Case Study – Large Multi Location Physician Group

Electronic Medical Records Implementation
Clinical and Billing Systems Integration

Situation

A non-profit network of multi specialty physician group practices in over 30 locations had made a series of acquisitions and affiliations with other groups over a period of years. The network that now consisted of approximately 1,000 physicians recognized the need to implement a single Electronic Medical Record (EMR) and clinical system that would unite the groups in their ability to transfer patient medical histories and procedures between various offices and specialists.

 
Problem

In order to implement the EMR system, the network had to deal with two 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. Second, all patient information originated with the physician who utilized an internal clinical system that was not fully integrated with a separate billing system.
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.

 
Folio Problem Solving

Folio was asked to review the current provider databases and processes of the network. Folio implemented a solution that consisted of the following elements.

• Existing databases were rationalized using Folio’s proprietary software tools to eliminate all duplicate, inactive and out of area providers.
• The databases were then matched to Folio’s reference database of all active practicing providers within the network’s region.
• The network wished to maintain their own physicians’ information. Crosswalk tables between the network’s databases and Folio’s database were developed. The network provided Folio with monthly electronic updates of changes in internal staff physicians and Folio added and removed network providers each period to maintain the crosswalk table.
• Monthly the network refreshed their provider data by incorporating Folio’s reference database of over 50,000 active practicing physicians in their multi-state region.

 
Benefits

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.

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