Home Forums Discussions Feedback and Recommendations Patient registration

When new patients come to the practice, we have them fill out some registration forms. In addition to their name, address, and insurance info, we have them fill out a medical history form and a questionaire (to help screen for bi-polar disorder). We have the forms posted on our website so that they can do these in advance, since it does take about 15 minutes.

Is there a way that any or all of this information can be captured and imported into AC into demographics page and possibly the initial note for the first visit (known allergies, social history, etc.)? Currently, we have to type or scan in the forms that they fill out. Also, some patients don't have internet access and still must fill out the forms in the office.

Instant Medical History - solves this problem. Allows patients to complete their Insurance, Past Medical History, and Subjective either at home or in the office with a tablet and interfaces (for $250) with AC.

J -

Are you using IMH regularly and loving it?

I found the interface cumbersome, and I found it nearly impossible to complete custom templates.

Maybe I didn't give it a fair shake. What has your experience been?

I am curious on your registration forms on the internet. I had key word had mine on the internet and then was encrypting them via email to me. I am currently working what I am going to do to make it HIPPA compliant. It was not being stored on a server but there is still some question as to the compliance of this practice. Is your on a server that is HIPPA compliant or just emailed and not stored? Any help would be great!

Alexis, from a compliance standpoint there are two major concerns which can be easily addressed:
1) Transmission - The transfer of the data from the patient's PC to your server and the reverse. This can be accomplished with the requisite level of SSL. This encrypts the data while it is being transmitted from PATIENT --> SERVER <-- PATIENT.

2) Data Storage - how the data is stored on the server. Most databases today have the ability to encrypt stored data, and decrypt it on request. This means even is someone were to get hold of the physical database files, they would not be able to extract any patient information.

So here is how it should work:
Patient --> Server
Patient is presented with form.
Patient fills forms.
Patient hits save.
Data is sent to the database via SSL Encryption.
Data arrives at the database and is encrypted and stored.

Server --> Patient
Patient logs in.
Database decrypts patient data for reading.
Data is sent to patient form via SSL Encrypt.
Patient "changes/updates" his/her data and hits send.
Data is sent to the database via SSL Encryption
Data arrives at the database is encrypted and stored.

Currently our forms on the internet must be printed out an carried in. Not optimal, but at least they are almost always completed in advance. We don't email it in because of HIPPO, uh, I mean HIPPA.

Thanks And yes I agree Wayne. My thing is getting them to bring it in prior to the appointment even jsut a few minutes. My office is VERY small. My receptionist and me So far it is working great but when I am up to capacity of CPE a day it may be a bit more difficult.

If I could find a cheap HIPPA way to have them email it to me, I would in a blink. But then we still have the no-show issues. I had two new CPEs not show up yesterday.

Wayne,
Step one, NEVER do a CPE on the first visit! We always insist on an "Establishing Visit". Almost all adults have at least one small issue to use as a Dx code for the first visit. It really is doing everyone a big favor and practicing better medicine.

First it makes them commit to at least two visits firming up their committment to the process and the doctor. But the real issue here is that the doc knows not who this new person is. Does she really need to see their old records according to their Hx, and that could take weeks after they sign your release. But as I explain it, we want to let the doc and you explore your issues, and who you are as a patient and a person, and according to what she learns the doc is almost certainly going to send you out the door with orders for labs and or images and other tests. And then when all that data comes back she will incorporate all this good data into a great CPE.

Now you have much less no-shows for these big slots, the doc is armed with much better data to get to know her patient and therefore care for them better too, and you break this process down into a two or three visit process that allows the doc and the patient to work thru what they will learn and attend to them in a more edible bites. How many patients have you had walk out the door with "too much new info" only to call and need to ask about how to take their new meds or test their own sugars??? Busting this out into a getting to know you kind of experience is better for the patient, better for the doc and her office, and in the long run usually helps get the patient accustomed to their new doc and their relationship with her. It's just much better medicine.

For those one or two people a year who are absolutely healthy as a horse and have NO issues (almost never once they are 30+) then your doc can code a new patient CPE. We are building a long term relationship and both sides are going to have to do some work for it. If the new patient doesn't care to do this, this is a great weeding out process for us. They want a get in and get out, they can go find another office. We do real medicine at our office and that still takes some time and effort, a relationship is developed and long terms treatment and other plans are made. This all takes time and we are not going to do "Marine" sytle or rushed.

