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Attachment D Downtime Procedures

Table of Contents
Definitions: ..................................................................................................................................... 3 Downtime procedures for IDX, NextGen, SCC, Quest, Novius, Rosetta, Cloverleaf, Openlink interactions. ..................................................................................................................................... 3 Scenario 1: Rosetta is down and Cloverleaf is up and Openlink is up. ......................................... 3 Scenario 2: Cloverleaf Down, Rosetta up, Openlink up. ................................................................ 4 Scenario 3: Openlink Down, Rosetta up, Cloverleaf up. ................................................................ 4 Scenario 4: IDX up, Nextgen Up, All Interfaces down ................................................................. 5 Scenario A: IDX down, NextGen up .............................................................................................. 6 Scenario B: IDX down, NextGen down ......................................................................................... 9 Scenario C: IDX up, NextGen down ............................................................................................ 12 Scenario D: IDX up, NextGen up, LIS (Laboratory Information System) down ......................... 13 Scenario E: IDX Up, NextGen Down, LIS (Laboratory Information Systems) up ...................... 14 Scenario F: IDX up, NextGen down, LIS (Laboratory Information System) down..................... 15 Scenario G: IDX down, NextGen Down, LIS (Laboratory Information Systems) up ................. 16 Scenario H: IDX down, NextGen Down, LIS (Laboratory Information System) down .............. 19 Scenario I: IDX down, NextGen up, LIS (Laboratory Information System) down ..................... 22 Scenario J: IDX down, NextGen up, LIS (Laboratory Information System) up .......................... 25 Scenario K: IDX Down, NextGen up, LIS (Laboratory Information System up, LCR up .......... 28 Scenario L: IDX Up, NextGen Up, Quest orders and results are down ....................................... 31 Scenario M: IDX up, NextGen is down, Quest orders and results are up. ................................... 32 Scenario N: IDX up, NextGen is down, Quest orders and results are down. ............................... 33 Scenario O: IDX is down, NextGen is down, Quest orders and results are up. ........................... 34 Scenario P: IDX down, NextGen down, Quest orders and results down. .................................... 37 Scenario Q: IDX is down, NextGen is up, Quest is down. ........................................................... 40 Scenario R: IDX is down, NextGen is up, Quest is up ................................................................. 43 Scenario S: IDX up, NextGen up, Radiology Management System Down................................. 45 Scenario T: IDX up, NextGen Down, Radiology Management System Up .............................. 46 Scenario U: IDX up, NextGen down, Radiology Management System Down ............................ 47 Scenario V: IDX Down, NextGen Down, Radiology Management System Up .......................... 48 Scenario W: IDX down, NextGen down, Radiology Management System down ....................... 51 Scenario X: IDX down, NextGen Up, Radiology Management System down ............................ 54 Scenario Y: IDX down, NextGen up, Radiology Management System Results up ..................... 57 Scenario Z: IDX up, NextGen up, Pathology (Winsurge) down .................................................. 60 Scenario AA: IDX up, NextGen Down, Pathology (Winsurge) Up ............................................. 61 Scenario AB: IDX is up, NextGen is down, Pathology (Winsurge) is down ............................... 62 Scenario AC: IDX down, NextGen down, Pathology (Winsurge) up .......................................... 63 Scenario AD: IDX down, NextGen down, Pathology (Winsurge) down ..................................... 66 Scenario AE: IDX down, NextGen up, Pathology (Winsurge) down .......................................... 69 Scenario AF: IDX down, NextGen Up, Pathology (Winsurge) up .............................................. 72 Scenario AG: IDX up, NextGen Up, Dermatopathology Down .................................................. 75 Scenario AH: IDX up, NextGen down, Dermatopathology Up ................................................... 76
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Scenario AI: IDX up, NextGen down, Dermatopathology results down .................................... 77 Scenario AJ: IDX down, NextGen down, Dermatopathology results up ..................................... 78 Scenario AK: IDX down, NextGen down, Dermatopathology results down ............................... 81 Scenario AL: IDX down, NextGen up, Dermatopathology results down .................................... 84 Scenario AM: IDX down, NextGen up, Dermatopathology results up ........................................ 87 Scenario AN: Faxing Down .......................................................................................................... 90 Scenario AO : NextGen up, SureScripts is down ......................................................................... 91 Scenario AP: Camera is down at check-in area ............................................................................ 92 Scenario AQ: Scanners are down at check-in area ....................................................................... 92 Scenario AR: Exam room laptops are down ................................................................................. 93 Scenario AS: All Printing is down in the Clinic (i.e. print server) ............................................... 94 Scenario AT: One printer is down in the clinic. ........................................................................... 94 Scenario AU: Health Center Network is Down ............................................................................ 96 II. Recovery Procedures ................................................................................................................ 96

