“A few years ago when were looking for a new system for enterprise wide appointment scheduling and a replacement for an aging OR system, we never imagined that our selection would become the premier vendor of choice [KLAS 2004 Surgery Management Summary Report]. We knew it satisfied our needs but, to see this affirmed in a nationwide survey is pretty impressive. USA ranked very high in prior KLAS reports as well. They are the most responsive vendor we have ever worked with, addressing our needs in a fair and timely manner. Besides that, RMS/ORMS is a solid and reliable product causing us the least of any problems we have with operations. USA also interfaces with our Siemens, Lawson, and Pyxis systems which we use for registration, supply chain, and patient accounting. Clearly they set the standards on customer satisfaction and attention to support. When you see their marks in the report they blow every one away by a full ten percent or greater variance including the long time big vendor favorites like Cerner, GE, PerSe, etc.!”

David Pecoraro, Former Vice President/Chief Information Officer
Jewish Hospital HealthCare Services

“You are always there when we need you and you always manage to get us out of trouble. It is sad to say this level of service is rather extra-ordinary these days and I can think of only a handful of vendors that consistently give us quality service. You are certainly high on that list. I wanted to take a moment to thank you for what you do for us. We appreciate you.”

Venu Rao, Director, Information Technology
Trinity Mother Frances Health Systems

"I just read about the KLAS awards. That was really great to see. I think yours is the best company we’ve ever worked with. Please give my congrats to all.”

Vicki Conner Coordinator, Clinical Information Systems
Monongalia General Hospital

For the second year in a row, Hospitals and Health Networks magazine has honored Inova Health System as one of the nation's "Most Wired" health care organizations. "Thank you, USA- you're a part of our success!"

Nanci Little-Gosnell, Chief Information Officer
Inova Health System

“I appreciate USA fixing this now and not waiting for the next release.  Your customer service continues to be outstanding.  All the bragging I do about the support department to prospective clients is well deserved.”  

Larry Grossman, Director, Systems Development
Jewish Hospital HealthCare Services Inc.

“Because of the ease of the system [periOperative Resource Management System] it has been easy to cross train others to also do scheduling, that is one of the beauties of the [ORMS] system.   With ORMS multitasking is a reality, with the other system it was so difficult that not many people could use it.

After the [ORMS] training everybody felt comfortable.  We really love the system, Kelly says to me ‘have I told you I love this system?’  There are no troubles, no down time, we are very pleased. ORMS is really great!  

Patti Stewart, RN, CNOR, Perioperative Educator
Mon Health System

"I have worked with the USA product [Resource Management System] since 1997 when it was implemented.  We schedule an average of 5500 appointments every week for 107 departments across 16 different facilities.  We have about 50 schedulers.  Unplanned scheduling system down time would result in rework and cause an inconvenience to the customer.  It would negatively impact our productivity and customer service.  I can't remember when the last unplanned downtime occurred."

Liz Anderson, Director Outpatient Department
Florida Hospital

"On behalf of the Scheduling Team at OSF HealthCare, I would like to personally thank USA for the commitment demonstrated to me and to the mission of the Sister's of the Third Order of Saint Francis over the past seven years. It has truely been an honor to work with such a customer-focused organization and one that will stand behind their product and staff. Thank you." 

Gina DeBoeuf, Application Specialist/Scheduling
OSF Healthcare Systems

One of the key concepts of business process redesign is that information technology serves as an enabler to achieve dramatic adjustments in work processes. As a result, significant improvements in operational performance are achieved at a lower cost. This case study describes improvements planned and implemented by a multi-facility hospital desiring to streamline the admission aspects of a patient’s hospital encounter, reduce hospital costs, and improve working relationships with physicians. The combination of process streamlining, executive leadership, inter-departmental cooperation and improved, automated systems has provided Florida Hospital dramatic savings and enhanced revenue opportunities.

Florida Hospital’s six campuses (facilities) contain more than 1,400 beds. It operates twelve walk-in medical clinics, nine rehab centers, and one home healthcare agency. In 1998, there were 63,655 admissions, 341,916 outpatient visits and 179,522 emergency department visits.

