Sunday, August 01, 2004

Smothering in Paperwork, Healthcare Providers Seek Cure in Groupware Richard Truex: ? Smothering in Paperwork, Healthcare Providers Seek Cure in Groupware by Shala Phillips You Don’t Have to Build It Yourself Domino-Based Healthcare Software Table Paperwork is the bane of the healthcare industry. But Cincinnati Children’s Health Medical Center has streamlined its bureaucracy with the help of Lotus Notes, saving money and improving care. Rebecca Reder, director of occupational and physical therapy at Cincinnati Children’s Hospital Medical Center, has a simple goal. She wants to spend more time doing what she went into rehabilitation to do—take care of children. With 4,000 employees, six satellite offices, and a sprawling central campus, Cincinnati Children’s is one of the largest pediatrics hospitals in the country. It’s the only the hospital in the Cincinnati area that’s devoted exclusively to infants, children, and adolescents; its 130 therapists have thousands of patients and a waiting list several pages long. Over the past 20 years, Reder has watched the hospital struggle to adjust its simple fee-for-service price structure to fulfill the complicated paperwork requirements of health insurers. When the therapists in her department and the speech pathology department began spending nearly half their day completing insurance forms and treatment authorization requests, Reder had enough. In 1992, she teamed up with Dr. Ann Kummer, director of the speech pathology department, to find a way to cut down on all the paperwork. The Prototype They didn’t find any ready-made software that could do the job. However, since Lotus Notes had the capacity for document management, collaborative computing, and WAN networking, they hired a local Lotus business partner, The Future Now (since purchased by Xerox Connect) to develop a custom Notes application. The result was a single Notes database to house all patient data and automate most forms. The application, which was deployed in 1995, was a success—as far as it went. It addressed Reder’s immediate needs and even won the 1995 Lotus Beacon Award for best industry-specific solution. But it didn’t scale well over time. With all of the patient data stored in one database, even simple modifications required significant reprogramming or taking the entire system offline. And The Future Now didn’t have the capacity to provide support. Enter Chart Links Dr. Ron Miller, a former geriatrician and president of Chart Links, a healthcare software company in New Haven, Conn., contacted Reder after hearing about the Beacon Award in early 1996. He proposed reworking the hospital’s forms management system into a workflow-based patient records system that could be sold to rehabilitation centers around the country. Reder and Kummer listened, they considered and, in the end, sold the system to Chart Links, whose programmers spent the next year revising it. While Chart Links labored on the code, Cincinnati rebuilt its entire Notes infrastructure, installing one server at each of its seven locations and upgrading to Notes 4.57. The HP LE servers run Windows NT 4.0 and have 480 MB of RAM and 28 GB hard drives. The occupational and physical therapy and speech pathology departments have more than 130 employees, but some of them are part-time workers who don’t need their own workstations. So the hospital installed 101 Chart Links workstations: 63 for the occupational and physical therapy department and 38 for the speech pathology department. Six laptops are available for clinics and home health care visits. The workstations are HP Vectra 350 MHz Pentium II computers with 32 MB RAM and 4 GB hard drives, running Windows 95, Notes 4.57, and the Notes Document Imager. Secretaries at the central hospital use HP DeskScan 4.5 scanners to scan in the 10 to 15 referral notes received daily from primary care physicians. With the infrastructure in place, Chart Links began deploying the application, converting data, and training users. Since the previous system used Notes as well, these activities took less than two weeks. On September 15, 1997, Cincinnati Children’s began using Chart Links (the product bears the same name as the company). How Chart Links Works Chart Links splits patient data across 20 databases, and includes databases to track referrals, evaluations, appointments, and insurance codes and charges. The system also includes patient, physician, and employee directories. Staff members enter new patient data, such as the patient’s name, address, primary caretaker, and insurance coverage into Chart Links when they receive a referral from a physician. From that moment on, when a therapist or other staff member creates a new document about that patient, the new Chart Links document inherits this patient information. As a result, a therapist no longer has to look up and retype the patient’s personal and insurance information when completing evaluation forms and progress reports. Therapists have to report on every patient visit to the referring physicians. In the past, therapists took notes on a legal pad and dictated them onto tapes that were sent to an outside transcription service. When the transcribed reports arrived, the therapists reviewed them for accuracy and returned them for corrections. Secretaries copied the corrected reports for the hospital’s files and mailed the originals to the referring physicians. The entire process took six weeks. Today, therapists take notes on their workstations during patients’ visits. When a therapist creates an evaluation form, Chart Links automatically enters the patient’s personal and insurance information. Therapists select standard progress statements, treatment plans, and therapy goals from drop-down lists, enter additional notes in open fields, and e-mail the completed reports to the referring physicians. The whole process requires only ten minutes. Evaluations often reach the physicians’ desks before their patients arrive home from the hospital. Insurance documentation is completed just as easily. Computerized Patient Record Systems As this table shows, the American healthcare industry is hastening to install computerized patient record systems. Whereas only 2 percent of healthcare organizations had such