Portfolio Project

EDUC 765: Trends and Issues in Instructional Design

By: Amie Gustavson

Submitted 6/23/17

0
PROJECT PROPOSAL MODULE 2
Project Title
Pre-Visit Phone Consultation appointments Proper Procedures for booking and
documentation

Sponsoring Organization
Childrens Specialized Hospital

CSH is the largest pediatric rehabilitation hospital in the US. The mission of CSH is to be the
preeminent provider of specialized healthcare services for infants, children, and young
adults.

Project Description
CSH recently implemented a new procedure. We now employ Care Ambassadors (CAs) to
assist our Physicians and Advanced Nurse Practitioners (APNs) with clinical
documentation. The primary role of the Care Ambassador is to conduct pre-visit phone
consultations with patients/families who are scheduled for medical visits. The purpose of
the phone consultation is to collect clinical information prior to the patients appointment
with the provider and reduce the amount of time the provider needs to spend collecting
basic information. The information the CA collects is documented in the electronic medical
record and is pulled into the Physicians/APNs documentation at the time of the patient
visit. The information populates the provider document and the provider adds to the
document during the visit. This document becomes the report for that patient visit in the
medical record. We have found that there are frequent errors, whereby the phone
consultation appointment is booked incorrectly or the CA documents into the wrong
account. Both of these situations result in the pre-visit data not feeding into the
Physician/APN document, causing extra work (entering the missing information) for the
provider at the time of visit.

Aim
Promote provider satisfaction and reduction of time spent per patient appointment (thus
increasing productivity) by providing re-training for both schedulers and Care
Ambassadors related to the proper booking and documentation of phone consultation
appointments in the correct patient account.

Target Audience
There are two target audiences for this project:
Schedulers
Care Ambassadors

1
Delivery Options
This instruction will be delivered via computer-based training module. Online training is
most appropriate due to the physical location of staff at 14 different sites. Also, computers
are readily available and staff already have a level of proficiency accessing online training.

2
FRONT-END ANALYSIS: INSTRUCTIONAL NEED MODULE 3
Instructional Need
A performance problem exists which impacts the efficiency and job satisfaction of medical
providers throughout the Childrens Specialized Hospital system. This performance
problem was discovered through analysis of physician complaints related to pre-visit phone
consultation documentation, completed by Care Ambassadors, not feeding information into
their physician reports. Examination of the medical records of patients whose documents
were involved in these complaints revealed the cause of the problem--the two documents
(the Pre-Visit Phone Consultation and the physician Initial Evaluation report) were created
in different patient accounts, and as a result, were unable to communicate with each
other. Further, the reason that the documents were created in two different patient
accounts was that the related patient appointments were scheduled in two different
accounts (documents are initiated following selection of a patient appointment). In order
for the two documents to share information, the appointments must be booked in the same
account.

Care Ambassadors have been contracted to assist physicians with clinical documentation.
This requires that the Care Ambassadors demonstrate a high level of skill navigating the
clinical documentation software and solid knowledge of the processes and workflow
related to the documentation. The role of the Care Ambassador is to collect medical
information via a pre-visit phone consultation with a parent/guardian of a future-
scheduled patient (medical history, description of current problem, etc.) to reduce the
amount of time spent by the physician collecting such information at the time of the patient
visit. The Care Ambassador creates a document in the electronic medical record that is
designed to feed information directly into the document that the physician creates at the
time of the patient visit.

There are two potential problem points that contribute to errors in this process:
1. In order for the CAs documentation to flow into the physicians document, both
appointments (phone consultation and physician office visit) must be booked on the
same patient account (this links the two documents in the system). Schedulers often
erroneously book phone consultation appointments and physician appointments
into two different patient accounts. Because the CA starts his/her documentation by
selecting the phone consultation appointment from the patients account list, this
causes the document created during the phone consultation to be unable to flow
into the physicians report. This leads to physician dissatisfaction and increased
time spent on documentation.
2. The second problem point occurs when the Care Ambassador initiates
documentation of the phone consultation and does not realize that the appointment
is booked on a different account than the physician appointment. The CAs are not
knowledgeable enough about the scheduling process or how to recognize
account/scheduling errors to catch incorrectly scheduled appointments before they
start their documentation.

