The Center for Democracy and Technology, a Washington, DC-based digital rights and privacy group, has taken over the Health Privacy Project. The merged organization will expand work on several lingering patient privacy issues, such as the role of patient consent for information use, enforcement for privacy lapses and the rights of patients to access their data. Privacy needs to be a higher priority as the U.S. government and other groups push for adoption of health IT, said CDT representatives.
Looking back on the massive HIMSS exhibition, I am struck by the enormity of change under way in the industry. I had multiple encounters with CIOs describing how their health systems are undertaking ambitious projects. These are invariably wrapped in a patient safety initiative, one that is being driven by the clinical staff, not the CIO. Following are a few highlights of the people I met in Orlando.
Deborah Gash, the CIO at St. Luke's Health System in Kansas City, told me how her hospital is really promoting patient connectivity. They're using Relay Health (now owned by McKesson) to facilitate online bill payment and clinical messaging. St. Luke's has some 4,300 patients enrolled thus far, all at the behest of physicians. Patients can see their lab results and medical records through a secure connection. St. Luke's has the potential to offer "e-visits" as well, although few physicians are taking advantage of it to date. Only recently have payers begun to ante up for the service.
Michael Krouse, CIO at Columbus-based OhioHealth, is leading the charge at the 16-hospital system for increased patient safety. Speaking at a McKesson press event, Krouse described how OhioHealth is deploying "closed loop" medication management technology. The goal is to automate the entire medication administration chain, from the initial order to dispensation on the floor. OhioHealth recently opened a new "digital hospital," Dublin Methodist, in which no paper charts are to be found.
Michael Kramer, MD, serves at CMIO at Michigan-based Trinity Health. Trinity has one of the industry's largest IT overhauls under way, as it is standardizing on Cerner clinical documentation tools across 31 hospitals. According to Kramer, Trinity has completed the staged deployment at 11 hospitals thus far, and is on track to have 11 more complete by the end of this year. It's a big undertaking with big numbers: Trinity has compiled some 3,600 order sets to date. It's also seeing reduced malpractice pay-outs at its automated facilities.
Melissa Foster, RN, is manager of nursing informatics at Homestead (FL) Hospital, where she is overseeing a project to capture documentation from fetal surveillance monitors directly into an electronic chart, from CliniComp. The setup enables centralized monitoring of up to 13 patient beds at once. Homestead has 11 nursing informatics specialists, says Foster, who reports to the chief nursing officer.
Jamie Welch is CIO of the Rural Hospital Coalition, based in Pride, LA. The coalition is supporting a state-wide data exchange that includes 24 rural hospitals. Funded by an $11 million state grant, the RHIO is just getting off the ground. I asked Welch about the exchange's odds for long-term survival, and she conceded that it may take five years to answer that question.
During a medical emergency--or even during the most planned courses of treatment--there always exists the chance for unexpected procedures, complications and longer-than-anticipated hospital stays. When a patient is finally released from care, the recovery process can cause both physical and emotional stress. All too often, this stress is multiplied for patients and their families when insurance companies deny coverage for the patient's treatment or days spent in the hospital.
Stifling hospital bills that are not covered by insurance can quickly devastate a family's financial security. As a result, patients are unable to cover their bills, thus affecting the financial status of the hospital that provided the treatment.
A few years ago, West Virginia University (WVU) Hospitals administration realized the need to revitalize operational procedures, in order to reduce patient length of stay and improve the quality of care delivered. Reducing denied coverage, improving coordination of care and improving the bottom line became the goals.
Finding the right solution was a daunting task for our large health system, which is based in Morgantown, West Virginia. WVU has an annual inpatient discharge rate of more than 22,000 patients per month. WVU Hospitals had quite a list of operational goals --streamlining and coordinating the utilization of services, improving case and discharge management processes, as well as incorporating a new, coordinated denial management practice with financial services.
A team consisting of senior management, physicians and care management professionals researched numerous companies within the industry to find technology that would most effectively manage patient throughput. Recognizing the burden denials management created for case managers and other hospital staff, as well as the trend towards paperless, wireless solutions, WVU Hospitals decided to look to a case management system to streamline operations and organize an effective appeals process. After extensive research into various case management options, WVU Hospitals decided to implement Allscripts' Case Management system in 2001.
