Many providers are not accurate when dictating identification information about patients. For example, doctor may know patient as “Suzi Jones;” however, the computer system may know her as “Suzanne Jones.” This causes confusion, and when electronic medical record (EMR) systems are involved, data is rejected.

Besides discrepancies in providers’ dictation, transcriptionists (MTs) are responsible for typing information, including medical record number, exactly accurately. A 10-12% error rate is normal when MTs are dependent solely on providers’ sound files for information.

Designed and implemented system that parses schedule information from clients to give MTs patient-specific information from a secure website.

Patient demographic information errors dropped by 90%. Biggest challenge to the process was getting originating demographic file from clients, since many organizations did not have dedicated IT resources for these purposes and disparate computer systems.

Clients needed ability to have notes returned to them in a number of note formats, such as letterhead, progress notes on a half page, special consult, and state-required document formats.

While the old paradigm was for transcriptionist (MT) to type into each of these templates, to ensure MT efficiency company needed to standardize data entry and make data accessible to a website.

Designed and built a system to parse typed notes into an access database and use MS Word to format notes in various formats required.

System resulted in improved efficiency of MTs 18%, standardization across clients, and data viewability from the web, and has given the company competitive advantage in the marketplace, ensuring providers a system that gives them what they need.

RI Unlimited uses transcriptionists (MTs) who are contractors. As the team grew, MT billing was taking too much time.

Investigated the issue and found that a main cause for delay was lack of standardization in billing information being sent by MTs.

Designed and implemented a new web-based tool called E-Invoice, which collected the information into an SQL database, allowing billing to occur through this information.

Entire payroll-streamlining project reduced payroll creation time by 85%. This system is still being used three years after implementation.

Y2K Project: All 16 locations needed to be fully operational on Monday, January 3, 2000. Many things needed to be checked, from utilities and medical equipment to computers and software. If something was wrong, there was a limited number of technicians to solve the issues.

Each location had a team who came in on Sunday, January 2nd for a four-hour shift. Teams ran through pre-assigned checklist of verify everything was operational. Command center was established so problems could be triaged, most critical problems getting resources first.

While there were minor issues that were caught and resolved, all teams successfully completed testing by 11:30. Monday morning openings, therefore, went without a hitch.

Because these employees came in on a holiday weekend, project office assembled care packages for each team member. A number of users mentioned that they appreciated the extra recognition.

Employees whose primary responsibility was training were supposed to have one prep day per week, to give them a break from the classroom and to allow them to schedule personal issues, such as doctors’ appointments.

Upper management strongly urged to use trainers even on their prep days, because cost of trainers was less than that of contractors. This, however, added the risk of burnout for trainers.

Long-term trainer burnout seemed a more significant concern than short-term profitability for a quarter; however, some trainers needed time off to prep less than others do. Met with staff and asked for volunteers to teach extra with financial incentive.

Reduction in training cost ensued without seriously affecting trainer energy levels, while the importance of honoring personal management commitment to the trainers of allowing prep time was also retained.

Y2K project for PacMed was executed by 12 teams of employees with other fulltime responsibilities. With competing priorities, it was difficult to get project tasks completed on time.

Accountability for the teams stretched across entire organization. As project manager, had no line responsibility for the teams, so it was critical to ensure that upper management was being kept apprised of their staff’s progress or lack thereof.

Met with each team monthly to check progress against their task lists. Based on activity, team was graded and any potential risks were identified and documented. Grading reports were then forwarded to executive team with recommendations for further intervention.

While some teams first resisted compliance, by August 1999 all teams were coming back with completed plans, and by December 1st all teams had executed their plans. When Y2K hit, PacMed had no issues.

While some executives believe that Y2K was a myth perpetrated by greedy hardware and software manufacturers, firsthand experience indicated that PacMed would have experienced problems had Y2K project not been successful.

Due to software configuration issues, enterprise-wide implementation was delayed 30 days. All existing training would be stale, giving the project high likelihood of issues with people having forgotten new skills. There was no time to schedule refreshers.

For each class, a homework packet was created and sent to each user, so they could practice their skills in the meantime. All clinic managers, knowing this would be crucial for their users, made time for staff to practice at least 15 minutes each day leading up to go-live.

