How to Avoid Bad Patient Data

[Tina Alviar]

If your Invision Patient Management system interfaces with other systems and exchanges Patient data, then you may find this helpful. I’ve worked with two types of interfaces and can share a few things I’ve learned about them.

When discussing setting up this type of exchange of data, you need to have a very good understanding of the patient flow in order to document the data flow. Otherwise, you may end up with unexpected results, creating additional work, patient dissatisfaction, and possibly authorization denials. If the account is being registered in SMS and simply sending patient data to another system, this will be a one-way interface. A lot of times this is used when you are simply feeding information to another vendor or system for them to use the data to load into their system. Typically companies doing billing for the physicians will request this type of information so that they get all the patient demographic and insurance information needed to bill the insurance and patient for the physician services. The only issue with this type of interface is if the receiver of the data obtains updated information, there is not an automated way to get this information back to update your Invision system. In which case, you may not receive the information unless you have established a manual process to exchange the data. This can become a customer service issue, if the patient thinks they have supplied updated insurance information. Patients don’t always understand that when they come to the hospital, they may get bills from the facility as well as any physician that may have seen them. 

Now if your facility has elected to set up a two-way interface, you will get the updated information, which would seem to be a good thing. But there are instances where the information will not always be the same between different providers/systems. It will present some challenges unless you have mapped out the patient flow and data flow in conjunction with your processes. You may need to request some limits on what data is exchanged and when it can be exchanged, or put in some type of alert that revised data has been received from the other system. For example, in some states the Medicare Part A coverage is handled by a different contractor than the physician Part B coverage. So when Invision sends the information, the receiver may update it to the insurance that will pay for the Part B services. This change in insurance information could send out an incorrect bill which will be denied, or it will alter the contractual allowances booked. Then your staff will update Invision back to the original information, which will get sent back to the receiver, who will in turn update it to suit their needs…and then you are stuck in a loop. 

If you walk through actual scenarios of patient flow, and all the points where updated information could be received and updated in either system. This will allow you to make decisions about whether you want to receive all updates, some or none.  You can also decide if you want to only exchange information for a limited amount of time.  For example, for pre-registered patients you may only want to exchange information up until the time the patient arrives and all information can be confirmed. And for outpatient accounts where the patient walks in, you may want to allow information to be exchanged for 48 hours or even for the same amount of time as you have your bill hold set for.

If you have EAD installed, then merges done in Invision also need to be done in the all downstream systems. You probably have someone who monitors the reports of potential duplicate medical record numbers created. If they are merging duplicate records for a patient in SMS, then the merge should also be done to the other downstream systems. This is especially important if the downstream system sends you registrations. If the other system has outdated duplicate patient records, then it could send you bad information back, potentially creating another duplicate record in Invision, or the registration being sent could be rejected by Invision due to RTIF errors. Either situation will require manual corrective action to either clean up the duplicate a second time, or to manually register the patient account that was rejected.

So if you are in a situation where the question keeps coming up, as to why your Invision system keeps getting bad data, this may give you a few things to consider. 

Tina Alviar has worked for over 25 years with Invision Financials and is currently Director of Patient Financial Systems at MedStar Health System.

The views and opinions published reflect those of the author and are not reflective of the MedStar Health System.