Developing a comprehensive EHR system for the largest eye care group in the United States
The client has the largest network of integrated ophthalmic service clinics in the United States. With over 60+ clinics spanning different cities in California, it’s home to the top ophthalmologists and optometrists, known for offering the best-in-class patient care. Their ophthalmology practices include Oculoplastics, retina problems, LASIK, etc.
- 60+ clinics across the US
- 100,000+ appointments handled per annum
- 1000+ eye care practitioners
The eye care group examines hundreds of patients every day. To manage patient records, medications, appointment scheduling, telehealth facility, billing, insurance claims, and related operations, a third-party EHR was deployed at each clinic in the group. However, as the healthcare system grew, the EHR system was not able to map well with the patient and admin management cycle. Also, as the number of clinics increased, the recurring cost of deploying a third-party EHR became high.
To manage the clinical workflows and reduce the cost of the EHR system for all the clinics, the eye care group wanted to build a custom EHR. This solution was envisioned to offer several benefits, which included:
- Managing and integrating the workflows according to the clinical practices and would help in enhancing overall productivity.
- A custom solution that could be a one-time cost for the eye care group and it would be deployed in all the clinics, saving 70% of the cost that goes into a third-party solution.
Team Daffodil designed the development roadmap using our unique program called the Discover & Frame (D&F) workshop. This approach helps the business development team understand the project idea, target users, competitors, revenue model, and technical risks. Along with this, it outlines the scope of the project, user flow, timeline, and the cost of developing a market-ready solution.
Once the product roadmap was designed, team Daffodil initiated the development of a web-based EHR system using Angular and PostgreSQL as core technologies. The EHR system was developed with 6 prime roles: Front desk, call center, patients, doctors, technicians, and financial team.
The project scope included fixing the defects of the existing system and introducing new functionalities under every module and secondly, API integration with insurance providers to get patients’ financial information and other API integrations for smooth performance of the application. The prime business processes in the EHR system included:
The Front-desk users can check upcoming and current appointments along with the patient’s A/c balance (co-payment, deductible, A/C balance). They can check the appointment status (check-in, pending, canceled) and the ongoing status of the appointment (with technician, physician, or checked-out).
The front desk user can also create superbill for patients which includes information like general information, medical information, follow-up plan, authorizations, procedures, appointment information.
The call center would be able to schedule an appointment by checking metrics such as service type, patient’s zip code, the radius of the clinic from patient’s zip code, doctor preference, and insurance type.
The users would be able to view the list of patients for whom billing was generated and add new encounters. This includes information like patient name, date of service, exam type, insurance profile, provider, location, insurance name, authorization number, modifier, etc.
Once the bills are generated, they are transferred to the claims queue and are then sent to the clearinghouses for further processing. The claims that have been cleared by the clearinghouses will be visible under the remittance section. Any rejection or no response for the claims can be managed under the Insurance module.
Dashboards for reporting were created for admin, doctors, and clinics. The key modules for admin constituted of Revenue from capitated and fee for service patients, Claims generated or redeemed, Check no-show, canceled, and rescheduled patients, New patients checking to the clinic, Clinic wise patient feedback trend, and Total revenue etc.
The key modules for doctors included Current patient load, Patients linked with the doctor, Number of clinics visited by a doctor, New & existing patients, upcoming appointments, etc.
Data Protection & Compliance
For patient data protection, the entire system is HIPAA compliant. Patient data related to treatment, payment, or operations in healthcare are protected against any unauthorized sharing with a third party. Also, third-party integration is done to ensure cross-work between diagnosis (ICD) and procedures (CPT) codes. International Classification of Disease (ICD) codes and Current Procedural Terminology (CPT) help payors to understand what service was performed and why.
In addition to this, measures have been taken to process insurance claims seamlessly. At the backend, a rule engine has been created that checks for NCCI PTP edits. NCCI Procedure-to-Procedure (PTP) edits checks for incorrect code combinations when the claim forms are generated.
The EHR system is deployed in all the clinics of the eye care group for admin and patient cycle management. Team Daffodil played a crucial role in the deployment and training of the solution to ensure that all the users have a seamless experience with the new EHR system. The teams at the eye care group have experienced a productivity growth of 60%. Since the custom EHR is a one-time investment for the healthcare group, the recurring cost of EHR deployment has been cut down to 80%. Apart from this comprehensive Electronic Health Record (EHR) system, a separate patient portal is in the development phase that would enable patients to view their documents, create appointments, check past appointments, clinical notes, medication history, insurance claim status, etc.
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