Case Study:
Vascular Institute of Georgia

Improving the Clinical Experience and Office Efficiency Using Secure Messaging and Custom Forms

August 2007

Intending to cut costs and improve workflow, Vascular Institute of Georgia finds that NorthPoint’s Secure Messaging Center also has enriched the clinical experience for patients — and providers.

In today’s competitive marketplace, practices need to use all the tools at their disposal to improve their processes, drawing on ideas from everyone in the organization. The Vascular Institute of Georgia (VIG), a six-physician, five-location practice in metro Atlanta, is one such practice. Dealing with all aspects of peripheral vascular problems, the practice is committed to providing the highest standard of vascular care in a professional and caring environment. This doesn't just mean working hard to cultivate a referral network by marketing the practice’s vascular lab through visits to area practices and participation at area health fairs. It also involves making sure that patients have a good experience — clinical and administrative — once they are referred to the practice. This requires involving everyone in the practice to generate ideas for workflow improvements.

An impending postage rate increase led VIG to sponsor a contest among employees to find ways to save time and money. One aspect of office workflow that many of the administrative staff identified for improvement was pre-visit forms, such as the medical history forms for regular new patients and those coming in for varicose vein procedures. The standard method consisted of either having patients complete paperwork at the office during their first visit or mailing the paperwork to patients who would complete it and bring it to the office at the appointment time. This system proved less than ideal, however. Not only was it costly monetarily, time that the staff could have used for other functions (scheduling appointments, for example) was spent in the labor-intensive task of manually printing and mailing these forms (4 to 5 pages each mailed up to 10 times per day).

The process for patient intake had important implications, impeding workflow and diminishing the quality of the clinical experience for patients and practitioners alike. Patients who forgot to bring their forms or had to complete them in the office caused delays for both the clinical staff and their fellow patients. Jessica Jarrard, Administrative Services Manager, of VIG observes, “Older patients sometimes need tremendous amounts of time to fill out paperwork, and often it is illegible.” Illegible forms did not contribute to the quality or efficiency of patient visits as clinical staff spent appointment time trying to decipher or verify the handwritten information. As a result, nurses and physicians were often required to use valuable face-to-face time with patients trying to clarify illegible handwritten entries.

The contest led staff members to take a critical look at the practice’s existing website, which provided routine information to patients, such as practice locations, physician biographies, and frequently asked questions, but no real way for practice-patient interaction. Staff members thought VIG could use its Internet presence as a way to begin the patient experience before they arrived at the office — by automating some of the pre-visit paperwork, which they believed could save significant amounts of time and postage as well as improve the experiences of both patients and clinicians. Jarrard notes that patient interest also played a part in this solution. Increasing numbers of patients “had been asking for a way to complete pre-visit paperwork online,” she says. It was both an indication that patients wanted a modern way do their pre-visit paperwork, “It was time to move into the 21st century” says Jarrard. Patient desire for this service further indicated that it would be successful.

VIG partnered with NorthPoint Domain to implement Secure Messaging Center (SMC) with custom pre-visit forms as part of the VIG Internet presence. SMC allows practices and patients to communicate safely and securely to request appointments and prescriptions and ask nonurgent questions, as well as complete forms such as patient medical history. SMC is simple and easy to use for practice staff and patients alike. Patients are directed to go to the VIG website to access, complete, and submit the forms in the HIPAA-compliant Secure Messaging Center. Patients are prompted to enter their information, review the information to ensure its accuracy, and then submit the request. After submission, the system generates a confirmation with a printer-friendly option so patients can make a copy for their records. The staff prints the completed forms and places them in the patient's chart for the clinical visit.

Using this secure tool on the practice website, patients access and complete forms from the practice website at home and submit them to the practice electronically before their appointments. These forms include:

• Medical information sheet, by which patients complete their medical history, including medication, allergies, hospitalizations, reason for visiting the practice, as well as their vascular history;
• Varicose veins information sheet, which provides the practice information about patients who are having vein tests and procedures;
• Appointment requests;
• Prescription requests; and
• Question or comment for nonurgent questions.

Phased rollout

Realizing that they were launching an entirely new process for staff and patients, VIG decided that introducing the online forms in phases would be the most practical approach. Rather than implementing the system through the entire practice at once, VIG launched a pilot program, using one scheduler to test the new processes. In addition, a Client Implementation Services Consultant from NorthPoint Domain spent time on-site training and updating workflow details to make the best use of the new tool, which included explaining how the system works, demonstrating it, and observing the staff as they began using the system. Jarrard says that VIG was “very happy with the support from NorthPoint,” who were “always available when we had questions.”

Although some patients had expressed interest in having online access to the practice, there was some uncertainty about how patients would react to the new system. However, patients took to the online method almost immediately. After SMC was introduced in February 2007, 58 patients took advantage of it that month and in the months since, the number has been roughly twice that. VIG expects volume to increase as the rollout is completed in all locations.

According to Jarrard, the practice has achieved “increased patient throughput and efficiency for the staff.” Having patients complete paperwork prior to the office visit increased the accuracy of patient information and record keeping and decreased the backlog in the waiting room.

The practice has received specific feedback from patients from VIG’s varicose vein clinic who, in addition to the vein patient orientation, appreciate the convenient online access to the practice. Says Jarrard, “They like that they can go online and ask questions 24/7.”

Based on the success of the process improvements to date, VIG is planning other online initiatives to further facilitate communication between patients and physicians as well as the addition of more information to the site, such as an expanded frequently asked questions section.

Although the initial purpose of the new system was improved workflow and reduced costs, it has positively affected patient care as well. Because patients submit the forms ahead of time and the information is more complete and easy to read, the clinical conversations focus on the information without taking up time to interpret the handwriting. “The physicians and physician assistants have noticed improved legibility and they don’t have to ask patients to clarify things as often,"” says Jarrard, which allows them more time to do what they do best — practice medicine.

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