Case Study: World-Renowned University Medical Center

• Paper-intensive patient letter creation process that wasn’t compliant with patient experience and HIPAA compliance goals.

• Lack of audit trail and tracking to find individuals responsible for potential breaches or patients impacted by receiving the wrong information.

• No visibility to individual efficiency or volume per clinic or specific packet type.

• Increased operational costs due to an ad hoc process, manual tracking and random quality inspections aimed at attempting to prevent PHI breaches.

• Inconsistent branding—more than 50% of patient letters did not meet the corporate branding guidelines. 

• Inability to incorporate urgent changes with letters negatively impacted patient experience.

• 120-day lead times to create a new patient letter type or make changes to existing packets within Electronic Health Record (EHR) system.

• Backlog of approximately 200 patient letters per day, requiring schedulers to spend additional time completing patient appointments.

• Manual chargeback with no tracking or auditing capabilities for postage and printing.

• Inability to create patient packets remotely requiring onsite presence of schedulers and supervisors.

The New Patient Package (NPP) is the medical center’s first chance to make a good impression with patients and convey a professional, organized and efficient brand message. The NPP provides all the key first appointment information that patients need. It is a personalized letter with confirmation of the patient’s appointment along with helpful facility information such as location and parking locations. It also includes modality-specific instructions, physician-specific questionnaires, pre-requisite information for specialty appointments such as fasting, and tests that need to be conducted in advance.

The medical center had a very time-consuming, inefficient and risk-prone process for creating patient packets. Their enterprise contact center scheduled all patient appointments for the medical center’s hospital and clinics and sent out each patient packet. Once an appointment was scheduled, the confirmation letter was triggered from the hospital’s EHR (Epic in this specific case), prompting the scheduler to walk to the printer and retrieve a printed confirmation letter.

Next, the scheduler assembled the patient packet by locating the correct location map, appropriate modality letter and physician-specific questionnaire. The collected papers were then manually sorted, folded, stuffed and sealed in a small or large envelope and placed into a specific bin for a mail center employee to pick up. This is the part of process which needed an effective & automated solution.

In an attempt to minimize incomplete or incorrect information in the packets, one medical center supervisor performed periodic quality checks by randomly choosing envelopes to audit for PHI compliance. Furthermore, removing cancelled appointment letters was manual, labor intensive and hit or miss. In addition, the medical center lacked a systematic process to stop printing, packet assembly and mailing of patient letters for appointments one- to two-days out—and information wasn’t reaching the patient before their appointment. Also, anything printed after the 11:45 a.m. mail drop time had to be locked at the end of the day for PHI compliance and redistributed the next day to schedulers—impacting efficiency, creating backlog, and causing delays in completing letters.

Managing and updating the pre-printed patient packet information was cumbersome and inconsistent. Various pre-printed forms were stored in folders, on countertops, in drawers or on shelves in multiple areas. Additionally, the print and mail center had to stock and manage the various types of pre-printed paper forms, which took them away from more value-added tasks. This had increased the propensity to send outdated information significantly and required additional version control efforts.

Incorrect information in patient packets had a direct impact on patient experience. The patient privacy would be impacted if the wrong information was sent to the wrong patient. This paper-based, highly manual workflow posed a significant privacy violation risk for the medical center.

In addition to the patient’s privacy risk, their experience was impacted by the backlog. The medical center was spending more than $40,000 a month on various patient packet components (prints, mail costs, returned mail, resources, etc.) and the charge-back process to different departments and clinics was manual, error prone and time consuming. Furthermore, there was no clear visibility on the volume, letter types, return mail and cancellation rates—depriving the medical center of valuable insights such as whether a no-show was due to undelivered mail.