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As hospices and their colleagues in the post-acute segment of the health care continuum begin searching for information systems to handle the wealth of data they are required to collect, they will find that the technology has been slow to catch up to industry demands.
Specifically, current systems’ reporting capabilities fall short of providers’ needs, says William J. Gardner, information systems consultant with Lorenz & Associates in Baltimore. Sound reporting capabilities allow providers to determine internal benchmarks from which to base utilization and outcome goals. Those needs are highlighted by pending ORYX outcomes measurement and the implementation of cost reports.
"Capture the appropriate information up front so that you can report benchmarks," Gardner says. "Benchmarking will measure [the] internal progress — or lack of — you are making."
According to Gardner, information systems in this data-intensive era need to be able to link clinical and financial in order to generate reports about:
• Referrals. Providers should have a snapshot of where their referrals are coming from — by physician or discharge planner, for example. The more sophisticated the system, the greater the opportunity to drill into the data to report referrals from specific geographic areas, for instance.
• Admissions. Information systems should be able to generate reports based on admissions by payer, diagnosis, and ZIP code.
• Visits. Providers need to be able to track visits according discipline or cost center as required by the new cost report.
• Demographics. The ability to break down patient characteristics by age, sex, geography, and activities of daily living (ADL) can provide added insight into how these factors affect costs and utilization.
• Discharges. Tracking discharges and length of stay can enlighten providers about utilization and track cost trends by diagnosis, payer, referring physician, and geography.
An efficiency tool
But an information system that can do all of the above can cost organizations well above $100,000, not to mention the time required to train personnel on its use. Providers also should ask themselves whether the large cash outlay is the worth it; whether the system they are considering can perform up to expectations; and whether the proposed system fits in with the provider’s short-term and long-term goals.
For now, providers should focus on systems that will help streamline their organization as well as provide a slew of reports, Gardner says. Before taking the plunge and purchasing an expensive information system, providers need to evaluate their operation. These evaluation steps include:
• Examining the process involved in moving information through the organization. If you are a young organization, it’s likely that a majority of your information is manually moved through the company. Nurses, billing clerks, and administration all have a hand in putting various pieces of data on forms and patient records and moving them from one department to the next.
Providers need to have confidence that their existing process is solid or understand where weaknesses exist. The term "information system" doesn’t necessarily imply automation, either. An information system in smaller facilities might be made up of a number of manual processes and low-level automation. It is more important to look at how efficient those processes are, than measure by technology, says Gardner. Automation should serve as an aid to enhance efficiency.
"There are probably a lot of manual pieces to this process that will very possibly remain manual," Gardner says. "There is information and work flow that isn’t wrong just because it isn’t automated. You have to do a work flow analysis to understand what your process is. Fix what’s not right."
• Fix redundancies and inefficiencies. Among the things that are wrong with many providers’ information processes are the existence of redundant tasks that bog its ability to run efficiently. It’s very common to find at least two groups doing the same review of the same information, but for different purposes.
For example, a hospice nurse may review orders for frequency and duration of visits to ensure that clinical tasks are being done as planned. At the end of the month, the billing department reviews copies of physician orders to determine what should have been done and match them up to the visits made.
"It’s an example of the redundancies that are created," Gardner says. "There are two different groups looking at the same information and asking the same questions, except one is using it for billing purposes and the other is using it for clinical purposes. The answers are the same, but they don’t share."
Providers need to also look for information that isn’t moving or going where it is supposed to go. Identify the point in the process where information is slowed or fails to reach its destination. The problem can be solved by changing the manual process or implementing automation.
• Create efficiencies where the opportunities exist. As mentioned earlier, look first at process improvement as a means of creating efficiency. Then look at automation.
"I enjoy technology for the sake of technology," Gardner admits. "But that’s the wrong thing for providers to be doing. It does not make sense to automate everything. It makes very good sense to develop an information system plan and then a technology plan. While most things will eventually be automated, that doesn’t necessarily make sense to automate them right now."
• Create an information system plan that supports your business plan. With all the challenges facing providers these days, it’s likely that most have developed a business plan outlining short- and long-term goals. Information systems technology should help provide solutions to issues raised in the business plan, such as emerging managed care business.
For example, Medicare may represent 80% of a hospice’s revenue, with fundraising making up a majority of the difference. If the provider is planning an expansion of its managed care business or moving into other product lines, the new information system needs to address this aspects of the business as well.
"Its goal is to provide information systems solutions to business issues, Gardner says. "The business plan says where you’re going. The information system plan says how you are going to get there."
After an analysis of information processes, providers should have a clear idea of their information system needs. Now comes the task of weighing cost against the benefits of various information system options. What providers should be willing to pay for, according to Gardner, is good reporting capabilities.
Through accurate reports, providers can gain valuable insight into their utilization and costs and make adjustments to improve patient care and efficiency. "Vendors will tell you that they have custom report writers," Gardner says. "Some do and some don’t. It’s a matter of how well they work and what their capabilities are. The way I approach this issue is that there are two extremes. On one end, there are information system vendors that have integrated good report writing and querying into their system. On the other end, you have less expensive systems that require you to export the data from your existing information system to a desktop database system such as Microsoft Access."
Purchasing an information system is like any other investment. Providers should weigh the short- and long-term benefits. For example, there are some entry-level systems for $20,000. Based on a provider’s long-term plan, spending the least amount can be an expensive proposition three years later when increased patient volume renders the system obsolete. Perhaps spending less serves more immediate short-term goals and the less expensive system provides something to build on over the next few years.
"If you’re a small [hospice], you can get into some automation pretty reasonably," Gardner says. "But also, you’re still not so big that you can’t handle many of the processes manually on a stand-alone PC using a spreadsheet. That agency needs to look at where it intends to go. Is it going to be a bigger [hospice] in one or two years? If so, now is the time to act; you’d better automate."