It Pays to Be SpecialConverting a Specialty Practice

Web Presence into Dollars

November 2,2012

Vickie Parry Scott Lungwitz Brian MoloneyMarketing Manager Web Content Specialist Managing PartnerIllinois Neurological Institute OSF HealthCare Imaginary Landscape, LLC

ISHMPR

Illinois Neurological Institute (INI) & OSF HealthCare

OSF HealthCare, owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois, includes:

Eight acute care facilities

One long-term care facility

Two colleges of nursing

A primary care network consisting of over 600 primary care, specialist physicians, and advanced practice providers.

Ranked 25 of 600 Integrated Health Networks.

Our MissionIn the spirit of Christ and the example

of Francis of Assisi, the Mission of OSF HealthCare is to serve persons with the greatest care and love in a

community that celebrates the Gift of Life.

Illinois Neurological Institute (INI) &

OSF HealthCare The Illinois Neurological Institute is the neuroscience

service line for OSF HealthCare

Employs +60 neurosurgeons, neurologists, physiatrists and mid-level providers

The INI has approximately 95,000 patient visits/year with a DCM of +$100M

Primary, Secondary &

Tertiary Markets

Specialty Centers Brain Tumor Gamma Knife/SRS Multiple Sclerosis Spine Institute Physical Medicine +Rehab Neuromuscular Sleep Medicine Neuro Ophthalmology

HeadacheBalance + VertigoStroke + CerebrovascularMovement DisordersEpilepsyPediatric Neurosurgery/NeurologyPituitaryNeuroradiology

Our Problem Growth of our neuroscience service line is dependent on

consumer/self referrals and referrals from outside our health care system.

Needed to attribute revenue to web efforts – without a CRM.*

Not meeting needs of our patients who are searching for us and our services online.

*this is important

How are We Going to Fix it? Worked with OSF Corporate

Marketing team and Web Developer (Imaginary Landscape) to create an online appointment request feature that meets the needs of our patients and enables us to track patient revenue.

First Appointment Request Application

INI Patient/Referring Provider Experience – Part 1

Physician Directory Listing by Specialty

INI Patient/Referring Provider Experience

Request Appointment

Button

INI.org Homepag

eFind a Physician

(Link in left navigation)

Physician Profile Page with Request an Appt. Button

First Appointment General (non-

physician-specific) Request Form

First Appointment Request Form

(Physician Specific)

Enter in patient information and reason for request.

Referring Provider

Patient

Submit

Provider enters in referring

information about patient

Submit

Fax Patient RecordsSuccess Request

Submitted

INI Patient/Referring Provider Experience – Part 2

Red Tape

Avoiding Breach and Risk

Bring Them to the Table

Be Prepared

Bring Them to the Table Layout the project scope

Present from the patient experience point of view as it relates to privacy/HIPAA.

Assure the room that you have processes and workflows in place to accomplish the project safely and securely.

Be Prepared

Bring Them to the Table Introduce your vendor to the team

Prep your vendor prior to meeting on the following:

Can you create a secure online tool for this project?

How do you create and deliver such a tool?

Will the tool be in a HIPAA secure environment?

Will you commit to a Business Associate Agreement?

Be Prepared

Bring Them to the Table Goals

Get the approval from Compliance

Compliance approved the initiative from a patient privacy/HIPAA point of view

Accepted Business Associate Agreement from vendor

Get the approval from Security

Security approved our initiative.

CAUTIONED that we must comply with future FTC security measures.

Be Prepared

INI Patient/Referring Provider ExperienceINI.org

Homepage

INI Website

Find a Physician(Link in left navigation)

Request Appointment

Button

6,000 Visits Monthly

Select Physician by Specialty

Physician Profile

Status

Contact Info

Reason

Administration Screens

Online Patient ViewAdmin View

Status:

•Unread

•In Progress

•Appointment Made

•Appointment Not Made

Cancel Reasons

•Insurance Conflict

•Not an appointment request

•Hours conflict

Contact Info

Reason

Submit

Patient Info

Referral Info

Insurance Info

Administration Screens

Online Referral View

Admin View

Patient Info

Referral Info

Insurance Info

Managing Appointment Requests Who should manage requests?

Call Center or MOA in charge of phones.

Already fielding phone requests.

All are trained nurses that can triage patient situations.

How should we manage requests?

Application sends an email notification.

Individual vs. role based email accounts.

