Spectrum Health

1

Implementing Emergency and Inpatient Cerner Registration

while Retaining Existing Patient Accounting Technologies

Ron BussaProject Manager

Jen NicholsManager, Revenue Cycle Systems

Jim DeJongeManager, Patient Access Services

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AgendaObjectives of TodayOverview of Spectrum Health and

Quick Facts (Who)The Vision (Why)The Plan (What)Technical ElementHuman Element (Most Important)Lessons Learned

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ObjectivesUnderstand “Human Aspect” of the

Implementation and What You Can Do

Lessons Learned from Implementing Inpatient Cerner Registration

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Overview of Spectrum HealthWho we are:

7 hospitals

13,000 staff

1,400 physicians

2,000 volunteers

140+ service sites

Who we serve:Service area covers a population of 3 million

450,000 health plan members

6,300 employers

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Quick Facts around Inpatient Registrations

Emergency Department (5 Hospitals)Average # of Emergency Visits/Day = 492Average # of Emergency Visits/Month = 14,760Average # of Emergency Visits/Year = 177,120

Admissions (5 Hospitals)Average # of Admissions/Day = 198Average # of Admissions/Month = 5,940Average # of Admissions/Year = 71,280

Outpatient* Visits/Year = 482,400 * Already Using Cerner as Registration System in

Production

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The Vision (Why)Deliver Exceptional Experience:

Deliver Better Patient Care and Patient Experience Demand Superior Quality:

Deliver Superior Care through the use of Technology

Optimize System Performance: Tighter Integration with Clinical Systems

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The Plan (What):Overall Roadmap

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Revenue Cycle Technologies

Cerner

Scheduling

Cerner

Registration Clinical Care

Cerner

Coding

HealthQuest/Third Party

Patient Accounting

HealthQuest

Denials/Revenue Management

HealthQuest/Cerner/Third Party

Scheduling

Cerner

Registration

HealthQuest

Clinical Care

Cerner

Coding

HealthQuest/Third Party

Patient Accounting

HealthQuest

Denials/Revenue Management

HealthQuest/Cerner/Third Party

Account Closure

HealthQuest

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Inpatient DataFlowMcKesson Technology: Role/Functionality Workflow—Surgery Future State

Bille

rO

ffice

Sta

ff/R

egis

trar

Fina

ncia

l C

ouns

elor

Sche

dule

rPr

e-Ar

rival

C

linic

alPr

e-Ar

rival

Fi

nanc

ial

Cod

erC

linic

ian

Scheduling Queue

Pre-Procedure Planning

Credit Verification

Authorization Tracking

Elgibility Verification

Address Verification

Register

Clinical Evaluation and

TreatmentEnd

Coding

Needs information and may have to re-perform

Credit Verification

Address Verification

Elgibility Verification

Authorization Tracking

Possible route toFinancial Couns.

Financial Counseling

Patient Payment Collected/Receipt

Patient Payment Collected/Receipt

Patient Responsibility Determined

Billing and Follow Up

End

End

Patient Identification

Possible route to surgery

Legend:

= Undecided

= HealthQuest = Cerner

= Plus

= Work Queue

= Third Party Vendor

=within application

=interface/integration between applications

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Registration Integration

CernerFull EMPI

OrdersResults

Results

Orders

Health Quest

Full EMPIADT: Person, Visit, Combines

Charges

ETL

ADT

CernerFull EMPI

Pyxis BW

DictaphoneMcKesson

PACSMayoClinic

SpecialtyLabs

Pyxis BL

Robot BL

Robot BW

Orders

Rad Onc BL

Rad Onc BW

CBORD

WittCardio PACS

Results

Cyto Lab

Mary Free Bed

GV IM

Priority Health

Mercury MD

Results

Philips BMDI

MMPC Orders

Winscribe

SoftMed

Health Quest

Full EMPIADT: Person, Visit, Combines

Charges

PracticePlus

Partial EMPI

Charges

ADT: Person,

Visit Combines

“Look Ahead”Active Integration

Lawson

Data Warehouse

ETL

ETL

ETL

ETL

Supporting Systems

Spectrum Health Enterprise System Backbone

ADT

Master Integration Model

• Real Time ADT• Full “person” knowledge

• FIN alignment

• Ongoing monitoring, management

• Batch Charges

• Manual Master Files

• Synchronization and timing critical

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Technical Requirements

Defined Technology Build NeedsCerner Registration ConversationPhysician PrivilegingRobust Integration

Rules and EditsCerner and HealthQuesteGate/IIP (Integration)

Monitoring and Reporting Tools

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Human Element:Staff Preparation

System Policies and Procedures Equipment Emotions

Make it intentional!

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Human Element:Current Registration System

What do they say?

“I can almost do a registration with my

eyes closed--I know it so well.” “I haven’t looked at a reference manual

for years.” “I like it when I can help a new staff

member find their way out of difficulty.”

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Human Element:Current Registration System

How do they feel?

Feel confident with self Feel comfortable with job Feel effective and efficient Feel good about accomplishments at the end of

the day Satisfactory emotional levels

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Human Element:New Registration SystemWhat do they say?

“Don’t see how this new system has anything over the one we were using.” “I have to go so slowly now. I have to think about each field.” “I’m lost. What do I do now?” “I know you need help. But, I really do not know what to tell you to do.”

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Human Element:New Registration System

How do they feel?

Don’t feel very confident about their own abilities

Don’t feel very comfortable about their capacity to do the job well

Feel slow and not very efficient

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Human Element:How Can Management Help?

Pre-Implementation Take time to have staff talk about the up-coming

changes Identify super-users; have them dig into the new

system; have them report back findings to staff Prepare staff for all changes: system, process,

procedures, equipment Have a training system that is identical to the Go-

Live systemHave staff Practice, Practice, Practice on New

Registration System

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Human Element:How Can Management Help?

Implementation & Post-Implementation Be a cheerleader during implementation (and after) Have candy, fruit, pizza available for staff Provide education / training and TIS support Provide super-user support Do relaxation exercises Watch for staff-in-stress and offer assistance Provide recognition and thank-you letters (movie

tickets)

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The Lessons Learned:Leadership Involvement is Critical to SuccessDecision might be a “Political Battle” “Open Line” of Communication to Physicians, Nursing Staff,

Revenue, Patient Billing etc…Open Lines of Communication to Staff. “The Why?”Customer Ownership and Scope Management (Phase I,

Phase 2, Phase 3 etc.)Functional/Integration/Enterprise TestingHave Cerner Domains “In Sync” (TEST, TRAIN, PROD etc.)Practice, Practice, Practice on New SystemBe Prepared for Issues/Comparisons but Have Staff

Understand Process of Reporting Issues/SuggestionsDefine Comprehensive Support Model Through Payment

ron.bussa@spectrum-health.orgjennifer.nichols@spectrum-health.org

jim.DeJonge@spectrum-health.org