3
A needs assessment was conducted in order to determine whether schedulers and Care
Ambassadors currently understand the process for booking and documenting pre-visit
phone consultations and how information flows between documents in the clinical
documentation software. Several members of each group, as well as their supervisors,
were shown examples of accounts in which appointments were booked incorrectly and
interviewed about what they were seeing. Results indicated that neither group had a
good understanding of the importance of booking and documenting appointments in
the correct patient account. The Care Ambassadors knew there were problems related
to their documentation, but assumed, as did the physicians, that the software was
malfunctioning. Because the CAs and physicians did not fully understand the problem,
the schedulers were never given feedback and were unaware of their errors until
feedback was given to them by the systems analysts evaluating the problem being
reported by the physicians.

In order to mitigate the problems caused by incorrect booking of phone consultation

appointments and Care Ambassadors lack of sufficient knowledge of the system to
catch booking errors (and have them corrected) before initiating their documentation,
retraining of scheduling staff and Care Ambassadors is needed. Instruction for
schedulers will focus on improving their understanding of the impact of scheduling pre-
visit phone consultations incorrectly and how to ensure that they are scheduling these
in the correct account; Instruction for the Care Ambassadors will focus on ensuring that
they are able to recognize incorrectly scheduled appointments prior to beginning their
documentation and that they know what to do when they find scheduling errors.

4
FRONT-END ANALYSIS: LEARNER CHARACTERISTICS MODULE 3
Learner Analysis
Primary Audience
Scheduling staff
Care Ambassadors

Secondary Audience
Physicians

General Learner Characteristics

Age 23-60
Gender: 70% female, 30% male
Education: Care Ambassadors - college students in pre-medical programs;
Schedulers high school diploma, some college graduates; physicians graduate
medical degree
Work experience: 1 week to several years

Entry Characteristics
Motivated to perform well and meet volume expectations
Varying levels of proficiency with computers
Varying levels of proficiency with the clinical documentation software (used for
both scheduling and documentation).

Contextual Analysis

Orienting Context
Improved proficiency with documentation system and physician satisfaction with
their work.
Learners dont want to make mistakes that physicians to be dissatisfied.
Care Ambassadors understand that their role is to assist physicians with clinical
documentation and that making mistakes negates their value to the physicians.
Some learners might assume that they already know how to select accounts
correctly and not give sufficient attention to the instruction.

Instructional Context
Online training module will be available on demand.
All staff have access to computer at all times while working.

Technology Inventory
All learners have access to a computer (laptop or desktop)
May not have speakers to access audio

5
Transfer Context
Training module will contain a software simulation that requires learners to
complete relevant tasks correctly.
This knowledge will be applied daily as schedulers and Care Ambassadors perform
their job functions.
A printable job-aid will be available for use after training.

6
INSTRUCTIONAL IMPACT BASED UPON LEARNER CHARACTERISTICS
Application of Learning Theories

This training course will be designed for adult learners. It will be a self-study module that
can be completed at any time (within a prescribed timeframe) and at the pace of each
individual learner. Because adult learners appreciate training that is specific to a perceived
need, this training will appeal to their desire to learn how to correctly perform their job
tasks related to booking and documenting for pre-visit telephone consultations. The
training will also recognize several characteristics of adult learners described by Knowles
in his book about androgogy (Knowles, 1980): self-directedness, prior experience with the
Meditech system, and orientation to learningthe learners will be able to immediately
apply the skills they learn from completing the training module. Additionally, they will have
access to the content of the training after they have fulfilled the training requirement
through our LMS; they will be able to review the training as many times as necessary and
whenever necessary.