Day of go-live, Command Central had virtually nothing to do. Vendor sent his team home at noon because everyone was so well trained.

This delay could have been devastating; however, because of the clinic managers’ commitment to ensure skill retention, this actually became a win-win situation.

Clients are billed by a line rate, so every file that is typed must be counted to determine how many lines were performed for that client. Process was being performed at end of billing period, causing time to create client billing to become unacceptably long as the number of clients grew.

There were thousands of files to count, and the automated counting process was taking as long as 90 seconds each to count.

Designed and built a process that counted files on a nightly basis. Web-based tools were implemented to monitor counting and modify data as necessary.

Not only was billing time was reduced by 91%, but changes made it possible for Executive Team to determine current billing status on a day-to-day basis. Eventually, plan is to make this count real-time.

Because of client expansion, a large number of transcriptionists (MTs) needed to be hired.

Process to qualify MTs for hire is complex, to ensure new workers have the quality necessary to succeed. This requires multiple tests, which must be graded. At any time in the process, an MT can be disqualified for hire. It was taking over an hour per MT to do this via email alone.

Designed and implemented a web-based MT Application system. System not only takes their information, it gives users tests and automatically sends pass/fail emails for each phase once tests have been graded. It also gives Operations tools to monitor progress for all MTs during application process.

Qualification time was reduced by 75%; as a result, four times as many MTs can be in process without increasing testing staff. After initial project, Operations determined that they wanted to track all MT contracts online. This step was incorporated into the process as well.

PacMed was having financial difficulties. Executive Team directed budget reduction of 20% and 15% of staff. Current staff was already working at maximum capacity to support all systems with current headcount.

In working with end-users, IT priorities were reevaluated. Some departments agreed to take over more of their own support. Applications group was successful in cutting two fulltime positions. While requested deadline was 120 days, affected staff was informed immediately so they could begin to look for other opportunities.

Both analysts were gainfully employed elsewhere before the deadline. Affected analysts commented that they were surprised at being given as much notice as possible, since it potentially put the department in a bind. However, company risk was minimized while honoring employment relationship with these analysts. Doing the right thing for staff without jeopardizing company goals is mission-critical for any successful team.

As a result of offsite classes, trainers were sent not only to company’s classrooms, but also to locations around the greater Puget Sound area. Because of distance, a problem with trainer’s absence could cause a class to be cancelled, resulting in unhappy clients and lost revenue. There was no global tracking tool on the internet letting the trainer see their schedule and none available.

Instituted two procedures. First, put daily schedule on a voicemail line that any trainer could call to verify where they were expected to be. Second, established check-in call line, where the trainer was responsible to call when they are arrived at their destination. All trainers were to check in at least 15 minutes before classes were to start.

New procedures eliminated unexpected trainer absences by 98%. In the two cases where trainers did not arrive on time (one with car trouble, the other with a misread schedule) alternative trainers were deployed without significantly affecting schedules.

PacMed signed partnership agreement with Swedish Hospital, which added 12 clinics that were not originally part of medical network. These groups needed to be integrated into infrastructure, especially at software level, so that data could be shared between new and existing clinics.

New clinics had no current infrastructure, which meant staff was not accustomed to using computer systems. In addition, timeframe for integration was very aggressive.

Established classes specifically for new clinic members, to address their lack of computer skills. Slowed other projects to accommodate resource constraints caused by this project.

Clinics were successfully integrated in required timeframe. Communication from decision makers to implementation staff was vital for successful planning of the initiative.

Y2K policies required that all key business partners be polled to ensure their Y2K compliance prior to year end. There were 120 of these relationships when all departments were polled. However, no department had the work force to ensure this work would be done in a timely manner.

Project office devised standardized documentation methodology for this compliance, and hired part-time contractor to monitor this part of project. Each compliance packet was reviewed and signed by affected department manager.

Only business partner that was seriously affected by Y2K happened to be a business that was being replaced for performance reasons anyway. Therefore, 100% of partners were compliant. More importantly, company was properly documented in case there was an issue. An alternative solution was found to compensate when the original was not working in a timely manner.