A feasibility study was conducted in August, 1995, to review and improve access to services, while endeavoring to reduce hospital costs. The feasibility study evaluated the potential of reengineering efforts from a cost-and-benefit perspective. There were at least 117 processes identified as part of the study. Each of these processes was studied and 475 options developed. The projected labor savings were computed based on the difference between current (1995) and forecasted functional process times. It should be noted that in 1995, Florida Hospital had only five facilities.

The patient admission process (both inpatient and outpatient) consisted of four sub-processes including patient scheduling, patient preregistration, patient precertification and patient registration. There were 394 steps in the entire patient admission process, which involved multiple departments and multiple areas of redundancy. Each department had control over it s schedule and there were 62 phone numbers across five facilities for physicians and patients to contact for scheduling various tests and procedures. Equipment and staff utilization could not be maximized because each location provided its own scheduling. Physicians and patients complained frequently.

The annual labor costs for this patient admission process were $5,400,000 including $2,100,000 in scheduling, $600,000 in preregistration and precertification, and $2,700,000 in registration. Approximately 58 full-time equivalents (FTEs) were involved in scheduling across the five facilities. The average rate of pay for the schedulers across all departments was $14.25. Each scheduler required specific clinical knowledge in order to schedule within the various departments.

The goals and objectives of the new processes were as follows:

• Develop a scheduling process that is easy to use, one that collects complete information and flows naturally to preregistration
• Develop a streamlined preregistration process so that 90 percent of scheduled admissions or procedures could be preregistered in advance
• Develop a greeting/express check-in concept for scheduled and preregistered patients
• Improve speed of data entry of registration information

Though many options for patient admission were developed, the options that were recommended include the centralization of all patient scheduling and preregistration functions into one department so that patients could be scheduled and preregistered with just one phone call. The scheduling functions would use an automated expert scheduling system in the sense of artificial intelligence. It was recommended that once patients had been preregistered and scheduled, they could then be checked in quickly upon arrival, thereby decreasing their wait in registration. The advantages of this process change would be the ability to provide one scheduling phone number for physicians and their offices across all five facilities, and the ability for patients to be checked in quickly so that they arrive at their point of service on time.

It was hoped, also, that an automated scheduling system could incorporate the knowledge of the departmental schedulers, so that some savings could be realized in the average pay rate for schedulers. Regardless, the projected cost savings from combining scheduling and preregistration were estimated at $712,018 annually.

Enterprise-wide scheduling systems in the market had been evaluated during the feasibility study, and system selection occurred at the end of the study. Information systems costs were determined, including hardware, network, cabling, interfaces, and annual maintenance fees. The cost of personnel required to implement the system, from both the vendor and hospital perspective, was also determined and negotiated. The return on investment was calculated once the system costs were obtained.

Proposals and presentations were received from several vendors including SMS, Eclipsys, PerSe, HBOC, Tempus and Unibased Systems Architecture, Inc., (USA). After an extensive evaluation, a contract was signed with USA in August, 1997.

Executive support is a prerequisite for any process redesign effort. Leadership is needed to work through the normal resistance experienced during any change. A "process owner" was appointed for each approved process change. The process owner is the person within the organizational structure who is responsible for the leadership and success of the planned change. The vice president of finance/accounting and patient financial services was appointed as process owner for the patient admission process changes.

The 1995 feasibility study was based upon 5 facilities. The system as implemented includes 6 facilities as described in the section labeled BACKGROUND. In addition, because of the capabilities of the selected vendor’s software, scheduling and preregistration was accomplished by just the scheduling department. The time standard comparison between the 1995 actual process, the proposed process outcome and the actual process outcome is as follows:

The labor savings are excellent, but at least as important is the improvement in service to physicians and patients. However, the original forecasted annual labor cost savings was projected to be $712,018 annually, as reflected in the column labeled "Proposed".

The target audiences for the communication strategies employed for the process changes included the physicians, the employees affected by the changes, and the patients. Breakfasts for the office managers and physicians were held prior to implementation to brief them on the proposed changes. Posters were placed in the hospital’s physician lounges, and information was communicated at medical staff meetings. These presentations described what the changes were, why they were being done, what information would be needed, and how the implementation would benefit the staff.

