Readers Write 12/29/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The Role of Automation in Reconciling Patient Records
By Beth Just

Duplicate patient records have long been a serious problem for hospitals, creating the potential for missing or inaccurate patient information that can lead to life-threatening care situations. They are also a substantial drain on financial, health information management (HIM), and IT resources.

Industry estimates are that 3-15 percent of patient records at a typical hospital are duplicates. That number skyrockets to 30 percent or higher for facilities that have been acquired or merged or are part of an integrated network. Exacerbating the sense of urgency surrounding the elimination of duplicates is the impact they can have on a hospital’s ability to qualify for incentive payments under HITECH. In particular, duplicates artificially inflate the number of unique patient records, which are the basis for several Stage One criteria.

That is why eliminating existing duplicates and preventing the creation of new ones must be an integral part of any facility’s data management strategy. In addition to easing the burden of achieving Meaningful Use, doing so also eliminates significant cost drain. One three-hospital system determined that the duplicate volume for its health system was more than 17,000 records.

The estimated annual cost of those duplicates? Anywhere from $554,000 to more than $1.2 million for repeated tests and treatment delays, as well as incremental costs related to longer registration times and correcting duplicate records.

The challenge is that reconciling and eliminating duplicates is a cumbersome, manual process that requires staffing resources most hospitals cannot spare. What’s more, these processes do nothing to prevent future issues.

Traditionally, the reconciliation process is executed entirely on paper. Potential duplicate records are identified as patient charts are pulled. They are then assigned to the HIM staff, which must analyze previous charts and other information to verify whether they are actual duplicates before they can be eliminated.

Even if a hospital’s information system provides reports of duplicate records, the data they contain typically is limited to key identifiers, such as name and date of birth. More research is generally required once potential duplicates are identified.

Progress on reconciliations is also typically tracked on paper, leaving room for error and duplication of work.

By automating portions of the reconciliation workflow, hospitals are able to quickly and efficiently weed out existing duplicates and prevent new ones. By allowing multiple duplicates to be reviewed in a single view, automated processes also heighten user control over the merge process, lessen the time required to complete the process and enable more effective quality assurance before records are merged. High-level process will also support merging records in downstream systems while reducing manual steps and associated costs.

Automation can also reduce the time and resources required for reconciliation. The best systems will also automatically document decision validity, track productivity and generate comprehensive, user-friendly reports that provide a complete view of efforts and insights into problem origination points.

After six months of manually analyzing duplicates records, the previously mentioned hospital system chose to leverage the efficiencies of an automated reconciliation process to eliminate duplicates prior to its transition to a new clinical information system. Today, it relies on the software to maintain clean, high-quality patient records. The automated solution resolves upwards of 500 duplicate records monthly at each of its three hospitals – and it does so with fewer resources than had previously been dedicated to the process.

Beth Just is CEO and president of Just Associates.

How Healthcare Is Different
By Rambling Man

Healthcare is unlike any other industry for a ton of reasons, a few I found the time to ruminate upon this morning.

What industry does not know its costs? There are examples of providers performing this analysis, but most community hospitals, ambulatory care centers, and primary physician offices operate from ignorance of this information. How can providers negotiate payer contracts without this knowledge?  This information will become increasingly important as the industry evolves from traditional payment models with ones based on quality of care and outcomes. This begs the question: how will we measure quality care and outcomes? The answer will inevitably involve more consumer involvement.  

How will the industry respond to the increasing demands upon the primary physician? Today’s reimbursement models force physicians to fit more patients into their daily routine, while still making the same amount of income. This model will eventually change the face of healthcare, and perhaps for the better. Demands on physicians to stay current with new clinical data, juggle a schedule of seeing 36 patients a day, and “practicing the art” seems super-human and may be outdated. 

These demands, combined with an alarming decrease in physician ranks, will create a new layer between the patient and the science. This new layer may be satisfied with Nurse Practitioners or Physician Assistants, or a skill-set not yet defined that focuses on data gathering and psychological insight.

How can patients do to better the system? Medicine addresses our physical vulnerability and fear of death, which are the darkest of human emotions. Physicians must have a serious sensitivity towards the emotional needs of patients, and one could argue society’s reaction towards death has worsened in the last fifty years. 

For many, years of pain or confinement to bed are better alternatives to accepting the inevitable. We expect our physicians to be the best scientist and psychologist all wrapped up into one package, but how have we changed as consumers? We need to bear a larger portion in the direction of medical care, and the systems that provide medical information to the consumers must be simplified for all. Health data banks, where consumers store health information and pay for data analysis, will emerge and become the centers of our data. 

