Quick Answer: eClinicalWorks Workflow Optimization
eClinicalWorks optimization is the process of modifying an existing eCW environment to improve clinical documentation, patient intake and routing, billing, reporting, and the overall performance of the system. It includes configuration changes, staff training and measurement, and helps practices to streamline and remove unnecessary work while ensuring accuracy in documentation and reliability in patient care.
Your team has experience with eClinicalWorks, but there are still a number of issues. Corrections still need to be made to documents, messages bounce around the office, and there is a backlog of work for the billing department. Additional modules probably won’t address the existing issues. eClinicalWorks Optimization consists of identifying the location where work breaks down, and then adjusting the workflow, configuration, and/or responsibilities.
Improving intake, developing and implementing templates, effectively routing tasks, adequately charging and capturing services, and generating useful reports are the priorities for most practices. This document assesses those areas, and describes how to perform troubleshooting, resolve performance bottlenecks, and evaluate the impact of changes.
Some representative workflow examples are provided to illustrate a point. Confirm availability and/or access to features in your deployment.
Start eClinicalWorks Optimization with a Workflow Audit
Pick a problem you can investigate. For example, choose a complaint like “We have a backlog of unsigned encounters.” or “We have repeated insurance corrections.” or “There are missing results.” or “There are claims that never reach the payer.” “Improving productivity” is too general of a goal.
Study a representative sample of encounters, starting from the time they are scheduled and ending with their payment. Look at both a routine, straightforward encounter, and an exception, for example an encounter that is rescheduled and has a different insurance, an outside laboratory result, or a documentation query. Document the actual workflow, which may include work done outside of eClinicalWorks.
Capture work done to prepare for handoffs
For each handoff, identify:
- Required input- the information that is required to proceed
- Responsible Role- the person or team that is responsible for the work
- Completion Evidence- proof that the work is completed
- Exception Route- where work is routed if required inputs are not available
- Measurement- outcome to be improved
An assessment should also evaluate enabled modules, interfaces, templates, permissions and reports. Staff may work around an unconfigured module or a policy. Each requires a different response.
Prioritize a problem you can verify
Choose an improvement that impacts patients, staff or finances, preferably with a short dependency list. If repeated eligibility corrections are a more realistic starting point than eliminating all templates, focus on that first.
Be specific with your target improvement, for example decreasing the number of encounters returned to registration to verify the subscriber, while still performing verification checks. Define an owner and the type of evidence that will be required to accept the improvement.
Heal Patient Handoffs at Intake and Scheduling
Staff often have to manually verify information collected in the front office. Consider access, availability and requirements together. A lack of verification staff may cause delays that are misattribute to the scheduling process.
With healow CHECK-IN, staff can review exceptions for the patient’s demographic information, insurance, forms and payment prior to the patient’s visit. However, exceptions still need to be investigated, which leaves a process burden on the staff.
Sometimes insurance information is entered by the patient, but exceptions exist for eligibility, benefits and authorization. An uploaded insurance card does not guarantee that a service is covered.
Use the example of a specialty visit to illustrate. A patient updates his/her insurance to a new plan, but an authorization for the previous plan remains. A stronger workflow would identify the change to the staff member responsible for processing the previous authorization.
Setup appointment categories and rules around cancellations and waitlists, if available. Ensure your online scheduling and staff scheduling have compatible eligibility rules for appointment categories.
Provide assisted intake for patients unable to complete digital forms. For telehealth provide connection instructions, and required intake, and a documented fallback process. Measure portal preparation rather than enrollment alone.
Customize Templates to represent Clinical Decisions
Templates should be customizable to document what the clinician assessed and decided. Keep notes short only if they remain accurate, clinically meaningful, and sufficient.
eClinicalWorks identifies templates, order sets and customization of progress notes as documentation tools. Their utility is reliant on the specialty, configuration and adoption.
Standardize the core and preserve the variation
Review templates and find duplication in required elements. Consolidate duplicates and eliminate unnecessary elements.
Decide what information will populate structured fields for reporting or downstream workflows.
For an illustrative chronic condition follow-up, staff can gather relevant information within their scope, the clinician can review it and determine next steps, and the assessment can drive the order and follow up. Clinicians should not have to repeat information that has been validated by staff.
Test shortcuts for accuracy
Macros and shortcuts should help in crafting language. They should not be used to document a conclusion, diagnosis, or service that was not rendered.
A clinical owner should be enlisted to approve template elements and Order Sets. It is best to test a typical encounter and then more complex cases, including exceptions.
