Automated pathways: What you need to know
Use computers to combine clinical, financial data
The computer-phobic health care industry is due for a wake-up call, experts say. Although the coming technical revolution has been heralded for years, it seems that automation is finally beginning to win the battle against paper-based systems, with clinical pathway technology leading the way.
And there are good reasons why you should get on board the high-tech train early, says Karen Zander, RN, MS, CS, FAAN, principal and co-owner of the Center for Case Management in South Natick, MA.
First, computers help you structure information and decision-making processes and allow for concurrent data collection and easier variance analysis. "They make it a whole lot easier to cut out steps," Zander says. "And they allow pathways to have greater depth."
They can also help speed up discharge planning, notes Sue Sedaka, RN, a case manager at MedSmart International in Costa Mesa, CA. For example, "if you're trying to determine whether a patient should be discharged to home, to an extended care unit, or a long-term care facility, you need to determine quickly which of those environments has the modalities necessary to facilitate the process the patient needs," Sedaka says. "And you probably haven't got three or four days to do a paper search."
Another advantage of information technology is that it can be customized easily for different disciplines. For example, computerized pathways can be designed to display different sets of data to nurses, physicians, and physical therapists, Zander says. That's important because members of each discipline tend to have different ways of processing information.
"Physicians tend to think more in algorithm style," Zander says. "Physical therapists think in a more protocol/policy style, while nurses tend to think in a problem-solving style. Visually, if you got inside different disciplines' brains, they'd lay out their work in different ways. What a computer can do for paths is allow different disciplines that have different pieces of work to do to display that work in a way that reflects how they think."
Computerized pathways also allow for information to be layered, Zander says. "If it's a matter of whether to order one antibiotic or another, a path can't possibly tell you all those decisions. It would just say `consider antibiotics.' But the choice of which one and how could be given by clicking on a link to a separate window," she says.
Computerized pathways can provide separate screens of information regarding patient education, or how to deal with problems such as patient noncompliance, Zander notes. Pathways also could be programmed to call up trend information about recent patients placed on the pathway. "Those kinds of things could be so helpful, and they take a lot more than any paper pathway can handle right now," she says.
Automation also can allow case managers to get a better handle on costs per admission by combining clinical and financial data, says Kimberly Jungkind, RN, MPH, CCM, a case manager at Thomas Jefferson University Hospital in Philadelphia.
Unfortunately, few hospitals have systems capable of effectively combining such data. The reason, Sedaka says, is money. "It's all well and good to say that everybody should be on-line with a megasystem, but the bottom line is how much that costs. And there's no way in today's discount environment to pass on those costs directly."
The compromise most hospitals have reached is to try to hook case management into their current computerized billing systems. "It should be the other way around," Sedaka says. "You need a case management system that drives billing."
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