Developing a comprehensive EHR system for the largest eye care group in the United States

Team Daffodil designed the development roadmap using our unique program called the Discover & Frame (D&F) workshop. This approach helps the business development team understand the project idea, target users, competitors, revenue model, and technical risks. Along with this, it outlines the scope of the project, user flow, timeline, and the cost of developing a market-ready solution.

Once the product roadmap was designed, team Daffodil initiated the development of a web-based EHR system using Angular and PostgreSQL as core technologies. The EHR system was developed with 6 prime roles: Front desk, call center, patients, doctors, technicians, and financial team. 

The project scope included fixing the defects of the existing system and introducing new functionalities under every module and secondly, API integration with insurance providers to get patients’ financial information and other API integrations for smooth performance of the application. The prime business processes in the EHR system included:

Frontdesk Scheduler

The Front-desk users can check upcoming and current appointments along with the patient’s A/c balance (co-payment, deductible, A/C balance). They can check the appointment status (check-in, pending, canceled) and the ongoing status of the appointment (with technician, physician, or checked-out).

The front desk user can also create superbill for patients which includes information like general information, medical information, follow-up plan, authorizations, procedures, appointment information.

Appointment Booking

The call center would be able to schedule an appointment by checking metrics such as service type, patient’s zip code, the radius of the clinic from patient’s zip code, doctor preference, and insurance type.

Billing

The users would be able to view the list of patients for whom billing was generated and add new encounters. This includes information like patient name, date of service, exam type, insurance profile, provider, location, insurance name, authorization number, modifier, etc.

Insurance

Once the bills are generated, they are transferred to the claims queue and are then sent to the clearinghouses for further processing. The claims that have been cleared by the clearinghouses will be visible under the remittance section. Any rejection or no response for the claims can be managed under the Insurance module. 

Reporting 

Dashboards for reporting were created for admin, doctors, and clinics. The key modules for admin constituted of Revenue from capitated and fee for service patients, Claims generated or redeemed, Check no-show, canceled, and rescheduled patients, New patients checking to the clinic, Clinic wise patient feedback trend, and Total revenue etc. 

The key modules for doctors included Current patient load, Patients linked with the doctor, Number of clinics visited by a doctor, New & existing patients, upcoming appointments, etc.

Data Protection & Compliance

For patient data protection, the entire system is HIPAA compliant. Patient data related to treatment, payment, or operations in healthcare are protected against any unauthorized sharing with a third party. Also, third-party integration is done to ensure cross-work between diagnosis (ICD) and procedures (CPT) codes. International Classification of Disease (ICD) codes and Current Procedural Terminology (CPT) help payors to understand what service was performed and why. 

In addition to this, measures have been taken to process insurance claims seamlessly. At the backend, a rule engine has been created that checks for NCCI PTP edits. NCCI Procedure-to-Procedure (PTP) edits checks for incorrect code combinations when the claim forms are generated.