In the end your patients will like the extra care, work and concern and your doc will feel better about caring for her patients as they actually get to know one another over two or three first visits. And for those who don't like we are fine with that, they can go to the big impersonal factory down the road.... Just wait til they see the care they get over there...

Wayne to achieve HIPAA compliance with Messaging the message is never transmitted, only the notification that a "message exists" is transmitted between the sender and the recipient. Both the sender and the recipient have to log in to VIEW the message on a secure server.

Hockey, I've discussed the CPE with various folk--there are other takes on it and I haven't decided which I agree with. Some doctors require the first visit to be a CPE. This gets them a small gain in reimbursement (initial cpe vs recurrent cpe) and allows them to review the detailed info of the past medical and family medical history immediatley. It also eliminates those Doc Jumpers who just come in for once a year for a sore throat or UTI and you never see them again as they go to whomever is convenient. It starts them off committing to the practice as a "medical home."

I've never looked at an "Establishing Visit" nor had one for any doctor I went to. BTW, how would you code that Establishing Visit?"

Alot of our patient population is really the 'young and healthy."I mean really. But often they have an acute illness and, since they are young and healthy, don't have a regular doctor. So we see them and have them come back for the CPE. Most do. But I would like to eliminate, or reduce, the new cpe noshows and not having a cpe on a first visit is definitely an option.

Wayne,
We simply code a new patient level whatever, usually a 3 or a 4 with whatever ICD-9, Dx code that is most appropriate be in high PB, Asthma or whatever. I'm telling you there's almost nobody by age 30-35 who doesn't have something... Again for the truely healthy horse, the visit can be a new patient CPE after all is said and done just do a real CPE.

But I'll bet ya dollars to donuts that once they go and get their labs done, something is going to get flagged. People eat like crap, don't get enough exercise, and do all sorts of stupid things to hurt themselves. Heck even "smoking" is a legitimate ICD-9 code for nicotine addiction.

And most people don't just call a PCP out of the blue for no good reason at all. Something made them make that first phone call or look you up in the phonebook or the carriers book or website. They are calling and coming in for some reason, even if it is a 45 year old husband who hasn't been to a doc in 20+ years and his wife finally nagged him enough to come see her doc at our place, your place. Why are you finally coming in today??? What hurts, what happened that scared them enough into finally call and make an appointment, now that is the question.

And here is why this multi-step process also works. Many of the people who call looking for a new patient physical are doing so because in our state many CPE's are covered in full or fall outside their deductables and the like,if their plan doesn't fall under ERISA which allows for such things to not have to be covered. They are trying to get in a single no pay visit where they can hit you up for months of refills on the inhallers, antihystamines, Lipitor you name is. Hey what kind of good medicine is it to write lots of Rx's half in the blind without bloodwork or previous records??? And then many of these Cheapos try to not come back for F/U visits to have a spirometry done, an ECG, review labs. How many folks want free phone calls post labs with no F/U visit?

This way if they want their meds, if they want our doc attention then yes they are going to get our docs attention. Write the Lipitor for one month only so they must get their bloodwork done and come in to have a real "documented" visit to review and make informed choices with the doc to get 3-6 months of refills. This now sets the patients up for a mind set of get their bloodwork done and then come in to have a F/U visit. we get lots of calls now from well taught and cooperative patients asking for their bloodwork orders so then they can schedule an appointment for about a week after the draw. It great!!! After a while they really start to get it. Now we really can help you control your cholesterol by having the data we need to continue as is or tweak your dose or perhaps make some changes, informed changes together with their doc. What a nightmare.

The whole concept is to get them onto a mind set that says they need to partner and cooperate with this process because it is a process to really help someone control their issues and live a healther life. If you want to get in and get out, there's the door there are plenty of rush jobs around town to go to. But if you want the real Village Medical of CNY and Dr Blake, then you must be willing to be a working equal partner in this deal here.

We don't have to be the PCP of everybody in Liverpool and the surrounding area and frankly in many ways we don't want to be. We just need enough to fill our panel and waiting room. And if the idiots in charge would finally start to understand that quality starts when you pay people really well for a job well done and insist that they actually slow down and get the details right then we could all make a reasonable living properly caring for people in the proper way that we are supposed to. Most PCP's and their staff already know and understand what needs to be done. It is simply a matter of getting everyone else on board to cooperate with and support the program.