I. Down Time Procedures Staffing Required for all Scenarios: o Help Desk ext. 4400 o Ancillary Department Administrator/Coordinator 1. Radiology: ext. 2784 or 3634 2. Laboratory: ext. 2498 or 8014 3. Pharmacy: ext. 7943 or 2782 or 4921 o UMG Informatics team - beeper during normal clinic hours?? Examples of Causes for all Scenarios: o Computer virus, Hardware or Software Failure, Power Surge or Loss Notification for all Scenarios: Once the situation is identified, the Ancillary Department will notify the System Administrator/Coordinator. The Ancillary Department must also notify the Help Desk in the Information Technology Department (X4400). The Help Desk will contact the individuals responsible for the Ancillary Department System support. First Line of Defense: Status Notification/Documentation:

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Definitions:
IDX Registration and Scheduling System used by all UMG clinics. NextGen Outpatient Electronic Medical Record. NextGen Fax Server Fax Server for NextGen Lab Information System Uconn Lab system. UCHC Lab and Dermatopathology results only will be flowing into NextGen. Quest Lab Outside lab vendor. Orders will be sent via interface to Quest and results will be flowing into NextGen via interface. WINSurge Pathology system interfaces with NextGen for results only. Siemens Novius- Radiology system at Uconn Rosetta - interface engine for NextGen which transfers health information using HL7 protocol Cloverleaf Siemens interface engine by Quovadx which transfers health information using HL7 protocol POLICY: The Disaster Recovery for NextGen Outpatient EMR system

Downtime procedures for IDX, NextGen, SCC, Quest, Novius, Rosetta, Cloverleaf, Openlink interactions. Scenario 1: Rosetta is down and Cloverleaf is up and Openlink is up.
Rosetta Down Rosetta Cloverleaf Openlink Comment Patient Registration and Sched data will not be filing in Nextgen, messages will queue up in Cloverleaf . The information is passed on to all the ancillary systems. Lab results will not be posting in Nextgen. Results will queue up in cloverleaf Quest orders will queue in Nextgen until Rosetta is up and running Quest results will queue in Cloverleaf till Rosetta is up and running Dermpath results will queue in Cloverleaf till Rosetta is up and running Radiology results will queue in Cloverleaf till Rosetta is up and running

ADT/Sched/Reg data from IDX to NextGen SCC lab results to NextGen NextGen lab orders to Quest Quest lab results to NextGen DermPath results to NextGen Radiology results to NextGen

Down Down Down Down Down Down

Up Up Up Up Up Up

Up Up Up Up Up Up

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Scenario 2: Cloverleaf Down, Rosetta up, Openlink up.


Cloverleaf Down Rosetta Cloverleaf Openlink Comment Patient Registration and Sched data will not be filing in any ancillary system. Messages will queue up in IDX. Lab results will not be posting in Nextgen or any other ancillary system (LCR, IBEX). Result messages will queue up in SCC system Quest orders will queue in Rosetta until Cloverleaf is up and running Quest results will queue on Quest side Dermpath results will queue in Winsurge till Cloverleaf is up and running Radiology results will queue in RMS system until Cloverleaf is up and running

ADT/Sched/Reg data from IDX to NextGen

Up

Down

Up

SCC lab results to NextGen NextGen lab orders to Quest Quest lab results to NextGen DermPath results to NextGen Radiology results to NextGen

Up Up Up Up Up

Down Down Down Down Down

Up Up Up Up Up

Scenario 3: Openlink Down, Rosetta up, Cloverleaf up.


Openlink Down Rosetta Cloverleaf Openlink Comment Patient Registration and Sched data will file in Nextgen. The departments that are affected are Invision and Radiology. Lab results will post in Nextgen but not in (LCR, IBEX). Results will queue in Cloverleaf for Openlink No affect in Nextgen No affect in Nextgen No affect in Nextgen RMS may not have current patient registration to result on a patient . However, if the results are sent from RMS, they should file in Nextgen

ADT/Sched/Reg data from IDX to NextGen

Up

Up

Down

SCC lab results to NextGen NextGen lab orders to Quest Quest lab results to NextGen DermPath results to NextGen

Up Up Up Up

Up Up Up Up

Down Down Down Down

Radiology results to NextGen

Up

Up

Down

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Scenario 4: IDX up, Nextgen Up, All Interfaces down


Check-in Process 1. Since IDX is up patients are arrived in IDX normally. 2. The appointments will not be flowing over to Nextgen since the interfaces are down. 3. The check-in person will have to create a new encounter when patient is arrived. 4. If a new insurance has been added in IDX it will not flow to Nextgen. They will have to make a copy of the insurance card and scan into Nextgen when back up. Patient Flow 1. Since NextGen is up they can document patient visits in Nextgen. 2. Lab and radiology requisitions will be printed. 3. Any new Radiology, lab, pathology and Dermatopathology results will not be in NextGen or LCR since interfaces are down. Checkout Process 1. Checkout report can be accessed since NextGen is up. 2. Follow-up appointments can be made in IDX they just will not be flowing over to NextGen. 3. The Superbill will not have the visit number on it. The PSR will have to enter number on superbill. Once all interfaces are up: Encounters will be created. UMG Clinical Informatics will contact Developers to delete empty encounters. Radiology, lab, pathology and Dermatopathology results will be sent to the ordering providers Inbox and PAQ for review and signoff.

