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Thread: Patient flow in "paperless" office

  1. #1
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    Patient flow in "paperless" office

    Our office is on the verge of going paperless using officemate/examwriter. The big problem we are trying to work out is patient flow. Once the patient is checked in, how do we keep track of them. We are used to having a chart that we hand off to either the Dr. or opticians. We are a busy office and I am fearful that we are going to overlook our patients if we don't have something to physically see/hand off to each other.

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    You do, it's the patient.

  3. #3
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    I know the patient is there but like I said we are a busy office and I am afraid they will get overlooked or not taken in proper order amongst all the walk-in Rx's and pick ups.

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    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    How does your office currently work? You mention that you typically hand off the chart, but how many steps are in your flow? Do you have a separate room for pre-test, or is it done in the exam room, and the docs go from room to room? Have you used computers in the past? Do you currently post a schedule? Do Walk-ins?
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  5. #5
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    Currently: Pateint checks in, fills out patient history, reception enters data to officemate and puts chart in pre-testers bin. Patient is then pre-tested and chart is put in Dr.s bin, Dr.s then either hands off to free optician or puts in opticians bin if they are busy. Meanwhile we do have a consistent flow of patients walking in with outside Rx's, adjustments, and pick-ups. We do have computers in every room of the office. Thanks for any suggestions you can give.

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    Master OptiBoarder rbaker's Avatar
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    The easiest and least expensive way to work around this pesky problem is to take a single sheet of 8 1/2 X 11 sheet of paper and write the customers name on it and pass it around the office in place of the old charts. You will now join the ranks of the semi paperless offices.

    You will find the implementation of a "paperless" office full of these little challenges.

  7. #7
    On the Sunset Tour! Framebender's Avatar
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    We use a clipboard that has the patient name on it and a paper copy of any insurance authorization that might be involved.

    Good luck to you!
    Days where my gratitude exceed my expectations are very good days!

  8. #8
    OptiWizard
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    Patient insurance should be pre authorized. Patient history is recorded by a technician and simultaneously entered into the system. Patient has all entrance tests completed in exam room. The order of patients can be designated outside of exam rooms...like plastic flags or numbers.

    Have technicians scribe on the computers for the docs. Doc is done, moves to next room. Tech escorts patient to optical to continue process and/or hand off patient.

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    For the ten millionth time, it is illegal to escort the patient to optical and hand him off, especially if the Rx is in your hand and you hand it off to the optician. Rx must be in the patient's hand at end of exam (translation of end of exam: Before the doctor leaves the room).

    Chip

  10. #10
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    We're 'semi-paperless' at the moment. So the patient is registered, and all their personal details go onto the top of the form, with a barcode that identifies the patient. Then pre-test info is written on the front of the form (habitiual RX, IOP's etc.). That is then entered into the computer by the optom in the room, and they print off a 'dispense report' on the back (refracted rx, prescribed rx, any recomendations or notes that the optom has entered that may be useful at the dispense stage). Then the patient is handed over to an optician to go through prior to frame selection, then it's back across to a desk for the dispense. It's great because you don't have to constantly ask the patients date of birth (or name if you just can't remember!), plus you have all that info right there in front of you at every stage, including frame selection when you might be away from a computer, you don't have to keep flicking through screens on the computer to find the right piece of information that you want, and you have something to phisically keep track of a patient. When the patient leaves the whole thing goes into a pile to be shredded.

    Before this we did try the 'fully paperless' thing, but it didn't work for us. What we did was have a small pot at each area of the store where we might lose track of the patient, so at the registration desk, in the waiting area before the patient goes in, at the front desk, etc. And if we told the patient to take a seat, or go and browse, or whatever, we would write the patients name and their time in on a slip of paper. That way we could keep an eye on who is next and what we need to do. We still have this on the front desk for repairs, adjustments, discussions, etc. It works really well, "just take a seat over there Mrs Jones, and one of my collegues will be over in a moment", you write on the card "Mrs Jones - adjustment" and then you can forget about it, safe in the knowlege that whoever is free next will be over to Mrs Jones to do her adjustment.