It is important that, in testing, expected or required information is entered to the appropriate location and the signed document represents what was captured.
Review Decision Support Alerts with clinical leadership and determine if the friction (nuisance) alerts can be safely removed. Preserve safety checks and determine what the impact of the change will be.
Clinical messages and requests should be routed to a clear recipient or owner. Review rules for different types of requests and documents separately.
EACH should have an agreed covering person, a rule for when it should no longer be covered, and a clear end state. Clinical urgency should conform to the approved practice pathway.
Give Messages, Results and Referrals a Clear Destination
When a result is received as a scanned document, determine the appropriate order, encounter or case and follow the same process as above. This also applies to completed referrals. Decide who verifies whether the referral was received. These statuses should help staff identify what remains unresolved.
Clarity must be defined in the same way for all forms of request for refills. It should include necessary administrative preparation and the review and signing of the clinical order by the prescribing clinician. Track repeated transfers, reopened tasks, and unresolved exceptions. Closing work without taking the required action provides little reassurance.
Connect Documentation to a Reliable Revenue Cycle
Improving eClinicalWorks revenue cycle management happens before a claim is generated. The accuracy of registrations, the provider’s enrollment status, the clinical documentation, coding, and payer requirements are just a few of the factors that may impact the ability of the billing team to submit a complete claim that is adequately supported by documentation.
Map encounter-to-claim process and show status
Track each encounter as it moves through medical coding services and becomes a claim, with a status recorded at each step. A claim should not be marked as submitted until the coding and charge entry teams have reviewed, clarified and approved all of the billable services.
Reconcile charges and encountered services
Verify that completed encounters have been charged and documented disposition for every service. Services that have already been paid should also have a documented disposition to ensure they are not charged a second time. Encounters requiring clarification should also be documented.
An illustrative review identifies approximately 92 correct charge records from 100 completed encounters. The remaining 8 charge records require further review. Some may be charges awaiting a signature, charges that have been duplicated, or charges that are missing. Resolve the reason before calculating financial impact.
When reviewing diagnosis codes, make sure to review other components of the encounter such as units, modifiers, the rendering and billing providers, the location of service and payer specific requirements, as well as the documentation to support code selection.
Trace claims through the entire processing workflow
A transmission status does not necessarily mean a payer acceptance status. Assign responsibility for clearinghouse and payer acknowledgments to ensure that the transactions return to their correct queue.
Separate payer denials from submission rejections, as their corrections paths are not the same. In the case of underpayments, review the service against the terms of the payer contract to see if modifiers or adjustments apply. Document each adjustment.
Denials are an opportunity for process improvements to address recurring documentation errors, or to correct registration controls for eligibility rejections.
Discover Where the Handoffs Create Billing Rework
Ask for an analysis of your eCW Encounter to Claim workflow and find out where the information flow is stopping. Base your workflow and billing process improvements on the results.
Diagnose Slow eCW Performance With Comparisons
“eCW is slow” describes a symptom. Chart loading, document viewing, search, interface delivery and a confusing workflow can feel similar to the user while requiring different investigations.
Start with the affected action. Record whether it involves one user, one workstation, one location, one patient record or multiple workflows. Compare an equivalent action under the same permissions where possible.
| Observed pattern | Initial comparison | Responsible investigation |
|---|---|---|
| One workstation struggles | Same action on another approved workstation | Local device, supported browser and endpoint configuration |
| One location is affected | Equivalent action from another location | Network path and local infrastructure |
| One user cannot complete an action | Same role with equivalent permissions | Access configuration, preferences and training |
| One workflow or record type stalls | Similar operation with another representative record | Workflow configuration, document characteristics or interface dependency |
| Multiple users and locations are affected | Correlate the affected functions | Deployment or application investigation with eCW support |
These comparisons narrow the investigation; they do not establish a diagnosis by themselves. Confirm supported browser, workstation and connectivity requirements with eClinicalWorks for your environment.
Provide authorized support staff with the exact action, reproducibility, affected scope and relevant approved diagnostics. Keep protected information within approved support channels. Capture technical event details internally when needed to correlate failures.
Avoid unsupported database modifications or disabling security tools to chase a performance improvement. For hosted deployments, coordinate infrastructure questions with the responsible hosting and application teams. Validate the same user action after a supported change.
Make eBO Reports Reliable Enough to Act On
Reporting becomes useful when a manager can explain both the number and the action it should trigger.
The eClinicalWorks Business Optimizer (eBO) offers financial, clinical, and administrative reporting, dashboards, and custom reporting services. The PG Management Dashboard offers visibility into operational and revenue cycle indicators. Confirm your access and available report definitions before finalizing your measurement approach.