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Scenario A: IDX down, NextGen up Check In Process


Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Lab labels required would be manually created as needed. Checkout Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B).

Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 4. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form.

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Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario B: IDX down, NextGen down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. c. If the patient has a change in their demographic information, please write the updates on the PVP. d. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Lab or radiology data that is required will be obtained via a phone call if needed. 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario C: IDX up, NextGen down


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Lab or radiology result can be found in LCR or by calling the Lab at x2498or Radiology department at x2784. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario D: IDX up, NextGen up, LIS (Laboratory Information System) down
IDX and Nextgen are functioning and all staff are documenting visits in NextGen. The Laboratory Department will notify the Help Desk in the Information Technology Department (X4400) who will notify the UMG informatics team that SCC is down. Informatics team will notify UMG departments of the downtime. All requisitions will continue to print in clinic areas. Results will not transmit from the lab system to NextGen until the LIS system is functioning again. Departments can call laboratory to get an urgent result at x2498. Results will not be in LCR. Critical results will continue as protocol. Once LIS is back up all lab results will flow into NextGen. The notification will be in the providers inbox and providers PAQ.

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Scenario E: IDX Up, NextGen Down, LIS (Laboratory Information Systems) up


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions. (Clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Lab or radiology results can be found in LCR or by calling the Lab at x2498 or Radiology department at x2784. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. The lab results from SCC and Quest will start flowing into the providers PAQ and inbox.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario F: IDX up, NextGen down, LIS (Laboratory Information System) down
Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions. (Clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Lab or radiology results can be found by calling the Lab at x2498 or Radiology department at x2784. Results will not be in LCR. Critical results will continue as protocol. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario G: IDX down, NextGen Down, LIS (Laboratory Information Systems) up An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. e. If the patient has a change in their demographic information, please write the updates on the PVP. f. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate
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5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders will be handwritten on requisitions. (Clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. If available find lab results in NetAccess LCR. 7. Lab or radiology data that is required will be obtained via a phone call if needed. (lab results will not be in NextGen since it is down) 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

The lab results will start coming over to the providers inbox and PAQ.

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Scenario H: IDX down, NextGen Down, LIS (Laboratory Information System) down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. g. If the patient has a change in their demographic information, please write the updates on the PVP. h. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list
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4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime. Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders will be handwritten on requisitions. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Any Lab or radiology data that is required will be obtained via a phone call if needed. To obtain lab results call x3601. 7. Any results will not be in NetAccess LCR since all systems are down. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system.

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a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Laboratory Information System procedures for downtime All requisitions will be handwritten in clinic areas. Results will not transmit from the lab system to NextGen until the Laboratory Information System is functioning again. Departments can call laboratory to get an urgent result at x2498. Once the laboratory information system is back up all lab results will flow into NextGen and providers PAQ. Notifications will be sent to the providers inbox.

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Scenario I: IDX down, NextGen up, LIS (Laboratory Information System) down ADT/registration information will not be coming over to NextGen. Scheduled/arrived appointments will not be coming over to NextGen. Follow current IDX downtime procedures and SCC downtime procedures An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. i. If the patient has a change in their demographic information, please write the updates on the PVP. j. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

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Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down, NextGen up, LIS and LCR down. 1. For any scheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 2. MA will room the patient. 3. Visit will be documented in NextGen since it is up. 4. Lab results will not be flowing to NextGen. If they need a result they can call the lab at x360. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system.
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a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic. The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

SCC procedures for downtime.: All requisitions will continue to print in clinic areas out of NextGen. Results will not transmit from the lab system to NextGen until the Laboratory Information System is functioning again. Departments can call laboratory to get an urgent result at x2498. Critical values will still use current protocol. Once SCC is back up all lab results will flow into NextGen and providers PAQ. Notifications will be sent to the providers inbox.

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Scenario J: IDX down, NextGen up, LIS (Laboratory Information System) up Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. k. If the patient has a change in their demographic information, please write the updates on the PVP. l. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down and NextGen up 1. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 2. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 3. If no labels were printed for the patient, patients name, TOO, DOB, Date of visit and visit # must be written on plain labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 4. All subsequent steps should follow normal uptime procedures for NextGen. 5. All results will be in NextGen. 6. Results will not be in LCR. 7. Lab labels required would be manually created as needed. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 4. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form. Lab results will be flowing into NextGen since NextGen is up. The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario K: IDX Down, NextGen up, LIS (Laboratory Information System up, LCR up Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Lab labels required would be manually created as needed. Laboratory results will be flowing into NextGen since NextGen is up and the LIS system is up. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). 5. For any emergencies staff can call X2784 to order radiology tests. Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 4. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form.

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The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it.

Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario L: IDX Up, NextGen Up, Quest orders and results are down
IDX and NextGen are functioning and all staff are documenting visits in NextGen. All Quest lab orders will be placed but not sent. (The user will receive a notification in their inbox that the result did not go through.) All Quest requisitions will continue to print in clinic areas. Orders and results will not transmit from the Quest to NextGen until the Quest system is functioning again. Departments can call Quest at 800-982-6810 or look in the Care 360 website to find the result they are looking for. Once Quest is back up all lab orders will be sent and results will flow into NextGen. The notification of the results will be in the providers inbox and providers PAQ.

