Connecticut Hospital Improves Workflow Efficiency Through 'Scripting'

Brian Thiel, for HealthLeaders News, July 24, 2007

As manager of managed care at Greenwich Hospital in Connecticut, it didn't take me long to realize the power of scripting technology. I manage many time-intensive and repetitive projects involving data entry or data transfer which are critical for the efficient flow of managed care contracts and fee schedules. I had always wondered why there wasn't a way to automate these tasks and eliminate the need to spend so many man-hours on these projects.

Two years ago, while at a Meditech User Group Conference (MUSE), I met the people from Boston Software Systems. When I learned about their workflow automation tool, Boston WorkStation, I found what I was looking for.

Boston WorkStation is a workflow automation and integration technology that allows healthcare organizations to respond to changing business, financial and compliance requirements by automating common tasks throughout the organization--including revenue cycle projects, interactions with Web sites, integrating new applications, systems and devices, and electronically monitoring and managing user activity.

Scripting "Aha!"
Before Boston WorkStation, I wasn't even aware of a software product capable of automating manual tasks, such as transferring data from one source to another like converting registration information to centralized scheduling. I didn't think that scripting technology could be reliable and flexible enough to use virtually anywhere I needed to connect systems or move data.

Greenwich Hospital is a 174-bed community hospital, serving lower Fairfield County, CT, and Westchester County, NY. It is a major academic affiliate of Yale University School of Medicine and a member of the Yale New Haven Health System. Since opening in 1903, Greenwich Hospital has evolved into a progressive medical center and teaching institution with an internal medicine residency. Sixty percent of the hospital's patients are outpatient, and 40 percent are inpatient.

I have been in my current role for the past three years, analyzing managed care contracts and fee schedule tables. Part of my job is loading these fee schedules into Meditech. The challenge is that there are several hundred CPT (current procedural technology) codes that are associated with the prices in these contracts.

It used to take three days to load each new fee schedule for each managed care contract for every year that it was updated. Multiply that by at least 10 contracts, and it's about a month's worth of time spent on manual data entry and nothing else. This was one of the reasons why we were going over budget in the business office.

I then turned to Boston WorkStation to automate the upload. It took only a day to write the script and the benefit has been dramatic. Automating just this task is saving the hospital tens of thousands of dollars per year.

Data conversion in days
Another project I worked on in the hospital involved converting registration information to centralized scheduling. I saw an opportunity to use scripting to convert all of the appointments that are in one of the dictionaries to the new central scheduling module in Meditech.

More than 10,000 appointments had already been registered and booked in advance in the previous system. I needed a way to convert all of those appointments into the proper time slots in the new system.

I created a script to first take an extract out of the dictionary and convert it into an Excel spreadsheet. The script continues by automatically and accurately pulling the appointments from the spreadsheet and uploading them to the Meditech scheduling module. This kind of dictionary-conversion project would normally take 700 man-hours, or about $10,000. If it had been done on an overtime basis, it would be $16,000. The script took four hours to write and test, and it finished uploading the appointments by the end of the week.

I'm also using Boston WorkStation in the materials management area, which handles conversions through two systems--Meditech for billing and charges, and Lawson for cost reporting. The hospital purchases products for materials management through the Lawson system. Typically, there are discrepancies between the codes used in Lawson and those in Meditech. Staff in the materials management department needed to reregister the new charge codes in Meditech so it would match the Lawson price numbers.

Usually all this data entry is done manually, but I wrote a script that loads 8,000 charge codes into Meditech and reduced a three-week project to one day.

I can create the script not only to perform functions, but to also respond to conditions such as pop-ups, variations in system speed or even kicking off another application. Since the script does just what a person would do, one creates a script by walking through the project just as a person would. I can think of literally hundreds of tasks that can be automated this way. I hate to waste time. If I see a quicker way to do something, I will take that route.

Sum of the parts
Using scripting technology has enabled me to convert my role from the business department to the information systems department. By applying this tool throughout the hospital, I've built my own job description. I plan to analyze workflows in each department to locate opportunities for greater efficiency in day-to-day tasks. My goal is to be the most efficient worker I can be and make sure the hospital is running economically in the process.

In addition to improving workflow of manual tasks, Boston WorkStation has allowed us to reallocate resources to more patient-critical areas. A keen eye on workflow is definitely helping the hospital.

Take registration, for example. One out of every five claims is denied in relation to a registration issue. If we could ensure all of the registration information we obtain is accurate at the time we obtain it, we could prevent hundreds of denials, and accelerate the revenue cycle. Making that process more efficient would equate to millions of dollars in savings. You can bet that's on my to-do list.

---

Brian Thiel is a financial applications analyst at Greenwich Hospital in Connecticut, a member of the Yale New Haven Health System.