  11. #11
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Some jumbled but hopefully helpful thoughts here..

    We did all our booking with our EMR as well. So we could print a schedule for the day and post it in our prep room, and then next to the computer in the exam room. If we had changes, a walk in, cancellation/reschedule, etc.. then we would use the magic of pen or pencil to make any edits necessary to that list. Do you seat patients after they are pre-tested in the exam room, or do you send them back to the waiting room? If you seat them for exam, perhaps you can designate the room number next to the patient's name on the master list for the doctor to reference, or use one of those color coded systems where you see the green flag, and it means go..

    All insurance is pre-authorized, and we actually kept that at the front desk for easy referencing.

    What we did to help us track things was create a "Recommendation/Action Slip" On it was space for things like the pharmacy, order trials or boxes for contacts, schedule follow ups, and make referral info.. along with a place for the doctor to write down the rx, and his recommendations for material, coatings, style, etc. The idea was to provide us with a way to double check information. The doctor I last worked with was not as comfortable with computers as he was with his pen and paper methods. So using the slip provided us a way to allow him the comfort of seeing things in print, and served as a double check to make sure the correct information was in the system. Heck he could write notes on it is necessary to get the patient out if there was a computer issue or he felt frazzled/rushed.

    The other nice thing about the recommendation slip is that we would print our lab orders, and we can compare the rx on it to the lab order as well. We kept it all together to form a "book" if you will.. so we could easily reference it if needed. Granted, we had a lot of measures like this for accountability and to reduce errors, since I was the only one who used EMRs previously.

    As far as managing the front end/optical.. this is where you need to rely on solid reception staff. As the patients come in the door, hopefully they are being greeted and asked what brings them into the office today. The receptionist should be able to act as "traffic director" for the opticians, and for the exam staff as well. Specifically they should be able to keep a list of the patient's name and service needed.. and then as one optician finishes up, the receptionist can tell them which patient is next, and what service is needed. Certainly those who are shopping for eyewear can browse and take a look around.. even those with repairs/adjustments can.. (they just might find something they want!) Hopefully your receptionist can track folks well enough to make things appear seamless.
    Last edited by Jubilee; 05-18-2011 at 03:51 PM.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  12. #12
    Optician Extraordinaire
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    We use a clipboard with insurance papers and a wipe off sheet that has the patient's name and what kind of exam they are getting.

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    Rising Star OptiBoard Gold Supporter
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    Our office is EMR and we found patients walking out the door without stopping at check out as they had Rx in hand and felt that their visit was complete. With 5 doctors in the office and 2 waitng areas it is controlled chaos to the bystander. We found that a yellow sheet of paper in the hand made the big diffference. Eveyone in the office saw that patient walking out with a yellow paper and knew to stop them before they hit the door. It also gave the patient the idea that they had to turn something in at the desk before leaving. It has patient's name address and insurnace on the paper, that's all. It's suprising what impact that yellow paper had on eveyone.

  14. #14
    OptiWizard
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    If you are smart, have the rx electronically printed at the check out area. Patient recieves it as payment is made for service (as should be the customary process for all exams...for the ten millionth and one time).

  15. #15
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    We are on the last phase of our paperless endeavor. I suggested the Plastic clipboard with dry-erase markings on it since I've seen it use at my Dermatologist's office, but that was vetoed.

    We currently use a plastic folder with Patient's info on 1/2 a sheet of paper cut length-wise. It gives us something to hold while we speak to the Patients even though most pertinent information is in Omate. There's no such thing as 100% paperless we have painfully learned.

    Good Luck!