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Scenario M: IDX up, NextGen is down, Quest orders and results are up.
Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab (including Quest) or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Lab or radiology results can be found in LCR or by calling the Lab at x2498 or Radiology department at x2784. Any Quest result can be found in Care 360 or by calling Quest at 800-982-6810. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. The lab results from SCC and Quest will start flowing into the providers PAQ and inbox. The Quest lab results will also flow into the providers inbox and PAQ. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario N: IDX up, NextGen is down, Quest orders and results are down.
Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab (including Quest) or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Lab or radiology results can be found in LCR or by calling the Lab at x2498 or Radiology department at x2784. Any Quest result can be found in Care 360 or by calling Quest at 800-982-6810. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Once NextGen comes back up staff will be notified by Clinical informatics via email. The lab results from SCC and Quest will start flowing into the providers PAQ and inbox. The Quest lab result will also flow into the providers inbox and PAQ. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario O: IDX is down, NextGen is down, Quest orders and results are up. An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. c. If the patient has a change in their demographic information, please write the updates on the PVP. d. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate
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5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders (including Quest) will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Lab or radiology data that is required will be obtained via a phone call if needed. (lab results will not be in NextGen since it is down) Quest lab results can be obtained by calling Quest at 800-982-1610 or by going into Care 360. 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system.
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a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

The lab results including Quest will start coming over to the providers inbox and PAQ.

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Scenario P: IDX down, NextGen down, Quest orders and results down. An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. e. If the patient has a change in their demographic information, please write the updates on the PVP. f. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime. Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders (including Quest) will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Lab or radiology data that is required will be obtained via a phone call if needed. (lab results will not be in NextGen since it is down) Quest lab results can be obtained by calling Quest at 800-982-1610 or by going into Care 360. 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

The lab results including Quest will start coming over to the providers inbox and PAQ.

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Scenario Q: IDX is down, NextGen is up, Quest is down. ADT/registration information will not be coming over to NextGen. Scheduled/arrived appointments will not be coming over to NextGen. Follow current IDX downtime procedures and SCC downtime procedures Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. g. If the patient has a change in their demographic information, please write the updates on the PVP. h. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

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Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Lab labels required would be manually created as needed. Checkout Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B).

Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C).
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Quest downtime:
Any Quest orders will not be sent. The users will receive a notification in the inbox that the order did not go through. There will be no results going into NextGen as well. If you are looking for a Quest result you can call Quest at 800-982-1610 or login to Care 360 website and find the result.

The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them. Once Quest is up all orders will be sent electronically to Quest and any results will flow into the providers PAQ and inbox.

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Scenario R: IDX is down, NextGen is up, Quest is up ADT/registration information will not be coming over to NextGen. Scheduled/arrived appointments will not be coming over to NextGen. Follow current IDX downtime procedures and SCC downtime procedures Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. i. If the patient has a change in their demographic information, please write the updates on the PVP. j. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list
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4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Lab labels required would be manually created as needed. Checkout Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B).

Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario S: IDX up, NextGen up, Radiology Management System Down


IDX and NextGen are functioning properly Requisitions will be printed out of NextGen and faxed to radiology. Radiology personnel will contact helpdesk and in turn helpdesk will notify UMG informatics department of downtime. UMG informatics department will notify UMG department via email of downtime. Radiology results will not be coming over into NextGen. Staff can call the radiology department at x2784 if a result is needed. If there are any significant clinical findings the radiologist will call or email the provider in the clinic directly. Once the radiology system is back up all final results will flow to NextGen and go to the providers inbox and PAQ for review and signoff.

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Scenario T: IDX up, NextGen Down, Radiology Management System Up


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any radiology results can be found in LCR or by calling the Radiology department at x2784 since they wont be in NextGen. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. The radiology results will start flowing into the providers PAQ and inbox.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario U: IDX up, NextGen down, Radiology Management System Down

Helpdesk will notify Clinic of downtime through Clinical shutdown email. Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. If someone is looking for a result they will have call the radiology department at x2784 since they wont be in NextGen or LCR. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. Once Novius is back up the radiology results will start flowing into the providers PAQ and inbox. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario V: IDX Down, NextGen Down, Radiology Management System Up An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. k. If the patient has a change in their demographic information, please write the updates on the PVP. l. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Lab or radiology data that is required will be obtained via a phone call (Radiology is at x2784) if needed. (Radiology results will not be in NextGen since it is down). 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
Contingency Plan Page 49 of 99 Attachment D Downtime Procedures

b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once the Radiology interface is back up and NextGen is also back up the radiology results will start coming over to the providers inbox and PAQ.