Agree on calculations before comparing performance
Document the definitions for your population, exclusions, source, grouping and status for each measure. Distinguish claim lines, patients, claims and encounters. They are different counting units.
Define the effect of payment adjustments, refunds, and reversals on payment reports totals. Define the treatment of incomplete, cancelled and unreported visits on encounter reports. Adhere to these definitions for comparisons.
Make eBO reports reliable enough to act upon
Reports should clearly indicate what is to be actuated by them
The eClinicalWorks Business Optimizer (eBO) allows financial, clinical and administrative reporting in the form of dashboards and custom reports. The PG (Practice Group) dashboard provides access to operational and revenue cycle indicators. Prior to determining your measurement approach, evaluate the report access and review report definitions.
Agree on measurements before comparison
Define the population, exclusions, source, grouping and status and other pertinent details related to a given measure. Distinguish between claims, claim lines and patients. For counting purposes, they are not the same.
For payment reports, define how reversals, refunds and adjustments affect the net payment total. For encounter reports define how and if incomplete and/or canceled visits are captured. The same should apply for comparisons.
| Measure | Suggested definition | Action it supports |
|---|---|---|
| Registration rework | Encounters returned for registration corrections divided by encounters reviewed | Correct intake requirements |
| Documentation completion | Signed eligible encounters divided by eligible encounters | Identify documentation barriers |
| First-pass claim acceptance | Initial claims accepted at the defined acknowledgment stage divided by initial claims submitted | Investigate submission defects |
| Denial rate | Denied claims or lines divided by adjudicated claims or lines, using one consistent unit | Address payer-specific causes |
| Unresolved task share | Open tasks requiring action divided by tasks in the defined review population | Review ownership and coverage |
These are suggested internal definitions, not universal benchmarks. A clearinghouse acceptance measure and a payer acceptance measure should be labeled distinctly.
For quality reporting, validate the eligible population and measure specifications. CMS ties reporting requirements to the applicable program and collection method. Confirm that documentation reaches the expected fields before interpreting apparent care gaps.
Validate a Report against Underlying Records
Select examples of records and track them through the report logic. Include a complete encounter, an exception, and a corrected transaction. Reconcile results to an appropriate source report and investigate differences.
An example provided by a vendor is from Indiana Health Centers. In an eClinicalWorks account, the organization described using eBO reports to identify missing charges, immunization registry errors, and patient outreach needs. This illustrates practical uses of reporting without establishing an expected result for another practice.
Add AI and Integrations Where They Solve A Defined Problem
Before adding software, determine the workflow, information gap, and expected outcome. Consider if a given capability would meet the requirement and compare software, training, and support in the evaluation.
Use AI Documentation with a Review Step
eClinicalWorks mentions Sunoh.ai as a tool to capture ambient documentation to create a draft note to be reviewed by a provider. Representative examples of the complete process, including review and edit, should be assessed.
Review speaker attribution, negation, and medication details. Ensure all clinical statements are present, and negative findings are documented. A fluent, grammatically correct draft still needs clinical review and verification prior to signing.
Follow the same process for other automation to determine the individual that will review uncertain outputs and where the outputs will be sent if automation is not successful.
Consider applicable consent, privacy, and legal requirements. Follow organizational policies for recording, processing and retention of patient encounter information.
Maintain exchanged information clinically useful
PRISMA enables access to records from participating sources. Build external-record review into the appropriate clinical process and preserve the source record. The reconciling clinician is responsible for determining the relevance of information for clinical care.
Define patient matching rules and fields for various interfaces. Agree on exception handling. Decide how the team identifies an order without a result or a result that failed to transmit. For APIs and custom reports, confirm the supported access method with the vendor; in some cases, direct access to the database is permitted based on the deployment and agreement.
Train Each Role on the Whole Process
The best training approach is to take staff through a real process. A simple demonstration of the functionality does not validate the workflow will hold up in a real-world situation.
Use appropriate test patients and scenarios. Registration staff can practice updating insurance benefits, while the clinical and billing staff test updating status, resolving a task and handling an exception as part of the Medical Billing Services workflow.
Assign a clinical owner for documentation, an operational owner for handoffs and an authorized system owner for configuration. Super Users should be able to analyze whether an issue is caused by a bad workflow design, a configuration issue or a vendor issue.
Pilot the process to a sample of users representing a cross-section of roles. Ensure that exceptions are visible and that downstream changes to status are made, as required, and that the necessary documentation is completed. When the acceptance criteria are met, make the process available to all staff and retain the responsibility guide. Upon a change to the software or staff, review the responsibility guide.
