Does IT promote Efficiency in Healthcare Facilities?

{The right technology, in the right facility, with the right people….}

This is part one of a two part series from Modern Healthcare Magazine’s May 26 article “Providers Turn to IT for Efficiency, but is it Working?” .  Though they start off discussing IT in laboratories, I believe we can take their words and apply it to any area/department of a healthcare facility.

“Indeed, technology plays a role in productivity across the board, and the healthcare industry is no exception. From faster laboratory results to real-time electronic information in emergency departments to online ‘dashboards’ that monitor performance metrics – providers have begun to embrace automated processes to improve their operations.”

Automated processes, along with point-of-care electronic systems can greatly increase operational efficiency. The keys to success (in my opinion) are: (1) a great implementation, which leads to great adoption and (2) an already well-run facility that’s ready for such an IT implementation.

Despite the boost in efficiency that IT can bring to a facility, there are usually some major hurdles to overcome.

“Still, there are significant challenges to adopting various technologies. Critics of electronic health records have said that the technology can be confusing and hard to implement, and it winds up disrupting work and limiting productivity.”

That is a very valid point. Technology can be confusing and often disrupting. And yes, if it’s not implemented right, it could perhaps limit productivity. That’s why you must have the right technology, implemented at the right facility, with the right people who are ready for such a change. Technology implementations will always bring about change. Naturally, we as humans are often resistant to change, especially when we what we’re doing now “works”. But bottom lines aren’t maximally impacted by what “works”. Patient care isn’t improved by simply what “works.” If you want to be competitive in this day and age, you better get ahead of the curve. Your facility better be ready for change, constant change.

Physician Documentation and Coding: Are Doctors Prepared?

This abstract from the American Journal of Surgery entitled “Surgical residents’ knowledge of documentation and coding for professional services: an opportunity for a focused educational offering” hints at the fact that most physicians are not properly prepared for coding and documentation in the real world of medicine.

We all understand that patient care is the most important aspect of practicing medicine. In Med School, physicians are trained to take care of patients. Many even specialize in a certain area of medicine and take care of certain kinds of sick people.But what about documentation and coding? Why aren’t physicians trained on how to best document what they did on patients? Isn’t good documentation important to continuity of patient care? Isn’t this how they are to defend themselves in a (heaven forbid) medical malpractice case? Isn’t this how they get paid? If physicians don’t know how to document, they’re losing….and its more than just dollars and cents. They’re honestly robbing themselves of being a “Best Pracitces” physician within the healthcare industry. So….WHY is this not taught to physicians in their formal education?

“The purpose of this study was to survey surgical residents and attending for their knowledge of documentation and coding and their opinions about its importance in their training and practice.”

The convenience sample: 60 surgical residents and 46 attendings from 5 surgical residency training programs

“Similar portions of residents and attendings, 82% and 89%, respectively, stated they had not received adequate training in DCPS (documentation and coding for physician services). The vast majority of residents (85%) felt they were novices at coding and billing, whereas 61% of attending stated that they were somewhat knowledgeable.”

So 82-89% of residents and attending do not feel adequately trained in DCPS. So how will they learn? Think about it…CMS, Joint Commission and all the other players have so many rules and regulations that doctors must play by; but the docs are never taught the rules in the first place. It seems that docs have to (a) learn the hard way by making costly mistakes (b) take initiative towards independent training or (c) continue to be losers in the area of documentation and coding.

Operating Efficiently

This short article brings to light the lack of lack of intra-operative IT system implementations in the U.S., along with the hope for “an uptick in adoption of health information technology under the twin prods of a falter economy and IT funding courtesy of the economic stimulus package.” With intra-operative being the least penetrated of the four areas of the OR market, it could potentially hold the greatest amount of opportunity. And with the stimulus package funding, the area with the most opportunity could be the greatest beneficiary of the funding. Here’s a little proof on how much the OR impacts a hospital’s bottom line: “The reality is the OR is the cash-flow engine of the hospital” says Kermit Randa, senior vice president of sales and marketing for Surgical Information Systems. “A hospital generates on average 65% of their margins from the operating room. According to the Joint Commission, 55% of the infections happen in the OR and well over one-third of the supply costs happen in the OR. You show me a poorly performing OR and I’ll show you a poorly performing hospital.”

Efficiency, Comprehensiveness and Cost-effectiveness when comparing Dictation and Electronic Templates for Operative Reports

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1560865

Here’s a great article comparing dictation to electronic templates. The results are pretty amazing. Looking at the time, efficiency, comprehensiveness and cost-effectiveness of the two could turn some heads towards electronic templates.

The study was done in Wishard Memorial Hospital’s (Indianapolis, IN) OB-GYN Department. During the four four-week study blocks, they performed 478 procedures on 440 patients corresponding to 5 selected study procedures. They evaluated the effects of templates on timeliness of completion, comprehensiveness and costs, and effort required vs. standard dictation. 

Most in the healthcare industry would agree that: “Dictated reports are frequently incomplete or delayed.” However, it could take some results like the ones in this article to show that: “Electronic note templates could potentially improve this process.”

“Templates resulted in dramatically faster times to the presence of a verified operative report in the medical record compared to dictation services (mean 28 v. 22,440 minutes). Templates increased overall compliance with national standards for operative note documentation and avoided transcription costs. Documentation with templates took slightly more time than dictation (mean 6.77 v. 5.96 minutes; P=0.036), not including the additional time necessary to subsequently verify dictated reports. We conclude that electronic note templates can improve the timeliness and comprehensiveness and operative documentation while decreasing transcription costs and requiring minimal additional effort on the part of the surgeons.”

Do You Equip Your Physicians with the Proper Tools?

“Hospitals across the country lose multiple millions of dollars every year due to mismanagement of the billing process. No matter the size of the organization, billing inconsistencies affect all healthcare facilities to some degree—even those that are on top of the problem. On average, providers lose 5 percent of gross revenues, and that can translate into millions of dollars for a single organization.”

“Improving Cash Flow with Better Charge Capture & Denial Management” MedAssets & HFMA. October 2005

As we all know, profit margins are tightly squeezed in the healthcare industry. The billing process has a huge impact on those profit margins. What do facilities bill for? Patient encounters. How do they know what to bill for? Through physician documentation. How will these patient encounters be properly documented? There… you’re stumped. It’s not through dictation after the fact, and it’s not on their 3×5 index card they carry around in their pockets.