When I was a union stagehand, they insisted in many instances that we slow down and pay attention to what we were doing, be unloading a truck, climbing a ladder, flying a pipe full of lamps up to trim Height or what ever. Rushing only leads to overlooking something or an accident and lower levels of quality. Nothing in this world comes for free, we can hurry and possible save some money or we can slow down and give you a great high quality job. And just remember many of those mistakes cost lots of money and have other consequencies, human ones. Why can't people simply understand that in our business? At some point efficency comes only from a job properly and well done, not the cheapest but really the best job. In terms of healthcare the savings from a job well done are almost too immense to calculate but we all know they are there.

And it starts with us insisting that folks come in ready to do their part in building a real relationship with a quality doctor who actually gives a CCHIT. Sure there are really healthy folks who only need to be seen once or twice a year and those few folks usually can have a CPE and a single sick visit a year or what have you. But most folks who have one or two chronic issues better get ready to do their share and it starts with coming in regularly for F/U and managment visits. Now if we could only get paid a real living wage for all those office visits.....

This sounds terrible, but who cares about HIPAA compliance. I am still waiting for the HIPAA police to actually declare themselves.

But, Wayne, there is a guideline in the hugeh HIPAA document which outlines step by step how you can send and receive email which meets with HIPAA regulations. It just involves sending a couple of emails back and forth between you and the patient.

I use CertifiedMail, which is $9.95 per month and works perfectly for HIPAA compliance. The only problem is most doctors cannot figure out how to make up a password and type it in. I mean it's so easy it is ridiculous. But, then again, I imagine the average patient is more tech savvy than most doctors.

Oh: www.certifiedmail.com

I was trying to tell other folks about your secure email but I couldn't remember the name, and you are there and I'm back here... So many of the IMP folks are talking about expensive UpDox and the like, I'll have to them later this week... Thanks

I'm actually here, lol.

Where??? lol

Who's on first??? Stay out of the in-field!!!

I'm in Maine, they are in Branson. I stayed home due to illness. Hell, I thought I would get a few more posts in, but it seems that they can't just have the conference; they have to post about it too.

Going to get some Indian food and a beer or two. I will be back on later.

Indian food, yes? Well I guess you don't have a stomach bug then... Feel better. Sure wish you would have made it there to show off all your good stuff. You're like our hero man....

ok. I'll check out Certified Mail. Thanks.

Let me tell you what I'm trying to accomplish in the short-term. I have new patient registration forms on our website, but I only allow the patient to print them and bring them in. I'd like to let them click on a "Email form" button, but it does have some health info and their SSN on it, so I'd like to try to make this "secure." Its for a new patient, not established, so they won't have access to something where they sign in, because I woundn't want to allow that type of access until after they actually established themselves with us.

Yeah, I haven't seen the HIPAA police either, but it is probably a compaint driven process. And I don't know about other areas, but patients in NYC like to complain about you even when they are the ones doing something wrong. But since they didn't get their way, they want to punish you. I swear, I'm gonna write a book!

So, does anyone have a suggestion on this? Would CertifiedMail fulfill this need? Is anything out there that will?

Wayne,

Let me think about it and get back to you tomorrow. I'm too tired right now.

Bert:

I tried certified mail. I found out our local HMOs want emails from patients written in "structured format" to pay for the e servies. "Structured format" - is available by those relay health etc., So I cancelled certifiedmail.com.

Still thinking about those relay health etc. for now.

Yeah, they want to pick the service provider that you use for any and everything. You only need to pay attention to that if you are going to try and have them pay of webVisits/Online Consultations/Virtual Office Visits...whatever you want to call the "e-mail-based" office visits. So far, the only company I've seen endorsed by the insurance cartel is RelayHealth.

But if you don't want to do the Virtual Office Visits, or at least don't want to have the insurance company pay for it, then you are free to do whatever you want.

I'm just looking for a "secure"or "encrypted" way to get this form sent to me from the website.

Wayne,

One of my favorite authors, Hugh Prather, wrote: "the window is not the view, the window allows the view."