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Scenario W: IDX down, NextGen down, Radiology Management System down If all systems are down Helpdesk will be notifying clinics through the IT clinical shutdown notification. An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. m. If the patient has a change in their demographic information, please write the updates on the PVP. n. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information
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3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Radiology data that is required can be obtained via a phone call (Radiology is at x2784) if needed. (Radiology results will not be in NextGen since it is down). 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C).
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2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once the Radiology interface is back up and NextGen is also back up the radiology results will start coming over to the providers inbox and PAQ.

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Scenario X: IDX down, NextGen Up, Radiology Management System down


Helpdesk will notify clinics of IDX and Radiology systems being down.

Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. o. If the patient has a change in their demographic information, please write the updates on the PVP. p. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Radiology labels required would be manually created as needed. For any Radiology results staff can call Radiology at x2784 for any results. Any new results will not be in LCR since Radiology is down. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). 5. For an emergency radiology tests staff can call Radiology at x2784 to get an appointment.

Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on
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the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 4. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form. The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Any new Radiology results will not be flowing into NextGen since Radiology results are down. Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO#. Once Radiology results come back up all results will go to the providers Inbox and PAQ in NextGen. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario Y: IDX down, NextGen up, Radiology Management System Results up


Helpdesk will notify Clinics that IDX is down.

Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. q. If the patient has a change in their demographic information, please write the updates on the PVP. r. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow All subsequent steps should follow normal uptime procedures for NextGen. Lab labels required would be manually created as needed. Radiology results will be flowing into NextGen since NextGen is up. Check Out Process 6. COA will review the checkout report in NextGen to see if follow up is required 7. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 8. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 9. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). 10. For any emergencies staff can call X2784 to order radiology tests. Telephone Process 5. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 6. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 7. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 8. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form.

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The superbill will not have the visit number on them since IDX was down. The PSR will have to manually write the visit number on it. Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario Z: IDX up, NextGen up, Pathology (Winsurge) down


IDX and NextGen are functioning and all staff is documenting visits in NextGen. The Help Desk must contact pathology system support, who will issue a task number for tracking purposes. Once Winsurge is notified, an approximation of down time will be determined. All requisitions will continue to print in clinic areas. Results will not transmit from the Winsurge pathology system to NextGen until the Winsurge is functioning again. Departments can call pathology to get an urgent result at x2980 or can look in LCR to see if it is in there. Once Winsurge is back up all lab results will flow into NextGen. The notification will be in the providers inbox and providers PAQ.

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Scenario AA: IDX up, NextGen Down, Pathology (Winsurge) Up


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. MA will room the patient and then document visit on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any radiology or lab including pathology results can be obtained by going into LCR or calling the radiology or lab department. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once NextGen comes up all results from the pathology system will flow into NextGen. They will go into the providers PAQ and the inbox.

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Scenario AB: IDX is up, NextGen is down, Pathology (Winsurge) is down


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any pathology results can be found in LCR or by calling the pathology department at x2980 since they wont be in NextGen. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. Once Winsurge is back up the pathology results will start flowing into the providers PAQ and inbox.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario AC: IDX down, NextGen down, Pathology (Winsurge) up An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. s. If the patient has a change in their demographic information, please write the updates on the PVP. t. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate
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5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab/pathology or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Lab or radiology data that is required will be obtained via a phone call (Pathology is at x2980) if needed. (Pathology results will not be in NextGen since it is down). 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once NextGen is back up the pathology results will start coming over to the providers inbox and PAQ.

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Scenario AD: IDX down, NextGen down, Pathology (Winsurge) down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate
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5. Mark the Reception List to indicate the patient has Arrived. 6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab, radiology,pathology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Pathology data that is required can be obtained via a phone call (Pathology is at x 2980) if needed. (Pathology results will not be in NextGen since it is down). 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once the pathology interface is back up and NextGen is also back up the pathology results will start coming over to the providers inbox and PAQ.

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Scenario AE: IDX down, NextGen up, Pathology (Winsurge) down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list
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4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down and NextGen up. 1. MA will be notified by check in that patient has arrived. MA will room the patient. 2. Visit will be documented in NextGen since it is up. 3. Pathology results will not be flowing to NextGen. If they need a result they can check LCR or call pathology at X2980 Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

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The PSR will have to enter the visit number on the superbill. Once the Pathology interface is back up the pathology results will start coming over to the providers inbox and PAQ. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario AF: IDX down, NextGen Up, Pathology (Winsurge) up An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list
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4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived. 6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down and NextGen up. 1. MA will be notified by check in that patient has arrived. MA will room the patient. 2. Visit will be documented in NextGen since it is up. 3. Pathology results will not be flowing to NextGen. If they need a result they can check LCR or call pathology at x2980 Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

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The PSR will have to enter in the visit number on the superbill. All pathology results will be in NextGen since the interface is up. UMG Clinical informatics Team will notify application developers to delete empty encounters

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Scenario AG: IDX up, NextGen Up, Dermatopathology Down


IDX and NextGen are functioning and all staff is documenting visits in NextGen. All requisitions will continue to print in clinic areas. Results will not transmit from the Dermatopathology system to NextGen until the Dermatopathology System is functioning again. Departments can call Dermatopathology to get an urgent result at x 3474 Once Dermatopathology is back up all lab results will flow into NextGen. The notification will be in the providers inbox and providers PAQ.