systems in 1998, 11 percent have them now—and another 32 percent are in the midst of installing them. Stage Percent of Respondents in 1998 Percent of Respondents in 1999 Not yet begun planning 24% 29% Have a plan for a records system 17% 25% Have a fully operational computerized patient record system 2% 11% Are installing necessary hardware/software 17% 32% Other 40% 3% Despite this ease of use, the volume of data generated by 8,000 patient visits a month can become overwhelming. To keep the system lean, Reder archives all patient information more than three months old. Historical patient information is still available to therapists, but the data doesn’t bog down the Notes databases that are used daily. The Advantages Although Chart Links spans more than 20 databases, Reder said that the system is so intuitive that new staff members need only four hours’ training to learn it. Thanks to Chart Links, the hospital has increased insurance reimbursements, improved feedback to referring physicians, and won more referrals. With the time required for paperwork and other nonbillable services cut in half, therapists can see more patients—which brings in more revenue—and spend more time with them. Authorized users can look up and edit any patient’s history, insurance status, therapy attendance, and progress from any workstation at the seven rehabilitation center locations. All support functions are centralized at the hospital’s main campus, and therapists no longer have to dictate reports and send them to outside transcription services. As a result, administrative costs have been reduced dramatically. A 1998 study by IDC, the Framingham, Mass., IT market research organization, reports that Cincinnati Children’s had a 264 percent return on its Notes investment by 1998. If the hospital had been able to buy Chart Links off the shelf, its return on investment would have been about 670 percent. All told, the hospital has saved more than $3.3 million from 1995 to 1998, according to IDC, while incurring only $864,150 in additional costs. Despite these impressive results, Reder advised other hospitals not to do what Cincinnati Children’s has done. "It’s a much bigger undertaking than you can possibly imagine to write an application from scratch. Buy something." Future Plans Unlike speech therapy, physical therapy takes place in large clinics where it’s difficult to use a computer during sessions. Reder hopes to equip the therapists with PalmPilots or similar handheld devices so that notes taken on the spot can be fed directly into the system. Reder also hopes to add voice recognition so therapists can dictate their notes during sessions. Both enhancements are at least a year away. Ultimately, automation alone isn’t enough. After all, automating an inefficient paper process leaves you with an inefficient electronic process. Reder and Kummer work with Chart Links regularly to modify the program as they refine internal procedures according to Reder’s simple equation: "The less time I spend on paperwork, the more time I have to take care of children." SHALA PHILLIPS is a freelance writer who lives in Boston and is a Group Computing contributing editor. E-mail: shala@alumni.rice.edu . Domino-Based Healthcare Software More than 70 Lotus business partners specialize in Domino-based healthcare solutions. This table lists several of the offerings. A complete list is displayed at www.lotus.com/healthcare , the Lotus healthcare industry home page. Vendor Axolotl Mountain View, Calif 888-296-5685 www.axolotl.com Product Elysium Clinical Messaging System Elysium Access Elysium Workstation Elysium Clinical Information Manager Product Description Elysium uses open architecture standards to interface with existing hospital and laboratory data systems and link independent physician groups with external organizations and healthcare partners, such as labs and hospitals. Price $15-$100 permonth per physician,depending on components used Vendor Chart Links New Haven, Conn. 203-469-0707 www.chartlinks.com Product Chart Links Product Description Patient-based medical records system for rehabilitation centers that tracks patient evaluation, treatment, and insurance records from the moment of referral to final discharge. Modules are available for speech and language pathology, physical therapy, and occupational therapy centers. Modules for audiology, physical medicine, nursing, social work, psychology, and case management will be released during the next 12 months. Price $1,495 per full time equivalent (FTE) for shared electronic chart $995 per FTE for reference libraries $4,995 for first site for scheduling capabilities Additional charges for third-party software, maintenance, support, and future enhancements Vendor IKON Office Solutions Buffalo, N.Y. 716-630-0001 www.ikonuny.com Product EntryNET Product Description Provides referring physicians secure access to hospital-based patient information including the patient’s insurance, current location, history, and lab results. Best suited for hospitals that regularly share patient data with third party healthcare organizations. Price $200,000 for unlimited user license $18,000 for on-site installation, integration, and training (includes 30 hours of customization) $30,000 for annual software maintenance Vendor Shared Medical Systems Corporation Malvern, Pa. 800-243-8483, x4886 www.smed.com Product SMS Groupware Solutions SMS PhysicianConnect SMS HospiceConnect Enterprise Policies and Procedures Enterprise Project Tracking Enterprise HelpDesk Enterprise Vendor Contact Tracking Enterprise Applicant Tracking Product Description SMS PhysicianConnect An electronic medical record solution for physician practices. Physicians use browsers to review patient history, enter orders, chart results, make referrals, and write prescriptions. Targeted at physician groups, managed service organizations, and hospitals with ties to community physicians. SMS HospiceConnect Similar to SMS PhysicianConnect, SMS HospiceConnect provides form-based records management to home health organizations, hospices, and hospitals with hospice care units. Enterprise Solutions A series of Domino applications to handle administrative aspects of healthcare, including recruiting, IT support, and organizational