The patient should return with their case number.b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,


4. Scan all Insurance Cards (front and back) even if the patient has provided caserelated documentation into NextGen and the insurance is in NextGen. If thepatient has added new insurance the insurance will not be in NextGen since IDX

is down.5. If brand new patient or patient has added insurance todays visit photocopy

insurance card and fax to Central Registration. Front desk will have to scaninsurance card next time the patient comes in


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5. Mark the Reception List to indicate the patient has Arrived.






2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.

4. Any lab or radiology orders (including Quest) will be handwritten on requisitionsand faxed to appropriate areas. (clinics need to have these on hand)

5. Any prescriptions will be handwritten on prescription pad paper.6. Lab or radiology data that is required will be obtained via a phone call if needed.

(lab results will not be in NextGen since it is down) Quest lab results can beobtained by calling Quest at 800-982-1610 or by going into Care 360.

7. If available find patient information in NetAccess LCR.8. A billing voucher needs to be filled out by provider and handed to patient at the



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Once IDX and NextGen come back up, the data from the HCH forms needs to be

re-entered or scanned back into the system.MA will access arrived encounter from IDX in NextGen (after Nextgen and IDXcomes up)

MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enterthose medications prescribed as new or stopped during downtime encounter viaMedication Module. Will enter any change in Allergy history via Allergy Module.

Completed documented HCH visit form with then be sent to medical records to

scan into arrived open encounter. Encounter will auto lock in 10 days.

The lab results including Quest will start coming over to the providers inbox andPAQ.


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Scenario P: IDX down, NextGen down, Quest orders and results down.



1. If the patient requires a Medical Record Number to be created, front desk person

will call central registration to get downtime number and the update HCH form.2. Review Patient Visit Profile and verify their demographic information.

e. If the patient has a change in their demographic information, please writethe updates on the PVP.

f. If the patient is a walk-in handwrite info on HCH registration update form.3. If a patient indicates that their visit is case related (Motor Vehicle Accident,

Workers Comp, etc.),a. Give the patient a pen and paper and send them to the phone to call

Central Registration. The patient should return with their case number.b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,



5. If brand new patient or patient has added insurance todays visit photocopyinsurance card and fax to Central Registration. Front desk will have to scaninsurance card next time the patient comes in.


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6. If the patient does not yet have a TOO number, the front desk will contact central

registration and ask for a downtime number to be assigned to the patient as wellas a downtime visit number (see IDX downtime procedures).7. If no labels were printed for the patient, patients name, TOO, The front desk can

print Nice labels from their workstation. DOB, Date of visit and visit # must be onthe labels so that these can be affixed to all printed documents (requisitions,superbill, specimens, etc).




2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders (including Quest) will be handwritten on requisitions

and faxed to appropriate areas. (clinics need to have these on hand)

5. Any prescriptions will be handwritten on prescription pad paper.6. Lab or radiology data that is required will be obtained via a phone call if needed.

(lab results will not be in NextGen since it is down) Quest lab results can beobtained by calling Quest at 800-982-1610 or by going into Care 360.





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MA will access Master IM template and enter visit type=Chart update. Will enter

chief complaint in reason for visit field on Master IM template. Will then enterthose medications prescribed as new or stopped during downtime encounter viaMedication Module. Will enter any change in Allergy history via Allergy Module.


The lab results including Quest will start coming over to the providers inbox andPAQ.


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Scenario Q: IDX is down, NextGen is up, Quest is down.

ADT/registration information will not be coming over to NextGen.

Scheduled/arrived appointments will not be coming over to NextGen.




2. Review Patient Visit Profile and verify their demographic information.g. If the patient has a change in their demographic information, please write

the updates on the PVP.h. If the patient is a walk-in handwrite info on HCH registration update form.






5 If brand new patient or patient has added insurance todays visit photocopy


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Appointment Arrival Process1. Confirm Scheduling and Billing Provider

2. Confirm PCP and Referring MD information3. Review Reception List Referral and Financial Comments information. Obtainnecessary Referral Authorization information if not listed on reception list

4. Collect Copay if appropriate5. Mark the Reception List to indicate the patient has Arrived.6. For any scheduled or unscheduled patients, the front desk staff must go into




Patient flow



Checkout Process




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Quest downtime:Any Quest orders will not be sent. The users will receive a notification in the inboxthat the order did not go through.

There will be no results going into NextGen as well. If you are looking for a Questresult you can call Quest at 800-982-1610 or login to Care 360 website and find theresult.

The superbill will not have the visit number on them since IDX was down. The PSRwill have to manually write the visit number on it.

Once IDX comes back up, the front desk must go in and arrive the patient in IDXusing the downtime TOO# and downtime visit # assigned previously.Clinical informatics team will notify Application developers and delete anyunlocked/locked encounters with nothing in them.

