DST gives Sisters of Mercy a clean bill of health

Healthcare providers today are under tremendous pressure to increase their efficiency and quality of service, while addressing increased regulations and combating the rising costs of operations. US-based Sisters of Mercy Health System (Mercy) is no exception.

St Louis-headquartered Mercy is a large system of hospitals, physician practices, health plans and health and human services, supporting a seven-state area. Mercy decentralises its operations with regional strategic service units, which have the benefits of local management and Mercy`s system strength.

One of these units is St John`s Mercy Health Care in St Louis. In St John`s quest to care for priority number one - the patients - challenges such as managing medical records and the billing process bogged down the revenue cycle.

"We identified three main business areas related to the revenue cycle with immediate opportunities for process improvements: Admissions and Registration, Health Information Services, and the Central Business Office," says Sheri Beekman, executive director of Receivables and Health Information Systems at St John`s.

Beekman says there were several challenges related to paper-based processing in those business areas, including:

* Managing loose sheets in the medical records;

* Storage space constraints in Health Information Services;

* Out-of-date archiving system in the Central Business Office;

* Need to improve storage and coding for outpatient records; and

* Need to scan and capture patient information at the point of admission (insurance cards, advanced beneficiary notice forms, consent-to-treat forms).

The unit`s challenge was to increase efficiency and quality of service while addressing increased regulatory requirements and reducing operational costs. To address these requirements, the unit contracted with DST Systems for HiBPM, DST International`s business process management solution, based on components of AWD (Automated Work Distributor).

"AWD is a solution Mercy and St John`s can grow with," says Fred Ford, VP for special corporate activities at Mercy. "With AWD, we can reduce the time-consuming paper shuffling among the business offices and improve our revenue cycle from start to finish. All of these benefits add up to the most important thing - more time to focus on our patients."

St John`s researched imaging vendors but found that AWD went beyond imaging to include significant opportunities for business process management (BPM), including process automation, integrated tools for quality control, and real-time business intelligence for reporting and performance analysis. Another key factor was AWD`s production-proven track record. "One major differentiator setting AWD and DST apart from the competition is their first-hand experience with their own solutions," says Ford. "With a visit to DST`s headquarters, we saw AWD at work in their own financial services operations. To us, this demonstrated their commitment to the product and the versatility of the technology."

Representatives from Mercy, St John`s and DST partnered to implement AWD in a way that would meet healthcare`s unique challenges. Goals included the implementation of a paperless, automated work delivery system to process medical records more efficiently and provide:

* Immediate access to imaged information;

* Improved utilisation of resources;

* Ability to print, e-mail, and fax images directly from a workstation;

* Systematic quality assurance capabilities;

* Documented audit trail and security features to comply with HIPAA (Health Insurance Portability and Accountability Act) regulations;

* Report writing capabilities to monitor work status and measure staff performance; and

* Reduced revenue cycle.

"AWD integrated with our existing technology and processes, so there was no major reengineering," Beekman says. "We were able to leverage our existing technology investments, with AWD as the bridge connecting the various application systems throughout the St John`s organisation."

AWD captures inbound medical records scanned into the system and stores them in a central information repository. Using St John`s business rules and requirements, AWD automatically delivers work to appropriate staff and physicians through the billing process.

Authorised staff and physicians across the organisation have immediate access to medical records in AWD, rather than having to search for and sift through paper files to resolve questions and issues - and complete the billing cycle. AWD also assists with HIPAA compliance by tightening information security, allowing only designated people to view information, and by providing an audit trail to track access to records as they progress through processing.

St John`s began production use of AWD in late 2002 and is continuing to implement it across the organisation. Benefits that St John`s has identified in each of its phase one business areas include:

With the ability to scan and capture at the point of service, staff have immediate access to admissions information, and management can perform thorough quality assurance on the data collected. This significantly improves denial management process by ensuring that correct and complete data is used downstream for submitting insurance claims. Admissions and Registration receives bed requests by phone and fax, which are automatically imported into AWD as images. This expedites the fulfilment process, streamlining communication among various departments.

AWD eliminates time-consuming filing, retrieval, re-filing and manual distribution of medical records, as staff have simultaneous access to imaged records and documents in AWD`s central information repository. AWD also automatically matches loose sheets to charts, reducing misfiled, unavailable or lost documents.

To manage and monitor chart deficiencies, AWD automatically routes medical records for chart analysis, coding and electronic physician signoff. AWD also automates correspondence requests for medical records, allowing St John`s to track these requests easily and accurately bill for them.

AWD improves the denial management process with automated creation and routing of failed claims reports and partial payments or denials. Staff also have immediate access to imaged documents housed in AWD`s central information repository (medical claims, payer/patient correspondence, admission information and more).

St John`s plans to expand the solution into administrative areas such as Cash Posting, Care Coordination, Contracting, Legal, Human Resources, and Accounts Payable.

"AWD has allowed many organisations worldwide to improve their processes; enhance customer service delivery; improve revenue generation and collection; reduce error and boost business intelligence," says Marisa Bellini, director of DSTi South Africa. "The exemplary success of St John`s indicates what can be achieved with South African healthcare organisations."