Addressing business and technology pressures
By Margaret Mayer
Boston Software Systems
From TODAY Magazine Archives www.tawpi.org
At the turn of the last century we finally realized the pundits were right: “all business is e-business.” The rise in use and popularity of electronic transactions has fueled an expectation of faster more accurate service from every business sector, including healthcare. Fulfilling the technology expectations of patients, government, physicians and financial managers becomes a matter of bridging a
multitude of gaps between the data sources that exist behind a transaction or information request. As in life science, where evolving species are most successful
when they are adaptable, those business organizations willing to adapt to new approaches, technologies and solutions will ultimately thrive. The pressures of particular business drivers within healthcare are creating opportunities for organizations to evolve or reinvent processes and workflows through the adoption of technologies that respond to these drivers.
While the goals of each organization define specific mandates,
major business drivers within healthcare can be grouped into three
main categories:
• Regulatory Issues (HIPAA, patient safety initiatives, interoperability
requirements)
• Technology Demands (new clinical applications, EHR, CPOE)
• Business Issues (faster revenue cycle, reduced FTEs,
Internet/portal connectivity)
The race to handle these pressures effectively requires a careful analysis of existing workflows and processes, as well as an evaluation of how technology is best used in a particular organization. Ultimately, how efficiently an organization can move data and share information determines how well it fills both the information and the process gaps that these business drivers create. The passage of the Health Insurance Portability and Accountability Act (HIPAA) has been the impetus to improve record keeping and has forced organizations to use technology to ensure compliance.
As deadlines approach for the various components of HIPAA, hospitals assume greater responsibility for managing the manual processes still in place and the associated reporting required by HIPAA. While HIPAA has been a great motivator in building a technical infrastructure within hospitals, HIPAA requirements in and of themselves are not revenue-producing activities and do not offer the financial return that enables organizations to hire staff dedicated to compliance.
Understanding Workflow and Tasks
The bottom line is that healthcare organizations will have to evaluate
how the tasks and processes that impact the basic operation of
the organization are completed. The complexity of information gaps in healthcare seems to strangle attempts to automate processes and fill these gaps. Because of the
way healthcare organizations have evolved, individual departments, clinics and physician practices have developed unique workflows to handle information within their specific departments or systems. These workflows are often developed in response to an immediate demand without consideration for how the information is ultimately used or how the process might be automated. These types of paper
or manual workflows may accomplish the initial goal of getting specific
information from one desk to the next, but they lack efficiency and
accuracy.
Every organization has processes or workflows already in place to
manage their business at any particular point. However, the proliferation
of small manual tasks abounds in the hospital environment,
creating points of failure for more strategic information strategies.
For instance, a fully functioning Computerized Physician Order Entry
(CPOE) system must integrate with:
• Clinical data repository
• Nursing and physician (and other caregiver) documentation
systems
• Clinical decision support system
• Results reporting system
• Electronic medication administration system
• Pharmacy system
That’s at least six informational gaps which need to be filled, and
within each area, manual tasks that may create points of inaccuracy.
As the demand for CPOE rises, the demand to fill those gaps and
automate tasks intensifies.
Filling Tactical Gaps to Automate Manual Processes
In healthcare, improving business processes may begin by evaluating
areas where paper-driven processes are slowing down workflow, contributing to inaccurate data use, and ultimately, to lost or delayed revenue. One hospital filled this task gap using powerful scripting software. Mount Auburn Hospital in Cambridge, MA. found that attaching accurate patient information to specimens going from clinics and physician offices to the hospital was a problem. In some cases, only handwritten patient information was accompanying a specimen to the hospital lab, creating many inaccuracies including wrong insurance, a wrong address or simply illegible writing. Lab personnel had to take valuable time to register patients using this information, which delayed the ordering of lab work. This ultimately caused billing delays, costly corrections and re-billing issues. The scripted solution allows Mount Auburn Hospital to realize faster turnaround in billing with fewer corrections. Lab work is expedited because personnel aren’t manually performing registrations.
The script works like this: When a sample is drawn, the physician’s office sends patient information to a text file in its IDX physician system. The script runs continuously Monday through Friday, from 8:00 a.m. through 6:00 p.m., automatically logging in and checking for new patient files to be registered. When it finds one, it automatically registers the patient into the hospital’s MEDITECH Magic system and produces an audit file detailing the number of records processed and any exceptions that were encountered. In addition, the script formats and sorts an Excel spreadsheet that details all of the actual data sent from the physician’s office. Both files are produced daily, are date stamped and the actual data is backed up. At the end of the day, a copy of the exception report and the Excel spreadsheet are e-mailed to a distribution list for review.
The Value of Automation
Automating specific tasks yields fast returns on investment. Reinventing whole processes, yields beneficial and predictable outcomes with payoffs that are both tangible and intangible. The mandate to make significant changes in hospital processes may come from one of the business drivers described above, but instituting those changes begins with a clear vision of corporate goals and buy-in from the administration and the business users. Ensuring that the
end product of process development lines up with the corporate
vision helps keep the process in focus and the staff fully committed
to its success.
When Credit Valley Hospital in Mississauga, Ontario moved to automate its registration process, they started at the top with the corporate vision and goals. They evaluated areas that would offer the greatest benefit and developed an Information Management Plan that focused on specific areas within the hospital that could benefit from process improvement. There were a number of reasons why Credit Valley chose to reinvent its registration process. With more than 40 registration areas (six areas off-site) and 163 registration users, it was difficult to monitor the accuracy or consistency of captured data. Inaccurate data capture
leads to lost revenue, incorrect patient demographics, inaccurate abstract data sent to the Canadian Institute for Health Information (providing part of the basis for hospital and facility planning and funding, disease surveillance, public health expenditures, physician
referral patterns and other community based services), incorrect contact information (needed for effective disease surveillance) and the inability to standardize for addresses, postal codes and residence codes.
Credit Valley’s IT department had two primary goals: standardize the way patients were registered and improve the quality of data being captured at the point of entry. This would create a proactive, rather than reactive, approach to information gathering. The hospital
began by working with the registration clerks to develop a Project Definition which identified all the fields on registration screens that were misused, misinterpreted or simply ignored. To enforce standardization, they established business rules which monitor users to ensure that no field is improperly filled or ignored. To ensure data quality and recover revenue, the hospital integrated an address validation product into the registration process, providing automated address look-ups. Since completing this project, Credit Valley has experienced an 80% drop in address inaccuracies that slow revenue recovery. They admit that any process enhancement, including this one, requires constant improvement and upgrades, but the financial and strategic rewards are well worth the work.
Developing On-Demand Processes
By closing the information gaps that exist throughout the hospital
environment, organizations reap fast financial rewards. Even the
automation of common manual tasks – such as re-keying data or downloading reports – allows for the reallocation of resources, substantial time savings and may save significant third-party vendor costs. Powerful task automation tools are available that allow hospitals to reinvent or realign processes on an as-needed basis to
develop the workflow that meets the expertise of their end users and supports their overall technology environment. Developing an environment for continuous, on-demand process innovation and workflow automation allows organizations to respond
not only to tactical needs, but also to strategic business requirements.
It bridges the information gaps in healthcare and lays the
foundation future technology demands.
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