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Scenario AH: IDX up, NextGen down, Dermatopathology Up


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. Any Dermatopathology results can be found in LCR or by calling the Dermatopathology department at x3474 since they wont be in NextGen. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. Once softpath is back up the Dermatopathology results will start flowing into the providers PAQ and inbox. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario AI: IDX up, NextGen down, Dermatopathology results down


Patient is arrived normally in IDX and labels are created. Staff will refer to IDX to look at the schedule for the day and monitor patient arrivals in IDX. Check in person will attach paper voucher with the labels when the patient is arrived and have it ready for the MA. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. HCH Form will be placed outside the exam room for the care provider. Provider will document visit on all HCH approved forms. Any lab or radiology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) Any prescriptions will be handwritten on prescription paper. To get any Dermatopathology results you have to call the Dermatopathology department at x3474 since they wont be in NextGen. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person. Once NextGen comes back up staff will be notified by Clinical informatics via email. Once softpath is back up the Dermatopathology results will start flowing into the providers PAQ and inbox. Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

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Scenario AJ: IDX down, NextGen down, Dermatopathology results up An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab, radiology,pathology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Dermatopathology data that is required can be obtained via a phone call (Dermatopathology is at x3474) if needed. (Dermatopathology results will not be in NextGen since it is down). 7. If available find patient information in NetAccess LCR. 8. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system.

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a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once the Dermatopathology interface is back up and NextGen is also back up the Dermatopathology results will start coming over to the providers inbox and PAQ.

Contingency Plan Page 80 of 99 Attachment D Downtime Procedures

Scenario AK: IDX down, NextGen down, Dermatopathology results down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.
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6. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 7. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 8. Use the paper Billing Voucher for visits during downtime.

Patient flow with NextGen down 1. MA will room the patient and then document on the HCH approved visit form all normal data, including vital signs, reason for visit, allergies, medications etc. 2. HCH Form will be placed outside the exam room for the care provider. 3. Provider will document visit on all HCH approved forms. 4. Any lab, radiology,pathology orders will be handwritten on requisitions and faxed to appropriate areas. (clinics need to have these on hand) 5. Any prescriptions will be handwritten on prescription pad paper. 6. Dermatopathology data that is required can be obtained via a phone call (Dermatopathology is at x3474) if needed. (Dermatopathology results will not be in NextGen since it is down). 7. A billing voucher needs to be filled out by provider and handed to patient at the end of the visit. The patient will hand the voucher to the check out person.

Check Out Process 1. Review the voucher to see if follow up is required 2. Collect Copay if appropriate 3. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 4. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 5. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic.

Once IDX and NextGen come back up, the data from the HCH forms needs to be re-entered or scanned back into the system. MA will access arrived encounter from IDX in NextGen (after Nextgen and IDX comes up) MA will access Master IM template and enter visit type=Chart update. Will enter chief complaint in reason for visit field on Master IM template. Will then enter those medications prescribed as new or stopped during downtime encounter via Medication Module. Will enter any change in Allergy history via Allergy Module. Completed documented HCH visit form with then be sent to medical records to scan into arrived open encounter. Encounter will auto lock in 10 days.

Once the Dermatopathology interface is back up and NextGen is also back up the pathology results will start coming over to the providers inbox and PAQ.

Contingency Plan Page 83 of 99 Attachment D Downtime Procedures

Scenario AL: IDX down, NextGen up, Dermatopathology results down An IDX reception list for every office is run nightly so they will need to refer to the paper reception list for who is coming in for the day. Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that require an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down and NextGen up. 1. MA will be notified by check in that patient has arrived. MA will room the patient. 2. Visit will be documented in NextGen since it is up. 3. Dermatopathology results will not be flowing to NextGen. If they need a result they can check LCR or call Dermatopathology at X 3474. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back? b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. If patient is calling about medical question and needs to speak to clinical staff. Call Center Staff will fill out Telephone Encounter form and fax to clinic. Once the Dermatopathology interface is back up the Dermatopathology results will start coming over to the providers inbox and PAQ. UMG Clinical informatics Team will notify application developers to delete empty encounters
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The PSR will have to handwrite the visit number on the superbill. Clinical informatics team will notify Application developers and delete any unlocked/locked encounters with nothing in them.

