Piedmont Athens Regional has created a unique workflow for new patient registrations for newborns. This workflow solved a particularly aggravating problem: It typically would take too long for a newborn to become registered as an individual patient, which caused unnecessary delays in patient care orders and record keeping required by insurance.
Interface Developer Mark Taormina described how they used Corepoint Integration Engine to find a solution that improved patient safety, reduced the amount of work required by caregivers and colleagues, and helped improve reimbursement.
Can you describe the newborn registration problem that you were looking to solve in more detail?
“This project came about because the labor and delivery unit and the mother baby unit were concerned that the baby accounts were not being activated quickly enough. That became a patient-safety issue because caregivers were unable to place orders on the baby accounts and get lab work done quickly.
Using the old process, the mother’s account would be activated when she came in to give birth. At that same time, the registrar would preregister the baby. When the birth took place, the nurses from labor and delivery would have to call a registrar to activate the account, which was problematic, especially in the middle of the night when we don’t have as many staff on hand and everyone is extremely busy.
There were also financial concerns because we needed the ability to capture in our registration system the Apgar Score of the baby. Using the old system, those scores weren’t always recorded.. When it was captured, the process was inefficient because the nurse had to verbally relay the scores to the registrar, who then entered it into the system.”
There’s a lot of data entry for the baby during both preregistration and activation. How are you using Corepoint Integration Engine to automate preauthorization?
“We utilized a few Action Lists in the engine to create some unique data workflows. Keep in mind that all this workflow detail goes on behind the scenes in the engine, so caregivers really only see the end result.
When the mother’s account is created or activated, we take that information and create a prereg message for the baby’s account. The preregistration message goes to Optimum that assigns the MRN and the account number for the baby, which are sent back to our Cerner Electronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conform....
Once that prereg comes back out of Optimum, Corepoint grabs it and sends an A24 back to the registration system because we have to link the baby to the mother. There’s another Action List that grabs the data file and generates a link message and sends it back to the registration system. So, at least two messages are automatically created when the mother is registered.”
What about activating the baby’s account after she or he (or they) are born?
“We went through all kinds of ways for this to happen. Ultimately, because of all the variables that could happen, the nurse activates the newborn account in Cerner.
We chose to use that Cerner feature because it required the least amount of data entry required to generate a message that we can then manipulate with Corepoint. Activating the account in Cerner only takes the nurse a few seconds. Once activated, Cerner sends an A08 message out that we grab with Corepoint and send to our registration system to activate the new account.
The final piece to all of this is the transmission of clinical data from Cerner to Optimum. Nurses enter Apgar scores, baby weight and method of birth in their Cerner documentation. This info comes out of Cerner as an RTF. I was able to find a pattern in the RTF, and using the ItemSplit operator in Corepoint, I capture and parse it out. I then use Corepoint to put it in the right HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... fields and send it back to Optimum to automatically input the needed clinical data.”
How much time does this save during registration?
“I’m not sure on the exact time, but creating a pre-registration takes some time. There’s a lot of data that’s in the mother’s account that needs to be entered into the baby’s account, and they didn’t have a way to automatically pull it in. They had to compare the mother’s account and replicate data between the two. Not having to manually enter the data really ensures accuracy.”
What feedback have you received from the nurses about their portion of the workflow?
“So with this new process, we put the power in the hands of the nurse, right there, in the room. They’re already in the record, they just pull up one window, they click a couple of things and save and hit OK. Within two seconds, that newborn account is active.
On top of that, I think this demonstrates to the organization that we are ready, willing, and able to use interfaces to improve patient feeds and automate manual processes. We’re told that we’re unusual for integration analysts because we do these sorts of things as opposed to just sticking to standard interfaces.
This project was like the perfect trifecta: We improved patient safety, we reduced the amount of work required by people, and we helped to improve reimbursement as far as capturing the required data that insurance companies want.”Tags: newborn, piedmont medical center, Workflow