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White Paper

Scheduling for Healthcare

Patient scheduling is an integral part of daily work for healthcare professionals, from family practices to large clinics, from physician offices to hospitals. Medical office staff has to schedule patients for dentist, optometrist, ophthalmologist, surgeon, psychiatrist and other general care and specialist appointments. Scheduling quickly becomes complicated if the doctor is practicing in several clinics and travels between medical offices. Appointments need to be coordinated, medical support staff has to be constantly aware of all new patients and doctorís schedule.

Patient scheduling can be greatly simplified with capable online scheduling tools and appointment management software. With the help of online scheduling, medical office staff can easily manage doctorís appointment schedules, patient records and individual appointments. Small medical practices can even allow patients to self-schedule their appointments online.

Scheduling systems should take patient, doctor and staff privacy and information security very seriously by enforcing high standards of electronic and physical security on the application premises and data center space. The application should not collect, sell, share, disclose or provide customer, appointment and service provider information to any third parties unless required by law.

HIPAA Compliance

HIPAA regulations will only apply to Appointment Software Scheduling services if and only if this scheduling software is used to perform insurance, payment or related transactions (HIPAA transactions), and to collect any medical history from patients. Standard features such as timed auto-logouts, protected passwords, strong 128-bit secure SSL encryption, patient registration and login options, just to name a few will also help compliance with the HIPAA regulations.

Patient contact and appointment information should be kept private and shared only with account administrator and authorized personnel.

HIPAA Compliance with the Electronic Transactions and Code Sets Requirements

The Administrative Simplification Requirements of HIPAA consist of four parts:

  • Electronic Transactions and code sets;

  • Security;

  • Unique identifiers; and

  • Privacy.

HIPAA does not require health care providers to conduct all transactions listed electronically. Rather, if they are going to conduct any one of these business transactions electronically they will need to be done in the standard format outlined under HIPAA. It is important for health care providers to see that their transactions are being conducting in compliance with HIPAA.

HIPAA Coverage

Organization can determine if they are required to comply with the HIPAA act if they are conducting or if a third party is conducting billing activities on their behalf, any one of the following business transactions electronically:

  • Claims or equivalent encounter information

  • Payment and Remittance Advice

  • Claim Status Inquiry/Response

  • Eligibility Inquiry/Response

  • Referral Authorization Inquiry/Response


Appointments are currently scheduled by professionals who will negotiate the appropriate times and dates with patients. These appointments can be made for any specialist at any location and can be arranged by phone, fax or email. These schedulers are able to coordinate examinations for claimants who may require more than one type of exam or testing on the same visit, thus reducing transportation issues, costs and processing time.

Detailed narrative reports are specifically tailored to the type of coverage and address such issues as causal relationship, disability, permanency, schedule loss, and apportionment. Board Certified physicians dictate detailed clinical findings. All reports undergo an extensive quality assurance review and are completed within seven business days.

American CITís Methodology and Approach

The Scheduling Software should allow Healthcare companies to:

  1. Schedule patients for exams, visits, treatments or procedures

  2. Securely access appointment calendars from multiple offices

  3. Easily navigate daily, weekly and monthly schedules

  4. Search, browse and update patient contact information database

  5. Create hardcopy and backup of appointments and patient records

  6. Schedule recurring appointments for multiple patient visits

  7. Cross-schedule between multiple medical offices and clinics

  8. Optionally allow patients to self-schedule appointments online

The Application should be Customizable

Schedule application should give users the ability to create custom schedules. These permit different schedules on different days, allow for different durations depending on the visit reason, and are easily changed on the fly. Correlating visit types and unique patient requirements help the schedule dynamically adjust to the changing environment of a busy physician's day.

Visit reasons can be specialty-specific to cater for different styles. Users can also customize their screen to show multiple resources for a day, week or even a month.

The Application should offer Simplified Daily Scheduling Tasks

Staff has rapid, simultaneous access to constantly changing schedules. Scheduling for providers, equipment and services at multiple locations is as easy as point-and-click. Automated warnings messages ensure attention is paid to billing issues and other special situations. Rescheduling and follow up visit copy functions are fast and easy.

Customizable searches find available slots, and show patient appointment histories. No-shows and cancellations are tracked, with automated prompts to fill cancelled slots from wait lists. An on-screen confirmation tool also will help staff rapidly deal with this necessary but time-consuming process and automate the results instantly in the main schedule.

The Application should offer better Practice Flow

Mini notes which will prompt the scheduler to ask important questions or give patients instructions, educating the scheduler to steer selected patients to other remedies before tying up valuable slots. For example, a patient may initially be directed to a laboratory to have labs drawn prior to the visit so that the results are available to the physician.

Known as IDCOP (Idealized Design of Clinical Office Practice), this is an enormous productivity tool that eliminates the time and cost of tracking ordered labs, reviewing the results, making a disposition on the results, tracking down the patient to inform them of the results, and changing the treatment or follow-up. At check-in, demographics can be verified and updated on-screen. The system also should notify staff if co-payments are due.