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Scenario AM: IDX down, NextGen up, Dermatopathology results up Check In Process
Registration Demographic, Insurance and Case Process 1. If the patient requires a Medical Record Number to be created, front desk person will call central registration to get downtime number and the update HCH form. 2. Review Patient Visit Profile and verify their demographic information. a. If the patient has a change in their demographic information, please write the updates on the PVP. b. If the patient is a walk-in handwrite info on HCH registration update form. 3. If a patient indicates that their visit is case related (Motor Vehicle Accident, Workers Comp, etc.), a. Give the patient a pen and paper and send them to the phone to call Central Registration. The patient should return with their case number. b. Write the type of case on the PVP (Study, Workers Comp, Motor Vehicle, etc.) and write the number obtained from Central Registration on the PVP. c. Photocopy any case related documents. 4. Scan all Insurance Cards (front and back) even if the patient has provided case related documentation into NextGen and the insurance is in NextGen. If the patient has added new insurance the insurance will not be in NextGen since IDX is down. 5. If brand new patient or patient has added insurance todays visit photocopy insurance card and fax to Central Registration. Front desk will have to scan insurance card next time the patient comes in. 6. Fax PVP with updates, and any case-related documents to Central Registration at X1272. 7. If brand new patient and patient does not have a T# and T# was received from Central registration the Check in staff member can enter in the patient in NextGen. They can enter in demographic information. 8. JDH Outpatient Areas that generate admissions using IDX Scheduling that requires an admission number in order to post orders or results should call X1660.

Appointment Arrival Process 1. Confirm Scheduling and Billing Provider 2. Confirm PCP and Referring MD information 3. Review Reception List Referral and Financial Comments information. Obtain necessary Referral Authorization information if not listed on reception list 4. Collect Copay if appropriate 5. Mark the Reception List to indicate the patient has Arrived.

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6. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 7. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 8. If no labels were printed for the patient, patients name, TOO, The front desk can print Nice labels from their workstation. DOB, Date of visit and visit # must be on the labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc).

Patient flow with IDX down and NextGen up 1. For any scheduled or unscheduled patients, the front desk staff must go into NextGen and manually create a new encounter for the visit, and change patient tracking to note patient is in waiting room. 2. If the patient does not yet have a TOO number, the front desk will contact central registration and ask for a downtime number to be assigned to the patient as well as a downtime visit number (see IDX downtime procedures). 3. If no labels were printed for the patient, patients name, TOO, DOB, Date of visit and visit # must be written on plain labels so that these can be affixed to all printed documents (requisitions, superbill, specimens, etc). 4. All subsequent steps should follow normal uptime procedures for NextGen. 5. All results will be in NextGen. 6. Results will not be in LCR. 7. Lab labels required would be manually created as needed. Check Out Process 1. COA will review the checkout report in NextGen to see if follow up is required 2. If the patient requires a follow up appointment, tell the patient we are in the process of upgrading our computer system. 3. Ask the patient if they would mind calling back for their appointment or if they would prefer for the office to call them? 4. If they would prefer to have the office call them, fill in the information from the voucher on the Check Out Follow Up Downtime sheet (see Attachment B). Telephone Process 1. If patient is calling to cancel their appointment and does not wish to reschedule at this time, a. Enter the patient and appointment information on the Phone Appt Tracking Downtime sheet (see Attachment C). 2. If patient is calling to cancel and wishes to reschedule, tell the patient we are in the process of upgrading our computer system. a. Ask them if they would mind calling back to reschedule their appointment or if they would prefer that we call them back?
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b. If they would prefer that we call them back, complete the Phone Appt Tracking Downtime sheet (Attachment C). 3. Telephone call center staff in the clinic will follow normal processes for messages to the clinic since NextGen is still up. They need to make sure that the patient on the phone is in fact a patient in NextGen since there will be no ADT feed from IDX to NextGen. 4. If they are a new patient calling up and not in NextGen yet they need to document the call on the HCH form. The PSR will handwrite the visit number on the superbill. Dermpath results will be flowing into NextGen since NextGen is up.

Once IDX comes back up, the front desk must go in and arrive the patient in IDX using the downtime TOO# and downtime visit # assigned previously. UMG Clinical informatics Team will notify application developers to delete empty encounters

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Scenario AN: Faxing Down


Causes: Fax Server not operative Additional Staffing Required: None Additional Equipment Required: None Manual Reports Required: None Notification to Senior Management: None IT notifies UMG clinical informatics team when fax server goes down. (An email is sent to Leis Weiss, Gretchen Daukas and Valerie Townley when the fax server goes down.) UMG clinical informatics will notify clinics by email when down. Clinics will print out any documents from NextGen that have to be faxed immediately and will use the fax machine in the clinic. If a fax fails in NextGen the user who tried sending the fax receives a notification in there inbox in NextGen and also UMG Informatics receive and email. The user should try re-faxing the document or manually faxing it on the fax machine.

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Scenario AO : NextGen up, SureScripts is down


UMG Clinical informatics will be notified via email of surescripts downtime. UMG Clinical informatics will notify clinics that surescripts is down via email/phone call. Any refills have to be faxed to pharmacies either through NextGen or a fax machine in the clinic. Patients that are in the clinic and need a prescription, the script will faxed through NextGen.

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Scenario AP: Camera is down at check-in area


Staff needs to call help desk at x4400 to open a ticket and have someone look at what the issue is with the camera. IT will determine if it is a software issue versus hardware issue. There are 2 other cameras that are setup in the front desk area to take patient pictures from NextGen. Staff can have those staff members take the pictures if they are not busy. If there is a line or it gets extremely busy when the camera is not functioning they do not have to take the patients picture and next time the patient comes is they can take the picture.