  16. #16
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    Quote Originally Posted by OHPNTZ View Post
    If you are smart, have the rx electronically printed at the check out area. Patient recieves it as payment is made for service (as should be the customary process for all exams...for the ten millionth and one time).
    Yes, this is what we do. The rx prints out up front at the checkout area. The doctor walks the patient out and signs it.

  17. #17
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    Hi Bwincky!

    Our office is almost 100% Officemate / ExamWriter.

    If you really want to track a patient, the only true way is to make sure someone was/is "there" for the handoff.

    However, if you want to go back, at the end of the day and check...
    You can run any number of reports.
    Daily: Deposit (tells who purchased)
    Daily: Day Sheet (tells what each optician / employee wrote up)
    Daily: Fee Slip Audit (tells what each patient purchased)

    And, on and on.

    But, again...The best way to ensure that every patient was not overlooked, is to make sure they are "handed off" from the Doctor to an Optician (*With Rx in hand to appease Chris :P), and that each Optician make "notes" in O.M. about whatever may have transpired.

    You can, also, print out the days appointment schedule, and compare it to the deposit ticket. Allowing you to ask "What happened with Mr. Smith?" the following day.

    Hope this helps.


  18. #18
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    Thank you everyone for your suggestions. I guess we are looking at joining the "semi-paperless" world despite all our efforts. :D To bad there isn't a way to click a button in officemate/examwriter to track them through each stage of their visit i.e.(check-in, pretest room, exam room, optical). It's also to bad that I am not computer saavy enough to create that myself and make millions!!!! :D

  19. #19
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    Quote Originally Posted by Bwincky View Post
    ... To bad there isn't a way to click a button in officemate/examwriter to track them through each stage of their visit i.e.(check-in, pretest room, exam room, optical). ...
    There is in My Vision Express. Our new Patient Tracker feature in version 10.0 does just that. Contact our sales department (sales@myvisionexpress.com) if you would like a demonstration.

    Sincerely,

    Jorge Torres
    Sales Manager
    Insight Software, LLC
    http://myvisionexpress.com - Accelerate your practice!
    877-882-7456 Ext. 721

  20. #20
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    Ok...there goes my millions! Turns out Officemate can track patients from room to room. Problem solved! Thanks again everyone for all your suggestions.

  21. #21
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    How is it illegal? When the patient hasn't paid for the service yet, they don't get the end product until paid. Just like anything else.
    Illegal in what state, certain states?

  22. #22
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    Navy: Read Eyeglass One, prevailing Federal Law on this subject. It plainly states Rx must be given to the patient in his hand at the time of examination\ Odd how many opticians and OD's claim to not have read this despite it being printed on Optiboards numerous times.
    Unfortunately this is one of the least enforced things on the books or you could make a good living without working for a doctor.

    Chip

  23. #23
    Doh! braheem24's Avatar
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    Aw Lawd, not again.

    First the world ended yesterday, now we're re-hashing the "Rx in hand" made up story.

    I offered a $1000 to anyone who could prove it several months ago, no takers the last time; yet resurrected again.

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    Chip
    Actually,
    http://edocket.access.gpo.gov/cfr_20...16cfr456.5.pdf
    Federal Trade Commission Chapter 456.5 says:
    456.2 Separation of Examination & Dispensing.
    It is an unfair act or practice for an ophthalmologist or optometrist to:
    (a) Fail to provide to the patient one copy of the patients prescription immediately after the eye examination is completed. Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patients prescription until the patient has paid for the eye examination.

    Additionally,
    http://www.ftc.gov/opa/2004/10/BUS62-contact.pdf
    Prescribers may
    require a patient to pay for the eye exam, fitting and evaluation before giving the patient a copy of the contact lens prescription, but only if the prescriber also requires immediate payment from patients whose eye exams reveal no need for glasses, contact lenses,
    or other corrective eye care products.

  25. #25
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    Fee for service, no one walks out our doors with script without at least rendering a copay or without giving us full authorization to bill their insurance for service(s) rendered.
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