Request Management

Appointment Request Management

Email Client Inbox

Clicks Link Contained in Email

Notification

Appointment Request Management – Part 1

Request from Referring Provider

Request from Patient

Request from Patient

Patient or

Referring

Provider?

Create Record in EMR

Contact PCP for Patient Records

Records Received

Call Patient to Schedule Appt.

Request from Referring Provider

Records Received

Create Record in EMR

Call Patient to Schedule Appt.

Notify Referring PCP of Appt.

Success Appt. Made

Appointment Request Management – Part 2

Update First Appt. Status

Update First Appt. Status

Call Patient for history

Timeline

Project Timeline

Project Timeline

Timeline

Project Timeline

The first, First Appointment Request was submitted during the first hour of launching, without promoting anywhere!!!!!!!!!!!!

Timeline

How Does it Look and Work?

HIPAA

HIPAA

Breach Notification Requirements

Individual Notice

Media Notice

Notice to the Secretary

http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/index.html

HIPAAThe Breach Roll

http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html

Caesar’s Cipher

Caesar’s Cipher

Cvvcem cv fcyp.

Attack at dawn.

HIPAAProtected health information (PHI) is rendered unusable, unreadable, or indecipherable to unauthorized individuals if one or more of the following applies:

1. Electronic PHI has been encrypted as specified in the HIPAA Security Rule by “the use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key” and such confidential process or key that might enable decryption has not been breached.  To avoid a breach of the confidential process or key, these decryption tools should be stored on a device or at a location separate from the data they are used to encrypt or decrypt.  The encryption processes identified below have been tested by the National Institute of Standards and Technology (NIST) and judged to meet this standard. 

http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/brguidance.html

Guidance to Render Unsecured Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals

HIPAA

HIPAA

4.2.2.1 Advanced Encryption Standard (AES)

The AES algorithm is specified in [FIPS197]. AES encrypts and decrypts data in 128-bit blocks, using 128, 192 or 256-bit keys. The nomenclature for AES for the different key sizes is AES-x, where x is the key size. All three key sizes are considered adequate for Federal Government applications.

What Does It Mean?If you…

Encrypt data in transit and at rest

Encrypt using AES-128

Put the encryption keys on another device

Then… No breach, even with a custodial loss

Results Between April 11, 2012 and June 30

2012, 53 patients requested appointments online.

80% made a general request vs. 20% requesting a specific physician.

59% completed the request form when our call center was OPEN.

Mixture of former/current patients (old $)and new patients (new $).

Results Of the 53 patients requesting an appointment only 11

were marked “appointment made” in the database. An additional 9 were referred to Priority Consult. * This is a problem

Of those new patients who were seen, the majority of them were from outside our primary service area and a greater percentage had commercial insurance vs. managed care, Medicare or Medicaid.

Data is pulled monthly from the request database and sent to Corporate Decision Support. We need Patient Name and DOB for tracking.

How Do We Track the Revenue Without a CRM?

Decision Support pulls the Medical Record Number (MRN) of each patient and attaches dollars. It is our intent to track these patients for at least one year.

Pull data for EVERYONE on the list, not just those identified as “appointment made”.

How Do We Track the Revenue Without a CRM?

Obstacles to Overcome Less than half of those who request an appointment actually

receive an appointment.

Staff Attitude – not receptive to self referrals and data is incomplete in the database.

Access. Some physicians unwilling to accept self referrals and some have lengthy (+4 month) wait times.

Lack of ability for referring physicians to attach patient records.

Some using appointment request form to ask general

questions vs. request an appointment.

Lessons Learned

Know your data. Just because a record says “appointment not made” doesn’t mean that’s the case.

Involve ALL staff from your call center from the very beginning – not just the manager.

Be in agreement on how you attribute dollars to the project.

Monitor your data and be prepared to take action if you don’t like what the data is telling you.

What’s Next? Implement a Patient Experience Team

Add a contact us form that is more prominent on the site.

Mobile App for Referring Physicians

Sharing of Patient Records through Epic and Illinois HIE.

Second Opinion Campaign

Tracking First Appointment Request entry sources

PPC; Display; Social Media; Organic Search; Directory Listing Other OSF Websites; etc.

The $$

We invested approximately $20,000 in the technology.

Through 7/30 we know that those patients who were seen had a DCM of +$186,710. And there will be additional revenue from these patients in coming months.

Of the $186,710, $183,120 was new $ and

$3,590 was old $

Questions?