The Application should provide Data Analysis and Time Management
Reporting capabilities include no show and cancellation tracking, appointment histories, user productivity, reminders, wait lists and more. The application should track the time it takes for patients to move through the clinic. Reports allow management to analyze these statistics to identify areas needing improvement so that you can maximize the use of reimbursable resources and improve patient satisfaction.

The Application should offer Industry Compliance and Security Standards

User defined, role-based security groups control access to different functions. Different view options ensure protected information is more secure while audit trails track all accesses to patient information and appointments.

Initial Tasks and Features that will be evaluated and addressed:

  1. User Defined Views. Ability to see services, equipment, or providers with day, week, and month views, and ability to see any number of resources side by side. Check also if Users have many options that control how they see data.

  2. Multi-Location, Multi-Resource, Enterprise Capable. The ability to Schedule for different facilities, providers, equipment and services to ensure maximum utilization of resources.

  3. HIPAA Privacy and Security. View options and automated logoffs prevent unauthorized views of patient information.

  4. Check In Module. Automate the check in process, save time and improve work flow by doing everything on one window including demographics verification, super bill printing (if used), patient photos, taking co-payments and printing a receipt, checking referrals and printing forms.

  5. Wait Lists. "First available" or "specific doctor" request automatically fills cancelled slots to ensure a full schedule and happier patients. Empty slots still incur overhead.

  6. Appointment Instructions. Print, e-mail or read instructions pertinent to a specific visit reason to ensure improved patient expectations and improve workflow (for example, the patient does not have to be rescheduled because they were never told to fast for labs).

  7. First Available Appointment Searches. The ability to Search by resource, date, specialty, appointment type.

  8. Appointment History Searches. The ability to Locate patient appointments easily including the ability to see no shows and cancellations.

  9. User Defined Blocking and Unblocking. The ability to Create time for appointments, time off, or build pressure valves into time grids for catching up.

  10. User Defined Color Coded Appointment Types. The ability to Guide the scheduler to make appointments that work correctly for the provider, equipment or resource.

  11. Color Coded Patient Types. The ability to Alert staff to VIPs, family of staff, disabled, delinquent accounts.

  12. Rapid Navigation Tools and Summary Screens. The ability to enable rapid completion of often repeated tasks while guiding users to schedule optimally while saving time.

  13. Customizable Time Grid Management. The ability to Allow resources to have different schedules for different days and gives the ability to change schedules at a moment's notice. Users can build in empty slots as pressure valves. Same day/open access slots can be created. Users can define specific appointment types and durations at particular times of the day or week. Time tracking helps staff design grids that match your real world situations and helps drive optimal workflow.

  14. Wave and Group Scheduling. The ability to Graphic appointment time views gives users the ability to optimize patient density by visit type.

  15. Simple Rescheduling and Rapid Copying. The ability to Schedule follow up visits or move them with just a few clicks.

  16. Patient Photos. If the application offers patient photos (where applicable) to Reduce mistakes at check-in.

  17. Balance Lookup. The ability to access account balances to help schedulers and other staff notify patients if they have balances due.

  18. Appointment Density Analysis Tools. Check if Graphic views is used to show times when the practice is busy and times when traffic is lighter, enabling better analysis and design of time grids.

  19. Overbooking. The ability to allow easy entry of walk-in patients.

  20. No Show and Cancellation Tracking. Simplifies follow up for legal and clinical reasons.

  21. Conflict Checking. Ensures staff does not schedule the same slots.

  22. Appointment Work Flow Time Tracking. Based on check in, treatment, and check out time, reflects activity-based costing, this is a powerful feature necessary to help manage bottlenecks and inefficiencies due to staffing issues or visit types and measure efficiency by specific procedure.

  23. User-defined Role-based Security Access. Includes audit trails and productivity analysis.

  24. On Screen Appointment Confirmation. Make the necessary but time consuming task of confirming appointments much faster. Check also if Appointment confirmations can be automated with IMA telephone system (CTI-Computer Telephony Integration).

  25. Specialty Specific Visit Reasons. The ability to Allow schedulers to rapidly select the reason for the visit from a list of common diagnoses or procedures linked to a specialty.

  26. Customizable Triage Hints. Prompt schedulers with appropriate questions to ask patients to improve scheduling, workflow, and patient access.

  27. Integration with Other Modules. Common demographics shared among modules, referral warnings, and integration with the accounting application.

  28. User-Defined Role-Based Security Access. Check if the application offers a complete flexibility down to the granular level giving the Administrators the ability to control access to different parts of the system. This helps with HIPAA compliance as well as ensures that functional groups in a practice have targeted privileges.

  29. Audit Trails. Audit trails track access to appointments, who has been blocking and unblocking slots and more.

  30. Fully Scalable. Check if the application is Scale to enterprise-wide, multi-specialty, and multi-site locations with master person index.

  31. Master Person Index. Reduces the chances of duplicate records and saves staff time.

    32. Integrated Database. Improves workflow by making more than just demographic information available in all modules. Reduces cost of managing inherent problems with bridged systems.