Application of Motivational Theories

This training will be developed as a computer-based learning module. The module will
contain extrinsic motivators such as a progress bar and messages of positive reinforcement.
The intrinsic motivation will be the desire of the learners of both audiences to improve in
their ability to complete their job tasks correctly. Because of the concentration of these
audiences in a younger age range, the use of the computer for this education engages the
learnersthey are comfortable with technology and accustomed to completing learning
activities using a computer. Graphics will be used to gain and hold the attention of the
learners.

Impact of a Diverse Audience on Instruction

There is wide variability of age and educational background in this group of learners.
Because the primary audience for the instruction will be the Care Ambassadors and
schedulers, the online training will be directed at those two groups of learners, with the
physicians receiving information in a less structured, informal method of instruction
a one-page explanation of how their documentation receives information from that of the
Care Ambassador and the conditions that must be met in order for the process to work
properly.

The learner group for this instruction is also diverse in that they are located at several
different hospital facilities through NJ. Because of this, the instruction will be distributed
online, via email link. A printable performance support document will be available in the
instructional module for reference after the initial trainingthis is also the document that
will be given to the physicians for a high-level explanation of the process and
troubleshooting tips. The training module will also be housed on a network drive that is
accessible to all stakeholders at any time for review of the material.

7
GOAL AND TASK ANALYSIS MODULE 5
Goal Analysis
Step 1 - Write down the goals.

1) The Care Ambassador selects the correct patient account to enter documentation of the pre-
visit telephone interview in 80% of trials, given performance support in the form of a
printed job-aid.

2) The Scheduling Coordinator books the pre-visit care coordination (telephone interview)
appointment and the Provider appointment in the same patient account in 80% of
opportunities, given performance support in the form of a printed job-aid.

Step 2 - Write down everything a learner would have to say or do for you to agree that the
learner has achieved the goal. This is not a list of what you will need to do as the
instructional designer or teacher.

Care Ambassador:

Accesses patient schedule in Meditech system

Identifies appointment booked for phone consultation
Identifies appointment booked for related provider visit
Compares account numbers on the two appointments to confirm that they match
Lists steps to take if account numbers do not match:
Contacts scheduling supervisor and inform him/her of the discrepancy
Provides scheduling coordinator with patient name, DOB, and account numbers of concern
Requests correction prior to date/time of phone consultation appointment
Confirms correction is made before documenting pre-visit phone consultation
Opens pre-visit care coordination document template and documents phone interview

Scheduling Coordinator:

Accesses patient schedule

Identifies appointment booked for provider visit that requires pre-visit telephone interview
Identifies account number associated with provider visit
Books pre-visit care coordination appointment in same account as related provider visit

Step 3 - Sort the items Listed in step 2.

Tasks sorted into two categoriesJob Task (the action required) and Troubleshooting (to ensure
that when mistakes are made, they are corrected before they impact the provider).

Job Task:

Care Ambassador:
Accesses patient schedule

8
Locates Pre-Visit Care Coordination appointment
Opens EMR (Enterprise Medical Record) associated with that appointment
Begins new document template to record information during Pre-Visit telephone interview

Scheduling Coordinator:

Accesses patient schedule

Books appointment for Pre-Visit telephone interview in same account as Provider visit.

Troubleshooting ability:

Care Ambassador and Scheduling Coordinator:

Identifies discrepancies between accounts that pre-visit and provider appointments are booked on
Takes necessary steps to correct problem before it reaches the provider

Step 4 - Write a complete sentence to describe each of the items on your final list.

Care Ambassador Opens the patient schedule, locates the Pre-Visit Care Coordination
appointment, opens the EMR (Enterprise Medical Record) associated with that appointment and
opens the Pre-Visit Care Coordination document template.

Scheduling Coordinator Opens the patient schedule and books the Pre-Visit Care Coordination
appointment on the same account as the related provider visit.