Scenario AQ: Scanners are down at check-in area


Staff needs to call help desk at x4400 to open a ticket and have someone look at what the issue is with the scanner. IT will determine if it is a software issue versus hardware issue. There are 2 other scanners that are setup in the front desk area to scan insurance cards into NextGen. Staff can have those staff members scan the insurance cards if they are not busy. If there is a line or it gets extremely busy when the camera is not functioning they can copy the insurance card and scan the copy into NextGen when the scanner is back up.

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Scenario AR: Exam room laptops are down


If an exam room laptop goes down and cant be rebooted staff need to let the office manager know and there are replacement laptops that are in the clinic that can be used. Default printers needs to be setup for the computer and can be done by calling helpdesk at x4400. Staff need to call helpdesk at x4400 and let them know that one of the laptops is not working properly and needs to be looked at.

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Scenario AS: All Printing is down in the Clinic (i.e. print server)
Designated staff in the clinic need to contact helpdesk at x4400 and notify them of the printers being down. They need to provide helpdesk with specific and adequate information of what printer is down and when it is happening and what they are trying to print. The following questions should be answered prior to calling: Is this happening on all printers or specific printers? Where are you printing from an exam room or office? Have you tried closing out of NextGen and Citrix and then gone back in? What application are you printing from? What are you trying to print? When did this start happening? Has this issue ever happened in the past? Describe the steps that you are doing when this issue occurs? Requisitions in NextGen: The clinic will have to document the orders in NextGen but also handwrite the orders on a paper requisition (LCR paper) and sign the requisition. Copy can be discarded. Inform Radiology and Lab and Dermpathology departments that printing is down in the clinic and that they will be receiving some handwritten paper requisitions since they cannot print requisitions out of NextGen. Scripts in NextGen: If the troy printers are down and scripts have to be printed in the clinic, the provider will have to order the medication in NextGen but also handwrite the script on prescription paper. Referrals in NextGen: Referrals can be tasked to the front desk and the front desk can review the referrals and enter them into E-consult. If the referral needs signature they can wait until the printers comes back up or the providers would have to place another order on the paper referral form.

Scenario AT: One printer is down in the clinic.

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Designated staff in the clinic need to contact helpdesk at x4400 and notify them of which printer(s) are down. They need to provide helpdesk with specific and adequate information of what printer is down and when it is happening and what they are trying to print. The following questions should be answered prior to calling: Is this happening on all printers or specific printers? Where are you printing from an exam room or office? Have you tried closing out of NextGen and Citrix and then gone back in? What application are you printing from? What are you trying to print? When did this start happening? Has this issue ever happened in the past? Describe the steps that you are doing when this issue occurs? Requisitions in NextGen: The users will have to choose another printer in the clinic that is working properly. The user can choose the printer by clicking on the document they want to print and go to File, Print and then choose the appropriate printer that is working. Scripts in NextGen: If both troy printers are down and scripts have to be printed in the clinic, the provider will have to order the medication in NextGen but also handwrite the script on prescription paper. Referrals in NextGen: Referrals can be either tasked to the front desk or printed to the designated printer or the provider can print the referral out using the designated printer that is functioning correctly. They can then be entered into E-consult by the front desk staff.

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Scenario AU: Health Center Network is Down


If the network is completely down, IDX, NextGen, SCC and Novius are all nonfunctional. All departments should operate in a Downtime situation. If the network is partially shut down the situation should be accessed, and procedures invoked as needed. In any situation, the Help Desk (x4400) should be contacted.

II. Recovery Procedures


Once there is notification of system availability the technical staff supporting the affected system must first validate the system is working properly. All interfaces which were not in operation must be restarted and validated by the source system and the receiving system staff. Once the technical staff has confirmed the system is functioning appropriately the general users will be allowed to access the system. Notification of general access will be done via DL- Clinical Shut Down Email or recorded message on the help desk telephone line. All notification banners will be removed and close monitoring of the affected system should occur for the next 24 hours.

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A 1

B C D E F G Walk In Appointments Friday, mm/dd/yy 12:00N - Saturday, mm/dd/yy

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Patient Name

DOB

SS#

Scheduling Provider Department

Appt Time

Is this Worker's Visit Type, Comp or Study Dur Related?

Entered into IDX (Initials)

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A B C D E F G Check Out - Follow Up Appointment Details Friday, mm/dd/yy 12:00N - Saturday, mm/dd/yy

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Patient Name

MRN

Patient Telephone

Provider

Is this Worker's Comp or Scheduling Date Appt Visit Study Department Needed? Type, Dur Related?

Entered Patient into IDX Contacted (Initials) ? (Initials)

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A 1

B C D E F G Phone Appointment Details Friday, mm/dd/yy 12:00N - Saturday, mm/dd/yy SS# or Street Address

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

Patient Name

DOB or MRN

Patient Telephone

Date of Appt

Contact Patient to Provider/De Cancel Reschedule pt Only? Y/N ?

Entered into IDX (Initials)

Patient Contacted? (Initials)

Contingency Plan Page 99 of 99 Attachment D Downtime Procedures