policies and procedures. Price Priced per physician. Call company for prices. Vendor xnet Houston 713-361-0020 www.xinc.com www.xnetconsulting.com Product Care Manager Product Description Procedure-based disease management system designed to help physicians manage acute and chronic illness in clinical and outpatient settings. Best suited for organizations with established care pathways. Care Manager is not an electronic patient record, but rather integrates with existing patient records systems, whether paper or electronic. Price $50,000-$100,000, depending on organization size and requirements Additional charges for product customization and care pathway development You Don’t Have to Build It Yourself Instead of creating their own software, a group of healthcare providers in Santa Cruz, Calif., bought a shrink-wrapped product Few healthcare organizations can afford to scrap their systems and build new ones from scratch. Instead, many choose to build the systems in stages. This was the prescription for an assocation of healthcare organizations in Santa Cruz County, Calif., a group that includes two hospitals, a home health agency, a radiology practice, a laboratory, and a physicians’ independent practice association. These organizations care for more than 70 percent of the county’s population, and their collaboration used to entail a great deal of paper shuffling. In 1994, representatives from each organization formed a committee to find a better way to share patient data. They knew they couldn’t spend two years developing a proprietary system that might be obsolete by year’s end. Nor could they expect physicians and staff to change their work habits for an automated system with unproven benefits and an uncertain future. They needed a system with an open architecture, one that was based on industry standards and that could be installed in stages and modified when technology changed. In May 1995, after an extensive search, the committee selected a Domino-based system from Axolotl, a software company in nearby Mountain View. Called the Elysium Clinical Messaging System, the system was still under development, which meant that the committee could influence its design. Deployment In March 1996, the organizations deployed the first version of Axolotl’s product, a Notes communications system that delivered messages, radiology analyses, and test results to participating physicians. The system used a distributed master patient index to link data gathered during clinical visits to patients. Physicians used Notes clients to view patient records and exchange files with colleagues. Physicians eventually began using Elysium to manage incoming patient data, send orders to staff, and store notes on patients. The Elysium messaging system converts all patient data in the messages to Health Level-7 (HL-7), a standard set of codes used to relay patient data between healthcare organizations. Each message is stamped with the physician’s digital signature and encrypted before it’s sent over the Internet. Now that the physicians are comfortable with the new messaging system, the organizations have begun adding components to automate daily activities. In early 1999, they added the Elysium Prescription Writer, which checks for drug interactions and allergies when a physician submits a new prescription for a patient. By the end of the year, they will add an electronic alert system to remind physicians about preventive care and patients with chronic diseases. The Benefits Today, more than 300 doctors and other health care workers use Elysium to exchange patient information; communicate with patients, specialists, and insurers; write prescriptions; check for drug interactions; review lab results; and send orders for ongoing care. While savings are difficult to quantity, one physician credits Elysium with saving the life of an 11 year-old boy with acute kidney disease. Dr. Joan Barber, the boy’s primary care physician, knew that the child could die unless he were treated promptly by a specialist. Unfortunately, his HMO took six weeks to approve referrals. Dr. Barber used Elysium to cut through the red tape and in a matter of days obtained authorization to send the boy to a specialist—without making a single phone call. Because the organizations implemented the solution over three years, employees have had plenty of time to adjust to the inevitable cultural and process changes. Because of this and the emphasis on using industry standard tools, training costs are low. More importantly, the organizations have done their best to ensure that they’ll be modify the system if they have to. Planning a Staged Implementation? Dr. Robert Keet, a practicing internist, participated in the deployment and now serves as Axolotl’s medical director. Keet recommends that healthcare organizations considering a staged transition to an electronic patient records system look for technology with the following characteristics: An open architecture based on independent coding standards used in the healthcare industry to relay patient data between incompatible systems, such as HL-7 and Logical Observation Identifier Names and Codes An industry standard communications backbone capable of supporting Internet communications Compatibility with current LAN/WAN technology A distributed data model with ownership of data at both the receiving and providing ends, rather than a centralized repository Unique identification of patients Ability to accept patient information from a variety of sources An intuitive and easily customized user interface. Copyright © 2003 - Penton Technology Media 6:00:13 PM    comment []

Sunday, March 07, 2004

Black Spot Sneakers Looking for the latest in sneakers?  Check out the Black Spot Sneaker here   2:01:13 PM    comment []

Sunday, February 22, 2004

HP Palm 200lx web page Palm 200lx web page http://www.palmtoppaper.com/ 3:43:58 PM    comment []

Computer Timeline Computers I have used... 1974 HP 21, 1978 DEC PDP 11 1979 IBM System 36 1980 Comshare Financial Modeling software 1981 IBM System 23 / Datamaster http://www-1.ibm.com/ibm/history/exhibits/pc/pc_9.html 1981 Radio Shack TRS 80 Model 16 1982 Apple II/e 1982 Apple III 1982 IBM PC 1983 Compaq Portable   3:11:23 PM    comment []

© Copyright 2004 Richard Truex.