Both Presented with a patient schedule, correctly identifies discrepancies between accounts that
the pre-visit and provider appointments are booked on.

Goal
After completing this course: the Care Ambassador will consistently document the pre-visit
care coordination report in the correct patient account to ensure proper flow of
information to the provider document; The Scheduling Coordinator will book pre-visit care
coordination phone interview appointments and provider visit appointments in the same
patient account to ensure proper set-up of documentation.

Objectives

Break the Goal down into Terminal Objectives (T.O). Then break each T.O. down into
enabling, performance-based objectives. List the domain (Cognitive, psychomotor, affective)
after the objectives. How many you have depends on how big your goal is.

Care Ambassador

Terminal Objective (cognitive):

Given a patient name and a future date of service, open the patient schedule in Meditech and
identify (point to) the two appointments (provider visit and pre-visit telephone consultation)
booked for the date.

9
Enabling Objectives:
In Meditech Scheduling desktop, enter provided patient name in search field accurately.
Identify (point to) provider visit appointment booked on date provided.
Identify (point to) pre-visit telephone consultation appointment booked on date provided.

Terminal Objective (cognitive):

After identifying two appointments, for provider visit and pre-visit telephone consultation, identify
(point to) the account numbers associated with each and communicate any discrepancies to the
supervisor, with no more than one error per 10 trials.

Enabling Objectives:
Identify (point to) account numbers associated with each of the two appointments.
Verbalize to a supervisor any discrepancies between account numbers of the two appointments.

Scheduling Coordinator

Terminal Objective (cognitive):

Given patient name and date of existing provider visit, create appointment for pre-visit telephone
consultation in the same account as the provider visit appointment in 9/10 trials.

Enabling Objectives:
In Meditech scheduling desktop, identify (point to) booked appointment for provider visit
Identify (point to) account number of provider visit
Book new appointment for pre-visit phone consultation, using same account as provider visit
account

Task Analysis Method

Procedural Analysis
The tasks of booking appointments and entering documentation in the Meditech system involve
series of cognitive steps. The steps must be followed in a particular order for the end result to
meet expectations. These two procedures include both observable and unobservable behaviors,
both of which can be accounted for with procedural analysis.

Task Analysis

Care Ambassador
1. Open Meditech system Scheduling desktop
2. Enter patient last name, first name in search field
3. From list of results, select correct patient name
a. If multiple patients with same name, check DOB
4. In patient schedule locate pre-visit phone consult appointment
a. Date of appointment
5. In patient schedule, locate upcoming provider visit
a. Date of appointment
6. Compare account numbers of the two appointments

10
 a. Account numbers match--open EMR and begin document to prepare for phone
consult appointment
b. Account numbers do not match--do not proceed with documentation and notify
scheduling supervisor of discrepancy and ask for correction of error before
scheduled appointment

Scheduling Coordinator
1. Open Meditech system scheduling desktop
2. Enter patient last name, first name in search field
3. From list of results, select correct patient name
a. If multiple patients with same name, check DOB
4. In patient schedule locate upcoming provider visit to have phone consult appointment
booked
a. Date of appointment
5. Write down account number of provider visit
6. Create appointment for pre-visit phone consult appointment using same account as
provider visit
7. After booking pre-visit phone consult appointment, confirm that both it and the provider
appointment are booked in the same account.
a. If not, correct immediately by rebooking appointment

INSTRUCTIONAL OBJECTIVES MODULE 5

[Goals, Terminal Objectives, and Enabling Objectives Check Rubric & Dont forget to map
the domains and level of Blooms Taxonomy with the objectives]

Project (Instructional) Goal

After completing this course: the Care Ambassador will consistently document the pre-visit
care coordination report in the correct patient account to ensure proper flow of
information to the provider document; The Scheduling Coordinator will book pre-visit care
coordination phone interview appointments and provider visit appointments in the same
patient account to ensure proper set-up of documentation.