Once Quest is up all orders will be sent electronically to Quest and any results willflow into the providers PAQ and inbox.


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Scenario R: IDX is down, NextGen is up, Quest is up

ADT/registration information will not be coming over to NextGen.Scheduled/arrived appointments will not be coming over to NextGen.




2. Review Patient Visit Profile and verify their demographic information.i. If the patient has a change in their demographic information, please write

the updates on the PVP. j. If the patient is awalk-in handwrite info on HCH registration update form.





related documentation into NextGen and the insurance is in NextGen. If thepatient has added new insurance the insurance will not be in NextGen since IDX

is down.5. If brand new patient or patient has added insurance todays visit photocopy

insurance card and fax to Central Registration. Front desk will have to scan


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6. For any scheduled or unscheduled patients, the front desk staff must go intoNextGen and manually create a new encounter for the visit, and change patienttracking to note patient is in waiting room.


8. If no labels were printed for the patient, patients name, TOO, The front desk canprint Nice labels from their workstation. DOB, Date of visit and visit # must be on

the labels so that these can be affixed to all printed documents (requisitions,superbill, specimens, etc).

Patient flow



Checkout Process1. COA will review the checkout report in NextGen to see if follow up is required2. If the patient requires a follow up appointment, tell the patient we are in the



voucher on the Check Out Follow Up Downtime sheet (see Attachment B).

Telephone Process


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Scenario S: IDX up, NextGen up, Radiology Management System Down

IDX and NextGen are functioning properlyRequisitions will be printed out of NextGen and faxed to radiology.

Radiology personnel will contact helpdesk and in turn helpdesk will notify UMGinformatics department of downtime.

UMG informatics department will notify UMG department via email of downtime.Radiology results will not be coming over into NextGen.

Staff can call the radiology department at x2784 if a result is needed.

If there are any significant clinical findings the radiologist will call or email theprovider in the clinic directly.

Once the radiology system is back up all final results will flow to NextGen and goto the providers inbox and PAQ for review and signoff.


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Scenario T: IDX up, NextGen Down, Radiology Management System Up



MA will room the patient and then document on the HCH approved visit form all

normal data, including vital signs, reason for visit, allergies, medications etc.HCH Form will be placed outside the exam room for the care provider.


Any prescriptions will be handwritten on prescription paper.Any radiology results can be found in LCR or by calling the Radiologydepartment at x2784 since they wont be in NextGen.


Once NextGen comes back up staff will be notified by Clinical informatics viaemail.

The radiology results will start flowing into the providers PAQ and inbox.




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Scenario U: IDX up, NextGen down, Radiology Management System Down

Helpdesk will notify Clinic of downtime through Clinical shutdown email.Patient is arrived normally in IDX and labels are created. Staff will refer to IDX tolook at the schedule for the day and monitor patient arrivals in IDX.





Any lab or radiology orders will be handwritten on requisitions and faxed toappropriate areas. (clinics need to have these on hand)

Any prescriptions will be handwritten on prescription paper.If someone is looking for a result they will have call the radiology department atx2784 since they wont be in NextGen or LCR.


Once NextGen comes back up staff will be notified by Clinical informatics viaemail.

Once Novius is back up the radiology results will start flowing into the providersPAQ and inbox.




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Scenario V: IDX Down, NextGen Down, Radiology Management System Up




2. Review Patient Visit Profile and verify their demographic information.k. If the patient has a change in their demographic information, please write

the updates on the PVP.l. If the patient is a walk-in handwrite info on HCH registration update form.


a. Give the patient a pen and paper and send them to the phone to call

Central Registration. The patient should return with their case number.b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,etc.) and write the number obtained from Central Registration on the PVP.




6 Fax PVP with updates and any case related documents to Central Registration


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2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders will be handwritten on requisitions and faxed to

appropriate areas. (clinics need to have these on hand)5. Any prescriptions will be handwritten on prescription pad paper.6. Lab or radiology data that is required will be obtained via a phone call (Radiology

is at x2784) if needed. (Radiology results will not be in NextGen since it is down).7. If available find patient information in NetAccess LCR.8. A billing voucher needs to be filled out by provider and handed to patient at the




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Once the Radiology interface is back up and NextGen is also back up theradiology results will start coming over to the providers inbox and PAQ.


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Scenario W: IDX down, NextGen down, Radiology Management System down

If all systems are down Helpdesk will be notifying clinics through the IT clinicalshutdown notification.



Check In Process

Registration Demographic, Insurance and Case Process


2. Review Patient Visit Profile and verify their demographic information.m. If the patient has a change in their demographic information, please write

the updates on the PVP.n. If the patient is a walk-in handwrite info on HCH registration update form.







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3. Review Reception List Referral and Financial Comments information. Obtainnecessary Referral Authorization information if not listed on reception list



7. If no labels were printed for the patient, patients name, TOO, The front desk canprint Nice labels from their workstation. DOB, Date of visit and visit # must be on

the labels so that these can be affixed to all printed documents (requisitions,superbill, specimens, etc).8. Use the paper Billing Voucher for visits during downtime.


