Electronic Registration Exchange (Virtual Patient Registration)

Background:

Patient Registration is an initial step in the patient access workflow that hasn’t changed or improved substantially since it first began. This critical step to onboard a patient with the healthcare provider actually serves the needs of multiple stakeholders, each with their own set of data requirements to enable their processes. The Patient Registration Stakeholders are Healthcare Providers, Healthcare Payers and the Patient.

The individual who completes the patient registration form has a different “role” depending on the stakeholder’s perspective. In general, Healthcare Providers view the individual as the PATIENT while Healthcare Payers view that same individual as a SUBSCRIBER. Additional characteristics may apply – for example the Patient may be a child and the person completing the registration form is the child’s parent or guardian. From the payer’s perspective the patient and the subscriber may be one in the same or the patient may be a dependent of the subscriber.

Healthcare Providers have an administrative, financial and clinical interest in the individual. From an administrative perspective providers are interested in having an accurate, unambiguous understanding of who the individual is in order to prevent the creation of a duplicate or overlay record. They are also interested in documenting communication channels (mailing address, phone numbers, NOK contact details) in case further details are needed later on. From a financial perspective the healthcare provider must gather details in order to determine who is ultimately financially responsible for payment along with sufficient data to submit bills and collect on insurance claims. And finally from a clinical perspective healthcare providers collect additional demographic dimensions at the point of registration in order to appreciate the home environment of the patient (identify other related individuals such as caregivers, guardians, siblings, and spouse). They also gather details such as race, marital status, ethnicity, religion, language preference and proficiency) to address other requirements such as population analytics and regulatory reporting. Data provenance or the meta data around when and where these demographic details were collected are also essential from a clinical perspective.

Payers are similarly interested in some of these same registration details but their business drivers are different. Payers need to have an unambiguous understanding of the individual’s identity in order to properly identify the person to their own systems. This is done so they may convey accurate eligibility details about that member back to the healthcare provider. This data is also important to detect potential erroneous or fraudulent billing. Extensive demographic dimensions pertaining to the individual are not needed for their purposes.

Another stakeholder in the patient registration workflow is the patient himself (or his/her representative – guardian, parent, spouse, caregiver, proxy, etc.) The patient wants to be assured that the information they provide is correctly captured and entered into the workflow. Attempting to fix data entry mistakes, especially if those errors cause the patient to be incorrectly billed, are a great annoyance. The patient also doesn’t want to fill out the same registration forms over and over again that all ask the same questions.

The Use Case:

The Actors

Healthcare Provider General Clinic – an owned facility of General Health System, Inc Registration Clerk

Healthcare Payer ABC Insurance

Patient John Q Public

E-registration Service The Service

The current workflow: John Q Public (age 62) arrives at General Clinic for an appointment. John has never been to this particular facility although he has been to other General Health System locations in the past. He has been asked to arrive 15 minutes early in order to fill out a new patient registration form. John completes the registration form to the best of his recollection. He skips over fields he doesn’t know the answer to (his spouse’s work number). After completing the paper registration form he signs it.

The registration clerk creates a photocopy of John’s insurance card and driver’s license, compares the data on the cards to the data on the form and inserts the photocopy into the physical chart. She them transcribes the hand written details on the registration form into the clinic’s revenue cycle system establishing a new patient record for John.

The data captured from the registration process is used for other purposes such as an eligibility request to ABC Insurance and is updated into General Health Systems electronic data warehouse for future population analytics.

The proposed workflow: John downloads an e-registration application from The Service onto his smartphone prior to his upcoming visit at General Clinic. He was informed about this new process for patient registration when he called to make an appointment the other week. The e-registration application process was recently adopted by General Clinic along with all other facilities owned by General Health System, Inc.

The e-registration workflow first has John establish an account with The Service. The account can only be accessed and edited by John using his login credentials. The Service is considered a Business Associate of General Health System, Inc. and as such applicable HIPAA regulations around Privacy and Security apply.

Next, John fills in the details that most registration forms request. A series of questions with help tabs allow him to logically follow the steps to create his online patient registration profile. He is prompted to fully complete fields and not skip over them. Data inconsistencies/errors are pointed out (a phone number without an area code) and data specificity is achieved (one phone number is described as Home – land line while another is described as Work – cell). The application prompts John to take an image capture using his cell phone of the front and back of his insurance card and driver’s license. John completes his registration profile and digitally signs and dates it. His e-registration data is held securely in encrypted format within The Service. At any time John can discontinue, edit or update his profile with The Service. He can share this profile electronically with any healthcare provider that subscribes to and is authenticated by The Service. He can also provide rights for others to exchange his profile on his behalf (his spouse for example who also has an account on The Service).

John does not have to arrive 15 minutes early for his appointment. He shows up a few minutes prior to his scheduled time and authorizes the submission of his registration profile electronically from the The Service via his smartphone application. (Unsolicited Response? Request/Response?). The data, in electronic encrypted format, is sent from The Service to General Clinic. General Clinic is an authenticated provider on The Service and has rights to request and receive registration profiles. The format of the data is appropriate for electronic data exchange and is directly consumable by the

Authorization Problems Summary

U1.1 A principal, such as the patient who establishes his/her own registration profile, wants to pre-configure access rights to specific data for persons or groups, in the context of an emergency.

U1.2 An associate of the principal, such as a caregiver, spouse, parent, guardian, proxy or other interested party wants to be able to establish and/or exchange the registration profile on behalf of the principal

U1.3 A principal wants to selectively choose which pieces of their registration data can be exchanged with a person or group (Select to exchange their full SSN, select to omit exchange of their SSN, select to exchange only the last 4 digits of their SSN)

U1.4 The demographic data is highly valuable to fraudsters and as such the principal wants mechanisms to provider a high level of security

U1.5 The demographic data in the context of federal regulations is considered personally identifiable information and as such the receiver (healthcare entity) wants to ensure that applicable HIPAA Privacy and Security provisions are maintained in the exchange of this information.

U1.6 Attaching an existing ...

U1.7 Current replaces paper process with electronic process