Employees who worked in the areas most affected by the changes (such as department scheduling and registrations) were told of the changes by their managers. Educational materials, which encompassed both the new scheduling system and the related operational changes, were prepared and distributed at department educational sessions. Patients were informed of the changes through a display of posters in the registration areas. These posters let patients know that they could call ahead and schedule their test or procedure, using one centralized scheduling number (as compared to 62), so that their scheduling and registration wait time could be reduced. USA, the system vendor, participated in meetings, training, consultations and the like as necessary.

In conjunction with the scheduling software vendor, information systems defined the type of hardware required for each area of the hospital, including the new centralized scheduling department. Hardware definition was based on the anticipated number of concurrent users, and the expected scheduling volume for the system once all areas of the hospital had been implemented. It was anticipated that once all areas were implemented, more than three million scheduling events would be completed each year. The hardware assessment also included definition of the required network, placement of personal computers, and printer and communication routers for all equipment. The primary client/server hardware was purchased from IBM. However, much of the hardware was already in place because of other applications.

The expertise of the current schedulers had to be transferred to the scheduling system. Each test or procedure had to be built within the scheduling software profiles, and resources such as physicians, staff, equipment, and available rooms had to be identified and associated with each item. Additionally, conflicts for the scheduling of a combination of tests had to be defined. That is, some tests must be done prior to subsequent tests; for example, an upper gastrointestinal series must precede a barium enema. These items and associated rules had to be defined on paper and submitted for entry into the scheduling software. More than eleven hundred items were built for one facility.

Since the existing hospital information system included all patient registration information, an HL7 interface between the scheduling system and registration system had to be defined and programmed to ensure that patient preregistration information could be collected at the time of the initial scheduling call. Additionally, all the existing patient medical record numbers had to be downloaded into the scheduling system so that this information would not have to be collected again at the time of implementation.

The primary method of communication for a centralized scheduling function is by telephone. Therefore, it is vital that an excellent telecommunication system be in place. Information systems had to evaluate the telecommunications capability of the hospital’s current phone system to ensure that such a call center could be supported. Additionally, because there were sixty-two phone numbers across five facilities, one of the key components of this evaluation was to ensure that the main facility’s phone system could support all of the calls coming in from the outlying facilities. A review of the planned phone system for the new facility was also conducted.

In order to reap the economic benefits as quickly as possible, the system was placed into production swiftly. The contract with the scheduling vendor was awarded in August, 1997, and the new centralized scheduling functions were implemented prior to the opening of a new facility so that tests and services could be scheduled for the opening week in January 1998. The designated hours of operation for centralized scheduling were 7 A.M. to 7 P.M. Monday through Friday. The radiology department in the ambulatory care center of the main facility was implemented two weeks later, in mid-January 1998. A critical aspect of implementation was the need for adequate training time. Prior to implementation, the selected schedulers were trained for approximately three weeks on both the scheduling system and the preregistration aspects of the new job.

When undergoing process redesign, it is important that people are measured in new ways. Many redesign efforts in hospitals have failed to measure process improvements accurately. The new measures must be achievable so that employees can feel a sense of accomplishment. Florida Hospital established key performance indicators for the new patient admission process change. These new indicators measured cost, effectiveness, efficiency, and customer satisfaction, and included the following:

• Eighty percent of the scheduling calls were to be answered within twenty seconds.
• The number of scheduling calls abandoned was to be 7 percent or less.
• The process changes would result in a minimum savings of $700,000 annually.
• Customer service complaints concerning inaccurate scheduling or other related issues would be less than 3 percent of the total number of scheduled events.
• Express check-in time would be five minutes or less.

In addition to the preceding performance measures, a call center such as the centralized scheduling department relies on other performance measures to ensure that patients and physicians are "delighted" into a mindset of loyalty and preference. These include the number of calls per agent per hour, the percentage of busy time by agent, and the average talk time.

IMPLEMENTATION RESULTS

Results of Key Performance Indicators