  32. User-friendly Windows Interface. Check if the system offers an Intuitive navigation, natural workflow pattern, and multiple options for quick data entry.

Major Activities that will be conducted and performed during this Phase:

  • Current State Evaluation- Business Processes and Technology Components

  • Enterprise Business Process Reengineering, Mapping and Redesign

  • Business Enterprise Architecture

Enterprise Business Process Reengineering, Mapping and Redesign activities and Tasks

The objective of business process re-engineering is to achieve a fresh perspective on organizational tasks. In a "redesigned" business process, activities that are managed as a single, coordinated operation by individuals or teams. Interfaces between activities are improved and the IT emphasis will be on supporting value-adding activities and making them more tightly coupled.
Our experts will perform business process reengineering using the latest modeling tools, methods and techniques under the UML (Unified Modeling Language) methodology. Our strategic business process reengineering approach is an enterprise-wide and will include concurrently a review of enterprise data requirements and data modeling.

Tasks to be performed:

  • Evaluation and Determination of Companyís Objectives, Wish list and Critical Success Factors

  • Analysis of the Core and Related Processes and Process Steps

  • Connect Organizational Units and Roles to Process Steps

  • Evaluation and selection of the appropriate Business Process Modeling Techniques

  • Process Triggers Modeling

  • Existing Data Integrity Evaluation

  • Data Flow Modeling

  • Process Flow Modeling

  • Documentation of the Data Stores and Their Relationship to Entities

  • Identification of all External Triggers and Events; Time-Based Events

  • Documentation of Business Rules and Logic Conditions

  • Critical Path Analysis and Process Improvements Requirements

  • Function Hierarchy Diagrams

  • Functional Decomposition Diagrams

  • Quality Assurance Techniques

Business Enterprise Architecture Activities and Methodology

Strategic Business Enterprise Architecture analysis will result in an enterprise- wide information systems strategy. This strategy provides an overview of the organization and its information systems requirements and serves as a structured framework for the development of the integrated applications thereafter.

Major deliverables of Business Enterprise Architecture:

  • The Business Direction Model

  • The Information Model

  • The Functional Hierarchy Model

  • The Application Architecture Diagrams

A) The Business Direction Model

The Business Direction Model outlines the goals and objectives of the organization, and then further defines critical success factors (CSF's) and key performance indicators (KPI's). Goals are broadly expressed statements that support the mission of the organization. Objectives quantify the goal. Critical success factors are those things that must be in place to achieve the objective and, in turn, to realize the goal. Key performance indicators are the specific measurements of success.

B) The Information Model

The Information Model is a diagram composed of high-level entities and the relationships between them, along with descriptions and examples. It is a model of the information within an organization, and illustrates how that information is linked.
The things of importance (entities) within the business, the properties of those things (attributes), and how they are related (relationships) are depicted on a diagram. In the strategy study, entities are defined at a high level and do not go into specific detail (e.g., address is defined, not street number, street name, city, zip code, etc.). Later, as more information is gathered during the analysis phase, this model will be amended and further detail added to produce the Business Data Model, which will provide the definition of the structure of all the data that is used or generated.

Data Model and Entity Relationship Model are synonyms for Information Model, and are often used interchangeably. When the scope of the modeling is across the entire business, the model is called an Enterprise Data Model.

Enterprise data modeling is a technique that aids in:

  • Identifying related and overlapping information across multiple systems elements

  • Reducing data overlaps and inconsistencies and data integrity problems arising as a result

  • Creating architecture solutions for data interfaces and potential integration of data elements that can be mapped to database designs for future in-house Information Technology projects and third-party software products

  • Developing a direct route to an integrated, flexible information resource based on a clear understanding of information requirements expressed as data structures, interdependencies, and common functionality

  • Planning for high-quality systems that better meet the requirements of business enterprise information processing, derived from business models agreed between managers, users and developers

  • Initiating working practices in the organization to support the implementation of structured techniques for information systems development and the use of supporting CASE tools

  • Improving productivity within Information Technology by clarifying basic concepts at the senior management level and often simplifying requirements or converging redundant development efforts

C) The Functional Hierarchy

Function modeling and Function Decomposition Diagrams provide a model of what an organization does (its functions) and how those functions can be grouped. The functions within a business are grouped into a hierarchy.

The initial Functional Hierarchy, created during the strategy study, is a list of the major functions of a business. It is created by analyzing the business, using the top-down approach. The starting point and highest function of the hierarchy is the mission statement or goal of the organization. The finishing point is an elementary business function in which a specific unit of work is defined.

The purpose of function modeling is to show how the mission statement is fulfilled by the functions performed within the organization. This is a powerful technique that can lead to fundamental questions about how an organization operates.

D) The Application Architecture

Once the Information Model and the Functional Hierarchy of the business Enterprise Architecture have been completed, the relationships and dependencies between entities and functions are established through high-level strategic analysis.

This interrelationship of entities and functions forms the basis for the application architecture. These are the key to insuring seamless integration of applications. When such a building block is completed, it is available to more than one application, and It will allow for intelligent sequencing of development efforts and eliminates redundant development.