World-Renowned Specialty Hospital Transforms Patient Access, Improves Productivity During EHR Transition


Leadership at a world-renowned specialty hospital on the East Coast envisioned that a transition to the Epic electronic health record (EHR) system would ensure its highly rated clinical performance would be accompanied by strong financial performance within the revenue cycle. Under the Epic project, the hospital would be moving from 11 EHR/revenue cycle applications to a single system.

The criteria for success would be the new EHR system’s ability to spark organizational transformation, especially with patient access.

To mitigate the potential for disruption, the strategy called for standardizing and consolidating patient access operations before the EHR go-live date. 


In 2014, the hospital engaged Guidehouse Inc. to provide a comprehensive assessment of its revenue cycle operations and identify opportunities to improve net patient revenue, as well as overall revenue cycle functionality.

The assessment involved qualitative interviews and shadowing of revenue cycle staff members to evaluate the operating environment. It also used revenue cycle key performance indicators to compare the hospital’s performance against industry leading practices. Significant opportunities for improvement were identified in various departments, especially in patient access.

Guidehouse was also selected to assist with revenue cycle management advisory, leadership, structure review, and process improvement for the specialty hospital. The goal was to attain measurable and sustainable performance improvements in patient access through several key initiatives. These included:

Centralized Admitting. A centralized patient access admitting area was implemented to provide every patient with the same experience. 

Prior to the engagement, the hospital had four different admission points, which prevented standardization of a single admissions process. Guidehouse partnered with the hospital to standardize policies and procedures to support a centralized admissions model, and developed interactive training and scripting tailored to new roles in the admissions department. Admissions staff were also cross-trained in patient access areas such as preregistration to help support these functions and resolve registration-related errors in work queues. The physical location of each patient access employee was also strategically determined to improve workflow, and comprehensive reporting was developed to assist admissions staff in prioritizing patient flow and staff workload. Finally, to support the transition to the new EHR system, the hospital and Guidehouse teams designed models that supported both pre- and post-conversion patient access workflows.

Go-Live Support and Transformation. Observations by the Guidehouse team and hospital leadership led to a focus on providing support to patient access throughout the EHR conversion. 

Guidehouse collaborated with hospital leadership to implement an accountability structure for operations and information technology staff to identify, prioritize, and resolve patient access-related conversion issues. The hospital and Guidehouse teams also developed productivity standards and reporting for daily authorization and preregistration rates, and designed productivity reports for
managers to monitor staff effectiveness and foster accountability. To ensure coverage selection best practices, the real-time eligibility system was redesigned. A system was also implemented for patient access staff to support physician practices with preregistration processes during downtimes.


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