I have always applied this concept to the visualization of data. The FORM is not the data, the form only allows you to see the data.

In my opinion you are getting caught up in the wording, and not looking at the requirements: You need to have access to the data on the form to re-present it for the patient when he/she arrives in the office, in a manner that meets HIPAA compliance.

All you need for this is a location (database) where the patient can "deposit" the data, and you can "withdraw" the data as needed. Forget about email and all that. The "system" can notify you by email, sms that a "deposit" has been made.

When it boils down to it HIPAA is about secure information STORAGE AND RETRIEVAL. It is no more than your bank is about secure STORAGE AND RETRIEVAL of your money. The concept is not different, neither is it new, it is only being applied to a different business process.

I do remember Relay Health. I looked at a website today called MedFusion. Looks pretty good. Of course, they go out of their way to hide the cost. I believe they quoted 60 cents per transation. And, according to them, based on the ROI, you would save roughly 2 1/2 million dollars per month.

http://www.medfusion.net/medical_pre_registration.html

I guess although there are many things it does, you could ues it only for registration, then you would have to decide it the 60 cents would be a savings there. You can do virtual office visits, etc.

It always kills me when it says, "We were able to educate the patient, and therefore save an office visit." I guess that's OK with an HMO, but if it's fee for service, you have just lost that visit amount.

George, you make a good point about the email or date being on a secure server, but I think this is very much like CertifiedMail which also has its limitations due to the doctor has to email the client first. Of course, it could be done in a different fashion.

This MedFusion looks very promising if the actual ROI is helpful. Again, to Wayne and joseph2, even if you used only the registration form, it would be worth it. I may even look into it. Of course RelayHealth is doable as well.

I think Medfusion is the one where, if you are a member of AAFP, they'll give you a free website of 5 pages. The problem with it is that you may not really "own" the website. So it may be difficult, at the least, to add certain customizations. For instance, I montitor things about my website (unique visitors, pages viewed, etc." Its actually a free service from Google. But when I had a website from Medem, I couldn't use it because I didn't have access to the code so I could insert 1 line of code that Google searches for to prove that you "own" the website. And Medem didn't provide any of the data.



No,George, I am not getting caught up in the wording. In this case, I want the actual form because they sign the form. Its a legal issue. I'd actually need to find a way for them to "electronically sign" the form and send it. Though I'm not quite sure the e-signature will be good enough. But I'm looking into these things in the hope of being able to set something up where the new patient can fill everything out online and send it to me before they come in. Maybe it should be one of those things where there is a checkmark for them to agree, like on some of the software EULAs. I'm not sure yet.

Wayne,

I will respond to this in 10 minutes...

I apologize Wayne. I guess I will just say I'm not quite sure what you are trying to do. Don't know if I could help anyway. If all it were was for them to download it and mail it back, I don't think HIPAA applies since they initiated it.

I know, for instance, that if I email a patient and say, hey, little Johnie's physical went great, that is a violation of HIPAA. However, if I go through the rigamarole of emailing them and asking them to email me back to allow me to share PHI with them, then I can email them about syphilis and all sorts of things.

It still would seem you would want some type of portal where they they fill out an electronic form and it is then sent to you. With some type of button they click to send it that says, "By clicking this button and sending this form you are attesting you are the one who filled out this document, blah, blah, blah.

But, again, sorry if I misunderstood. Which I probably did.

Wayne Pls use FireFox for the link below:

I would start with a Wizard, that looks like this:
http://www.visualizedata.info/cms/default.aspx

Once the data is saved, I can pull it into a "report" which displays as a PDF and allows you to print for signature.

Again...this is very simple stuff!

First off we just went over the HIPAA thing for this kind of stuff at IMP Camp. If you get the patient to first sign a waiver stating that they understand that the transmission may be less than secure and they sign that they are OK with this, then you are covered. I not 100% sure but Bert could be on to something with us emailing the patient first with the same basic thing and then they email back saying, that's OK with me. I'd check just to be sure.

Also we discussed using the portal of the carrier's choice and this is fraught with peril. This is especially true in terms of "E" visits. Personally, never do them thru the carrier's portal of choice. You have been warned.