1. MA will room the patient and then document on the HCH approved visit form all

normal data, including vital signs, reason for visit, allergies, medications etc.2. HCH Form will be placed outside the exam room for the care provider.3. Provider will document visit on all HCH approved forms.4. Any lab or radiology orders will be handwritten on requisitions and faxed to

appropriate areas. (clinics need to have these on hand)5. Any prescriptions will be handwritten on prescription pad paper.6. Radiology data that is required can be obtained via a phone call (Radiology is at

x2784) if needed. (Radiology results will not be in NextGen since it is down).




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2. If patient is calling to cancel and wishes to reschedule, tell the patient we are inthe process of upgrading our computer system.






MA will access Master IM template and enter visit type=Chart update. Will enterchief complaint in reason for visit field on Master IM template. Will then enterthose medications prescribed as new or stopped during downtime encounter via

Medication Module. Will enter any change in Allergy history via Allergy Module.Completed documented HCH visit form with then be sent to medical records toscan into arrived open encounter. Encounter will auto lock in 10 days.

Once the Radiology interface is back up and NextGen is also back up theradiology results will start coming over to the providers inbox and PAQ.


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Scenario X: IDX down, NextGen Up, Radiology Management System down

Helpdesk will notify clinics of IDX and Radiology systems being down.




o. If the patient has a change in their demographic information, please writethe updates on the PVP.

p. If the patient is a walk-in handwrite info on HCH registration update form.3. If a patient indicates that their visit is case related (Motor Vehicle Accident,

Workers Comp, etc.),a. Give the patient a pen and paper and send them to the phone to call

Central Registration. The patient should return with their case number.b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,




6. Fax PVP with updates, and any case-related documents to Central Registrationat X1272.


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Patient flow


Radiology labels required would be manually created as needed.

For any Radiology results staff can call Radiology at x2784 for any results. Anynew results will not be in LCR since Radiology is down.

Check Out Process



would prefer for the office to call them?4. If they would prefer to have the office call them, fill in the information from thevoucher on the Check Out Follow Up Downtime sheet (see Attachment B).

5 For an emergency radiology tests staff can call Radiology at x2784 to get an


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the phone is in fact a patient in NextGen since there will be no ADT feed fromIDX to NextGen.

4. If they are a new patient calling up and not in NextGen yet they need todocument the call on the HCH form.


Any new Radiology results will not be flowing into NextGen since Radiologyresults are down.

Once IDX comes back up, the front desk must go in and arrive the patient in

IDX using the downtime TOO#.Once Radiology results come back up all results will go to the providers Inboxand PAQ in NextGen.



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Scenario Y: IDX down, NextGen up, Radiology Management System Results

up

Helpdesk will notify Clinics that IDX is down.



2. Review Patient Visit Profile and verify their demographic information.q. If the patient has a change in their demographic information, please write

the updates on the PVP.r. If the patient is a walk-in handwrite info on HCH registration update form.


a. Give the patient a pen and paper and send them to the phone to call

Central Registration. The patient should return with their case number.b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle,etc.) and write the number obtained from Central Registration on the PVP.




6 F PVP ith d t d l t d d t t C t l R i t ti


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Patient flow


Lab labels required would be manually created as needed.Radiology results will be flowing into NextGen since NextGen is up.

Check Out Process




voucher on the Check Out Follow Up Downtime sheet (see Attachment B).10. For any emergencies staff can call X2784 to order radiology tests.



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Once IDX comes back up, the front desk must go in and arrive the patient inIDX using the downtime TOO# and downtime visit # assigned previously.



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Scenario Z: IDX up, NextGen up, Pathology (Winsurge) down

IDX and NextGen are functioning and all staff is documenting visits in NextGen.The Help Desk must contact pathology system support, who will issue a tasknumber for tracking purposes. Once Winsurge is notified, an approximation ofdown time will be determined.

All requisitions will continue to print in clinic areas.

Results will not transmit from the Winsurge pathology system to NextGen untilthe Winsurge is functioning again.

Departments can call pathology to get an urgent result at x2980 or can look inLCR to see if it is in there.

Once Winsurge is back up all lab results will flow into NextGen. The notificationwill be in the providers inbox and providers PAQ.


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Scenario AA: IDX up, NextGen Down, Pathology (Winsurge) Up


MA will room the patient and then document visit on the HCH approved visit formall normal data, including vital signs, reason for visit, allergies, medications etc.



Any prescriptions will be handwritten on prescription paper.

Any radiology or lab including pathology results can be obtained by going intoLCR or calling the radiology or lab department.


MA will access arrived encounter from IDX in NextGen (a

Documents

Nextgen_downtime_procedures Sample From Hospital