Start thinking of linking your APGs to other systems
Integrating could add value to your grouper
(Editor’s note: This is the second part of a two-part series on ambulatory patient group technology. Part one, in last month’s issue, explored the current software market. In this issue, Outpatient Reimbursemement Management looks at how the grouper fits into a facility’s existing information system.)
When the Health Care Financing Administra- tion (HCFA) in Baltimore finally imposes prospective payment on outpatient services, ambulatory patient group (APG) technology will mushroom. There will be almost no end to the possibilities for integrating the software, experts say.
But most health information managers will have to wait until that happens. HCFA officials estimate APGs will likely be imposed on freestanding centers in early 1998. According to some estimates, prospective payment won’t hit ambulatory care on a national level until at least later this year, perhaps the next.
In the meantime, plugging in the essential grouper to work seamlessly with your facility’s host system requires a series of steps. Start by asking yourself these questions:
1. Why would we want to connect the two?
"The goal is to get one black box [the grouper] to speak to another black box, your facility’s mainframe," says Bradley A. Sweet, director of product development at IRP Systems, a software vendor in Wilmington, MA.
This way, everyone at your hospital or ambulatory care center can share APG data and freely integrate the information with other databases throughout the system. By itself, the APG software can only talk to the limited number of users linked to the software’s own internal database.
2. What if we don’t integrate the software?
Unless you can successfully bridge the two systems, you can’t do much more than process claims for payments, says James Ziegler, software engineer with Codemaster Cascade, an APG product vendor in Santa Cruz, CA.
For now, you may be content with simply grouping the CPT-4 and ICD-9-CM codes with their appropriate APGs, then packaging and consolidating them for payment. But what if your administrator wants to combine six months of past APG data with financial figures for every clinical department in tracking utilization?
Without a way to interface the two systems, you would have to pull the data from each source manually and perform the calculations using yet a third data management software, Ziegler says.
3. Can our present information company integrate the grouper?
A few large information vendors such as Shared Medical Systems in Malvern, PA, or Medicus Systems Corp. in Evanston, IL, are packing licensed APG software into their mainframe programs.
But managers who go this route may have to reinvest heavily to get a fully integrated system, in effect replacing what they may already have in use. "The issue boils down to would you rather get your car’s air conditioning installed for you or replace the whole car later at a higher price?" Sweet says.
After answering these initial questions, interview potential APG product vendors, and ask them the following questions (vendors’ answers will suggest facts about the strength of their technical support program):
• What are the basics behind linking the grouper to the host system?
In most cases, plugging your APG program into your host system will require additional steps beyond the grouper installation. APG vendors will charge extra for the service. Costs vary with each company and the extent of the work.
The link-up usually requires an "interfacing software," which bridges the grouper to the facility’s host computers. The service becomes cheaper if the product vendor has previously collaborated with the mainframe company, Sweet says.
IRP, for example, has an inventory of about 40 custom-designed interfacing software programs that fit several large mainframe information companies. Basically, the interfacing programs enable the systems to extract data from one source in a format that can be read by the other and to store the data in a repository that can easily be accessed and read again by both.
• Can a simple PC version integrate with a host system just as well?
A major issue with PC systems is available memory. For optimum performance, a system needs a minimum of 560K at the DOS prompt, Sweet says. Some PC versions of the grouper can serve as a limited substitute for a facilitywide client-server. Codemaster Cascade’s grouper, for example, has a built-in database that self-installs with the product.
Users can freely access the database from any PC workstation, but the repository can’t talk directly to an outside database that serves the entire facility. Internally, however, users can do virtually anything with the information and import the data back to its source in a single-record text file.
The company plans to release a version of the grouper later this year that lets departments such as lab or surgery to separately import and export batched data into the APG repository simultaneously.
• What if our hospital has an internally designed information network?
Ask the vendor about a development kit for home-grown systems. Some firms can custom-integrate the software provided the basic operating system is sufficiently common or well-known and adaptable to particular applications.
For example, the IBM AS/400 operating system is extremely adaptable to reconfiguration, according to Sweet. Determine whether the system adheres to national computer protocols, which can also simplify integration. The leading standard is called Health Level-7, which was developed by the American National Standards Institute in Washington, DC.
• How well can the grouper interact with other programs?
With a fully integrated system, managers can easily batch APG data from medical records, billing, and other sources to distinguish, for example, high-volume, low-value claims from low-volume, high-value ones. An integrated system can speedily sort claims by these categories and separate data by other parameters such as significant procedures.
The grouper and other data management programs should fit as one into the facility’s main system. But "decide first how your department plans to use the information," says Dave Fee, product marketing manager with 3M Health Information Systems in Murray, UT. You may not need to pay extra for unnecessary performance functions.
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