Preserve Access and Data while Improving Workflows
Service changes impact who can see what and where information flows. Review the security of permissions, exports, interfaces and external services.
According to HHS guidance, cloud services that handle electronic protected health information (e-PHI) for a covered entity generally constitute a business associate relationship. While a business associate agreement (BAA) and the organization’s risk analysis are still necessary, a vendor’s assurances and security policy do not fulfill the risk analysis.
Conduct role-based access and approved authentication controls and administrative changes. Limit access to e-PHI to the least amount necessary. Protect exports of reports and support documents through approved storage and communication means.
Prior to use of an AI service or integration, ensure that the permitted use, data access, retention and deletion are determined. Also ensure that the responsible parties are defined prior to integration with clinical services.
Generally, the operational suggestions provided in this document are to be implemented in conjunction with clinical, privacy and security suggestions. Changes in configuration do not automatically satisfy HIPAA or payer requirements.
Measure ROI Without Overstating the Result
An optimization project can reduce rework or improve the usable capacity of a system. Projects can also potentially recover supported reimbursement. Measure these effects separately and the calculation will still be understandable.
Consider all costs associated with the project, including configuration, consulting, licensing, training, and support costs. Internal administration costs should also be included. If existing staff are taken away from support or billable work to perform project activities, they still incur a cost to the practice.
This calculation should only be used for a defined scope and a comparable project:
- ROI = (attributable financial benefit – optimization cost) ÷ optimization cost × 100
- Consider a hypothetical example for 1,000 comparable transactions:
- The project reduced the number of registration corrections from 80 to 40.
- Each registration correction was estimated to cost the practice $10 to process.
- The rework benefit was estimated at 40 × $10 = $400.
- The project costs in this scope were estimated to be $250.
- The ROI would be ($400 – $250) ÷ $250 × 100 = 60%.
Keep in mind that an improvement in efficiency (i.e. a reduction in time spent performing an activity) may not result in an automatic reduction in headcount. The available capacity may simply be utilized for another activity, or the improvement may result in throughput being improved without a decrease in paid labor.
Improvement in reimbursement capture (or recycling) should also be treated independently from billed charges. Improving cash flow does not automatically increase practice revenue. Make sure volume and mix of encounters are not adversely impacted before attributing the project.
If a consultant is used, make sure a defined scope exists, and expected outcomes and activities are verified. The handoff should occur with the practice understanding the configuration and how to interpret the results.
Create a Better Workflow for eCW
Combine all your documentation, process, and billing needs in one single discussion. Discover what is most valuable to fix and develop an achievable strategy that works for you.
Frequently Asked Questions
Which eClinicalWorks workflows should a practice optimize first?
Start with a recurring problem that has a clear owner and measurable impact, such as registration corrections, incomplete documentation or rejected claims. Follow representative encounters to identify the cause, then choose a change your team can test and verify before expanding the project.
Can eCW optimization help when the software feels slow?
It can help identify whether the problem involves a workflow, permissions, a workstation, connectivity or the application. Compare the same action across relevant users and locations. Use the findings to direct supported troubleshooting rather than applying a generic speed fix.
Should every clinician use the same templates?
Use a shared core for required information while allowing clinically justified differences by specialty and visit type. Template standardization should improve consistency without making documentation inaccurate or cumbersome. Have clinical owners approve content and verify that required structured fields populate correctly.
Can a practice optimize eClinicalWorks without purchasing add-ons?
Yes. Clearer task ownership, existing template improvements, better use of enabled features and focused training may address the problem. Review your current configuration and permissions first. Add a product when its expected benefit justifies licensing, integration, training and support costs.
Can better eCW workflows reduce claim denials?
They can address preventable causes involving registration, documentation, coding and claim submission. Results depend on the underlying denial reasons, payer rules and follow-through. Track changes by denial category and confirm that the correction reaches the responsible source workflow.
When should a practice involve an eCW optimization consultant?
Consider outside help when a problem spans several teams, internal expertise is limited or reporting and interfaces require specialist work. Confirm relevant platform experience and request specific deliverables, testing criteria and knowledge transfer. Keep clinical decisions and authorized system changes with the appropriate practice and vendor owners.
Identify Areas for Improvement
For this Optimization, choose one documented problem, designate an owner for it and agree upon the evidence that will prove an improvement. This will provide your next eClinicalWorks Optimization Project with a workable starting point and a result that your practice can measure.