They really want you to use the portal of their choice because then they get to spy on both you and your patient way beyond just an E&M code and one or two ICD-9's. This allows them to pay half the price of a standard office visit (lost revenue to you) while most of the time they get to pay nothing at all, because at approximately $30 for an e-visit, with more and more plans having $20-$35 co-pays, you do the math. Half for you, nothing for them. Gee I wonder who comes out ahead in this little game?

But much more importantly, these e-visits that they host and you portal thru them, allows them to see and read every word that went on between you and the patient! CHART REVIEW! These conversation between you and your patients become ammo for later office raids and give backs!!! Seriously, please don't any of you use their portals, you are leaving yourselves naked and defenseless. They then get to see what kind of visit leads to what kind of coding and then use that information to throw in your face. It's as damning as a video tape, don't do it!

There are many reasons to not give a carrier the charts requested in one of their pre-exsisting condition fishing trips and each and everyone of you should know what they are. Furthermore, many times like here in our area, our biggest carrier doesn't bother when they sign on new memebers, even with large employer groups, to find out who had previous coverage so they are not subject to such waiting periods by law. Instead they intentionally do it on a "claim by claim" basis so they can screw us and our patients.

But you all know that a certain patient had Aetna for two years prior to getting switched to BC/BS let's say. So when you get one of these letters, don't even send a thing or even respond. Instead call your patients, explain the rules and what to say and then simply sick the patient on their employer and the carrier. It works like a charm! And you know who your "love to fight back and raise a stink" patients are. Just sit back and revel in the thought of that person going ape on human resources and the carrier's customer service reps... Now no charts sent, you get paid, they get what they all deserve. I think it's great.

So please never ever use the carrier's portal. We have to be smarter than that, and when they ask why tell them exactly why you refuse to use their portal. Because it is your sworn duty to protect your patient's privacy even from them. They actually don't have a right to know all and see all. So says the Medical Society's best and brightest.

PS: That is why most of them will pay for an e-visit but not for a better phone visit where you and the patient can have a good exchange of information as you ask good leading questions that would take forever in a back and forth volley of emails. They can monitor the email in their portals, where as they are none the wiser than an office visit with the phone calls.

Think people, think. Protect yourself and your patients. This is your relationship, and these bozos are but interlopers that are ruining the intimacy of it all. Kick 'em out of your exam rooms...

Hi Wayne for the time being we are a pdf that they print and can either a) bring in prior (very easy since we are on an island and most folks are within 10 min of my office) or b fax. I just logged in to the system this am and over the weekend 4 people have faxed in. We just made the change on Friday! One commented she felt more secure printing and faxing rather than the way I had it which was submit electronlically. I had it encrypted and sent to email until Friday. Hope this helps.

Currently, our patients print the forms and bring them in. HIFM, you had it encrypted and sent in? For a new patient? How, may I ask? You can see how we do ours right now, just go to our website.

George, I will take a look at your link a little later today.

No need to appologize Bert. I don't think I was really clear overall in stating what I am trying to do. My bad. Now, its not just HIPAA that concerns me here. The form asks for their SSN, and I don't want that sent electronically w/o some type of protection from snooping eyes. Plus, it gives consent to our privacy policies and for us to collect the insurance payment directly. Yeah, I hadn't thought of the button thing until last night.

Hockey, you bring up some interesting concerns about the e-visit portal of choice. Especially since ALL of the companies ONLY accept RelayHealth. They won't cover Medem,which is sponsored by the AMA. Not to mention any other company's system.

George, that is a great start for an electronic form as far as obtaining there demographic/medical history info. I've collected medical history this way before actually, but it was through a third party's secure portal (Instant Medical History). It just needs the encryption on transmitting it to me and the e-signature.

Wayne, as I said earlier, this data collected can be generated as a PRINTABLE PDF which looks EXACTLY LIKE YOUR FORM for the Patient to sign when he/she comes into your office.

Once the patient signs the form, you should be able to then move this data into AC.

The FORM does not need to be encrypted. The DATA needs to be encrypted!

As I keep saying a form is only a tool to capture and display data. However, once the data is captured it can be RE-DISPLAYED in other FORMS.

OK, stupid question of the year: And, it is really stupid.

Can you join the AAFP if you are not a FP. I mean a pediatrician is half, right?

I don't know -- but why would you want to?

For Medfusion. Plus, your articles are about ten times better than ours. I know I can read them anyway.