And finally, and arguably more difficult, is that we require a change in attitude regarding death. Fear of death is the motivation behind the largest portion of healthcare expenditures. Has our consumer psychology foregone quality of life in favor of quantity? Changing these attitudes will not happen overnight and will not be easy.  Each of us facing our ultimate demise need to do so with dignity and faith that death is a beginning to a larger chapter in our existence.

As I Stand With Nozzle In Hand
By Mr. HIStalk

Pumping gas is boring. There’s nothing you can except fidget and enjoy the fumes (which I do). The high point for me is spotting a squeegee in a nicely full container so I can at least pretend that my windshield is dirty and entertain myself for a few seconds by cleaning it (or curse the lazy clerks who’ve left the squeegee in a desert-dry container because they just don’t care).

Sometimes I read the stickers on the pump, like the last inspection date or how to find the emergency shut-off valve (daydreaming of heroically saving an entire neighborhood by stopping a spreading ocean of flame as I sprint confidently to shut down the pumps like John Wayne in Hellfighters). While scanning for those exciting tidbits the other day when I was in another state, a sticker on the pump caught my attention. Under a picture of a scowling, R. Lee Ermey-lookalike state trooper, it said Drive Off, Lose Your License.

I marveled at the political clout of the gas station owners. Shoplifting, walking out on a restaurant tab, or any kind of petty theft are all subject to a ponderous legal system with generally light penalties for first-time offenders. The punishment, if it ever comes, is generic and disjointed from the crime. But somehow the gas guys used their political grease to get politicians to approve a very specific (and severe) penalty for a specific type of theft affecting only them.

Obviously the R. Lee sticker was designed to get your attention. The Lose Your License part is a lot more dramatic than, Drive Off, You Will Probably Not Be Arrested and At Worst Will Get a Slap On the Wrist Months From Now Even If You Are Arrested, and That’s Assuming the Unmotivated Dry-Squeegee Clerk Cares Enough to Chase You Down the Street To Get Your License Number.

I was appalled. What does skipping out on a gas station tab have to do with the privilege of driving? That makes about as much sense as … uh oh … penalizing doctors for not using electronic medical records.

Gas stations could have eliminated their problem without judicial favoritism by simply requiring cash customers (are there really any left?) to pay before pumping. Just like EMR vendors could have boosted use of their products beyond the pathetically tiny percentage of busy, pre-HITECH doctors willing to use them by making them easier to use and designing them to increase doctor efficiency rather than accumulating interesting but not always clinically helpful data for insurance companies and the increasingly intrusive Uncle Sam to poke around in to find reasons not to pay for services already rendered.

Even though I’d paid at the pump, I decided to go into the C-store for a soda and some nutritionally devastating snacks (anybody for an jelly orange slice or a pack of those mini-donuts slathered with coconut gunk?) On the wall beside the “deli” (where the commissary-made sandwiches encased in their nitrogen-filled coffins are moved from totes to the refrigerator in a form of “cooking”) was the C-store’s health inspection sign.

I read those. If I’m going to a strange restaurant (especially if it’s Asian or Mexican), I’m going to seek it out right away to make sure the cooks at least occasionally wash their hands and don’t store the goat carcass designated for employee lunches in the same refrigerator as the desserts, at least during the inspector’s surprise visit. (As a second-level review, I always check out the customer restrooms since whatever disgusting state those are in is ten times cleaner than the areas customers can’t see, like the kitchen).

I want to see those health inspection signs on hospital and practice doors. Give me a letter or number score of how well they adhere to quality measures, as measured by a totally independent and fear-inspiring government bureaucracy (not the chummy Joint Commission, which has given hospitals glowing scores right before the state inspectors came down on them like the wrath of God for running shockingly lax operations). I would turn tail just as quickly from an impressively ornate medical provider’s facility with a C-minus score as I would from a $5.39 all-day Chinese buffet restaurant that doesn’t even own a trash can (but with illegal immigrant employees who probably wash their hands more than the average doc even though they’re deboning chicken thighs instead of probing people).

So thumbs-down for making up new penalties to encourage whatever behaviors the politicians and those who influence them have decided are desirable. Thumbs-up for letting businesses run their own affairs, but with mandatory full disclosure to their customers. Let the market decide whether and EMR-wielding C-minus practice is preferable to an A-grade practice using an IBM Selectric and one of those, “Sara, this is Sheriff Taylor” telephones that look like the far end of a clarinet.

But in the mean time, I’m thinking about applying a for a few paltry million of the HITECH bonanza to create an EMR awareness program for the paper-clinging providers. I’m calling up R. Lee Ermey, posing him in a government-looking suit and power tie, and putting him on stickers for manila folders that read Write Order? Lose Income.