Terminal Objectives and Enabling Objectives

Care Ambassador

Terminal Objective (cognitive):

Given a patient name and a future date of service, open the patient schedule in Meditech and
identify (point to) the two appointments (provider visit and pre-visit telephone consultation)
booked for the date.

Enabling Objectives:
In Meditech Scheduling desktop, enter provided patient name in search field accurately.
Identify (point to) provider visit appointment booked on date provided.
Identify (point to) pre-visit telephone consultation appointment booked on date provided.

11
Terminal Objective (cognitive):
After identifying two appointments, for provider visit and pre-visit telephone consultation, identify
(point to) the account numbers associated with each and communicate any discrepancies to the
supervisor, with no more than one error per 10 trials.

Enabling Objectives:
Identify (point to) account numbers associated with each of the two appointments.
Verbalize to a supervisor any discrepancies between account numbers of the two appointments.

Scheduling Coordinator

Terminal Objective (cognitive):

Given patient name and date of existing provider visit, create appointment for pre-visit telephone
consultation in the same account as the provider visit appointment in 9/10 trials.

Enabling Objectives:
In Meditech scheduling desktop, identify (point to) booked appointment for provider visit
Identify (point to) account number of provider visit
Book new appointment for pre-visit phone consultation, using same account as provider visit
account

ENABLING OBJECTIVES MATRIX & SUPPORTING CONTENT MODULE 6

Enabling Level on Blooms Learner Activity (What Delivery Method
Objective Taxonomy would learners do to master (Group presentation/lecture,
this objective?) self-paced, or small group)

Identify Comprehension In a computer-based Self-paced, computer-

account the Care module, learners will based learning module,
numbers Ambassador must identify (click on) the built in Lectora.
associated with be able to identify account numbers
each of the two the account associated with
appointments. numbers on each appointments from a
of the two presented screenshot of
appointments a patient schedule. 5
that have been examples will be given;
booked for the learners must correctly
patient visit identify the account
number in all trials.
Identify Synthesis the In a computer-based Self-paced, computer-
incorrectly- Care Ambassador, module, learners will based learning module,
booked pre- after identifying identify (click on) pairs built in Lectora.
visit telephone the account of appointments, from
consultations, number for each screenshots of patient

12
given a appointment, will schedules, which reflect
screenshot of compare the two a pre-visit phone
an example of account numbers consult and a provider
two booked to identify visit that are booked
appointments discrepancies. erroneously on two
in a patient different account
schedule (pre- numbers. 5 examples
visit telephone will be given; learners
consultation must correctly identify
and provider the errors in all trials.
visit).
Verbalize to a Analysis the Learner will respond to Self-paced, computer-
supervisor any Care Ambassador a series of multiple based learning module,
discrepancies must explain to a choice questions about built in Lectora.
between supervisor why the reason that the pre-
account he/she believes visit consultation and
numbers of the an error has been the provider visit must
two made in booking be booked on the same
appointments. the two account. Immediate
appointments. feedback will be given
and the feedback given
for incorrect responses
will include an
explanation of why the
response was incorrect.

REFERENCES
Richard Culatta (2016). Instructionaldesign.org

Pappas, Christopher (5/25/16). 4 Tips to Use Criterion Referenced Instruction Principles in

Online Training. elearningindustry.org

Teachinglearningresources.pbworks.com (edited by Gayla S. Keesee). AndrogogyAdult

Learning Theory.

Rit.edu/academicaffairs/tls/course-design/instructional-design/adult-learner

Cft.vanderbilt.edu (2017). Motivating Students.

13
FINAL PROJECT RUBRIC

Please see the final project rubric at: http://www2.uwstout.edu/content/profdev/idtrends/Portfolio-Rubric.pdf and the
reflection paper rubric at: http://www2.uwstout.edu/content/profdev/idtrends/Portfolio-RubricReflection.doc

14