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Readers Write 12/29/10

December 29, 2010 Readers Write 13 Comments

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

12-29-2010 7-31-46 PM

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.

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Currently there are "13 comments" on this Article:

  1. And I thought that the use of EMRs was necessary in order to get to the point where there can be “a letter or number score of how well they adhere to quality measures, as measured by a totally independent and fear-inspiring government bureaucracy”.

  2. Well done. I always find it amazing to consider that the EMR stimulus money actually slowed EMR adoption in the short term. We’ll see the long term affects of it. Certainly interest is up, but will that translate into action? I think the first wave of EMR adopters will determine the future of EMR adoption. If it goes well, many more will follow. If they adopt EMR software that makes their life miserable in the name of government incentives, then the EMR won’t have stimulated anything and will actually set back EMR adoption.

  3. Is HITECH a euphamism, and are EMR incentive payments simply throwing doctors a few bones so that they will practice and live their lives the way the government wants them to? Not to pick on healthcare, feel free to apply this march towards government control on any industry. Computerization to achieve productivity and better patient care is fine, but doing this correctly should not have a timeframe placed on it. Let the private sector figure it out.

  4. RE: 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

    You hit the nail on the head…80% of healthcare costs are spent in the last 20% of a life. We live in a country that is founded upon the principle of ‘life, liberty, and the pursuit of happiness”. Wonderful ideals.

    What is not addressed (understandably) in the Bill of Rights is: how much/ how good a life. That leaves us with a big problem to solve. In other societies where you are not ‘guaranteed life’, rationing, euthanasia, and other approaches are accepted.

    What people do not realize is the cost of healthcare in these United Sates is a primarily a societle problem, not a cost or efficiency problem (although they do contribute). To ‘fix it’ someone needs to be willing to answer the core question – what price life? I am afraid it won’t happen in my, or my children’s life time.

  5. I totally relate to the dried up wiindiw washing gear and bugs all over the windshield. Its kind of like the user interface on emrs- you never know whwre the next bug will hit. Still the idea Beth raises on duplicate records is interesting too. Normalization is the buzz word for that. Buzz and bug kind of go together too. I just wish for more opportunities to find contiguiyy by making wonderful free associations like this a reality – only this is possible with Mr. Histalk.

  6. My hubby owns c-stores and an oil company. With all the enviornmental regulations, theft and underground storage tank liability, that industry makes healthcare appear to be an utopia. When gas is purchased and placed at a c-store, the money for that load of gas has been electronically paid to the major oil company before the tanker pulls out of the terminal along with all state and federal taxes on that load. Average profit on a gallon of gasoline to a store owner is less than a penny in the Southeast. So if you drive off, everyone has been paid already but the store owner and the help. And hooray for a severe consequence for a bad behavior- maybe we need more of that.

  7. @Mr. HIStalk – I think I’m in love! Thanks for putting it bluntly and in terms even a nimrod could understand – most all of us do, after all, pay for gas! You might consider taking your analogy a bit further and associating the gas tax to what Uncle Sam gets when we fail to achieve MU—or how the requirements are going to change and become a greater burden over time. Once Uncle Sam gets his hands on something, he doesn’t let go—he only wants more! Really, when has incentivizing not created a false market? Anyone seen the GM vs. Ford numbers lately? Also, I have a house for sale, but we’re done giving loans to people who can’t pay…too bad.

    @HISJunkie – Great statistic to support Rambling Man’s point. It might seem insensitive, but while we don’t need to force death via euthanasia, rationing, population control, etc., we could stop fighting it so much!

  8. HISJunkie – RE: 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.
    *I have a hard time believing fear of death is the prime motivation for health expenditures. I might believe the desire to be free of pain, or the desire to not be separated from a loved one for the rest of life, etc. Also, quality of life

    We live in a country that is founded upon the principle of ‘life, liberty, and the pursuit of happiness”. Wonderful ideals.
    *The point of the Declaration of Independence (not Bill of Rights) for ‘…life, liberty, and the pursuit of happiness’ is not that they are wonderful ideals, but are God given rights that a gov’t may not mess with, and to the degree that we diminish our view of that we move closer to becoming a society traveling along the same path as so many others before us that counted life as less than God given. The societal problems from this issue will rage with a vengeance if we ever collectively and legally decide to remove those rights.

    ”What price life?” I am afraid it won’t happen in my, or my children’s life time.
    *Be thankful. I doubt you would like the result of society or gov’t placing a price on life.

  9. JustMe, you have a right to life, not health. And you certainly don’t have a right to cheap or free health. As with all things, you get what you pay for. As we try to find ways to live longer and healthier lives, we can’t expect that to happen without some financial cost. Ironically, too many people, unfortunately, get caught up in the pursuit of happiness and right to liberty part of that and abuse their bodies, which sort of limits the health and lifespan of those same people.

  10. Interesting points, but I think there is an interesting counter argument that full disclosure is only possible with an EHR. Though I admit this is probably more of a theoretical argument than one that is born out in practice, I’ve seen again and again the hopelessness of ever really understanding any of the data without an army of auditors which would be a horrible burden on the business. Unless we have standardized data collection and analysis how is a consumer supposed to know that a given practice is good or not? Of course I know EHRs don’t guarantee easier collection of this data… but it sure seems like they should.

  11. Anonymous – I don’t disagree with you on any of that. I think my reaction was spurred by what I read (maybe accurately, maybe not) as HISJunkie’s tendency to favor other countries’ positions on the sanctity (or lack of) of life. “That leaves us with a big problem to solve. In other societies where you are not ‘guaranteed life’, rationing, euthanasia, and other approaches are accepted.” We may actually be talking apples and oranges since the constitutional reference is really talking about gov’t responsibility to protect the freedom to live life without hindrance from anyone, especially gov’t.

  12. Most of the patients with whom I speak seem to just want their doctors to work together: share information about their care, (God forbid) coordinate treatment plans to not duplicate paperwork, tests, drugs, etc. and to be able to communicate with their doctors.

    This is all, of course, possible without health IT. Maybe I shouldn’t be, but I’m astounded when practices in the same office complex fail to communicate in the most basic ways. They might as well be on different sides of the planet vs. 40 feet as the crow flies from each other.

    Not that most of what’s being required in stage 1 of MU does little to support these activities, but gaining many of the benefits that patients envision that they want from health IT would be possible if docs and other clinicians would coordinate care and work together better…without health IT.

  13. I thought Rambling Man was on point right up until that last sentence: “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.” Life can and should be wonderful, exciting, and rewarding, but to view death as a beginning rather than an end is a fantasy. If it makes it easier for people to face death by hoping that there’s a god calling for them then fine, but to say that each of us *need* to face death with faith is shortsighted. Do dogs need faith as well? Do birds get to go to heaven? Do fish get another chapter too? How about insects? Is god definitely a white man in flowing robes or could god maybe be a small Asian woman? We know so much about the universe that humans couldn’t have dreamed of when storytellers penned the chapters of the bible. I absolutely need my friends, family, and community to face death, but why on Earth would we believe that another “chapter” awaits us.

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