Reducing denials by reducing length of stay Implementation of a case management system greatly affected the denials management process at WVU Hospitals by decreasing the patient's length of stay. Before the implementation of the case management system, a patient's medical team would depend on the bedside nurse to keep everyone updated on patient needs, plan of care and discharge status.
But now, the case management system streamlines communications so that all members of a patient's care team--doctors, nurses, social workers and case managers--are up-to-date on a patient's progress and anticipated discharge. In fact, the case management system keeps the team informed of the exact barriers keeping the patient from safely returning home, such as missing lab results, consultations, and family needs. Today, case managers can more efficiently and effectively orchestrate a patient's discharge with the help of this system.
In retrospect, case managers use the reporting capabilities of the system to produce concurrent medical service line reports for the medical services lines and senior management team evaluating length of stay compared to their benchmarks and analyzing avoidable day reports. As a result of this implementation, WVU Hospitals were able to reduce their actual length of stay by a half day in the first 12 months.
By 2003, WVU Hospitals were performing well below our average length of stay goal of 5.5 days. In addition, WVU Hospitals reduced length of stay and patient days for high-risk, complex patients who stay in the hospital for over 15 days.
Alerts, reports and appeals--fighting denied days After implementation of the case management system, managing the process of preventing and appealing insurance company payment denials also improved. Before automation, utilization review nurses spent a large portion of their work week filling out endless paper work, searching for proper coding, and awaiting signatures from doctors in order to start the process of appealing a denied claim. Now, the process is proactive and seamless. While the patient is still in the hospital, the payer specialist sends a review to the insurance company--communication that documents the patient's acuity level according to established criteria.
Establishing how sick the patient is allows for the payer to authorize treatment and prevents them from claiming at a later date that the care was not necessary. Automation also allows more proactive census management as we know with more precision how many in-patient days authorized by payer--called "certified days"--we have in the system.
Proper coding is available to the specialists directly on the workstations, cutting back on small errors that can make a big difference. If a denial is reported to the facility after filing with the insurance company, the payer specialist can document the denial and alert the appeal coordinator to initiate the appeal process. This process happens while the patient is still in the hospital, and continues after discharge, as needed.
The reporting capabilities of the system keep all members of the team up to date on the specific needs of the denials management team from the initial threat of denied coverage, and through the entire appeals process. For example, an e-mail is sent to all members of a patient's care team, as well as various members of the hospital administration, to inform the team the patient's insurance has threatened a denied day.
In addition, the reports are used to track for trends and assist with workflow prioritization--a process which includes physician reporting, tracking and logging necessary documentation, and preparing for necessary hearings. Although this can be a complex process, the capabilities of the case management system have made the denials process at WVU Hospitals more efficient and has yielded positive results for both patients and the hospital.
Looking ahead Due to the reduction in patient length of stay and increased effectiveness in denials management, WVU Hospitals have greatly improved operational efficiencies and financial security. The hospital has noticed greater success rates in winning denied day appeals. This success rate has made a significant fiscal contribution. By reducing excess days by about 400 per month and improving the facility wide appeals process, WVU Hospitals have been able to add an estimated $140,000 per month and $1.5 million per year to the hospital's bottom line.
With the comforts of a more controllable denials management process and a stronger bottom line, WVU Hospitals are prepared to continue their standard of excellence in patient safety, as well as look towards a future of steady growth. And most importantly, patients and their families can return home to continue recovery with the confidence in the organized, highly successful denials management system and care team working to protect them.
Online personal health records began as password-protected templates for storing basic medical information, accessible from any computer connected to the Web. Many PHRs now automatically link to hospital Web sites; some upload data from medical devices; and others allow doctors to access your medical history even if you're unconscious and far from home. Internet giants Microsoft and Google have now upped the ante, developing sites that combine PHRs with search engines and other services.
ProMedica Health System, an Ohio-based 10 hospital network, has signed with McKesson for an array of clinical software, pharmacy automation and medication distribution services. ProMedica hopes to enhance patient safety and help improve operational efficiencies and reduce healthcare costs.
"This initiative is being driven first by patient safety and quality of service," said Michael Ruhlen, M.D., vice president, medical informatics at ProMedica.
Bottomline Technologies, a vendor of document imaging and management software, has signed an agreement to buy Optio Software Inc. for $44.9 million. Alpharetta, GA-based Optio has a special focus on healthcare, where it has more than 700 organizations using its technologies.