Don't make a costly software mistake
Institute finds value in cheaper version
Imagine having outcomes reports available at the touch of your fingertips. You tap on the computer keyboard, and in minutes, your printer spits out a multicolor graph analyzing the impact of different therapies or medications.
That was the vision of Colorado Neurological Institute (CNI) in Englewood, CO, when outcomes managers began working with a software development company on a customized product. One year, seven versions, and $10,000 later, the institute ditched the project and returned to the more pedestrian, pre-packaged Paradox software, a database program that can be modified to provide outcomes analysis.
As medical groups delve more deeply into clinical outcomes, CNI offers a cautionary tale with a sobering conclusion: "You don't necessarily get more for your money," says Kristen Mahan-Moutaw, manager of clinical outcomes. Going for the more complex solution to software needs can backfire.
CNI, a nonprofit membership society that provides educational seminars and lectures, a journal, medical outreach, clinical research, and outcomes management for neurology specialists, launched its outcomes initiative in 1994. In addition to tracking disease-specific clinical variables, the institute collects information on charges, patient demographics, quality of life, patient satisfaction, and referring physician satisfaction.
The institute's outcomes management team, which includes computer specialists, began with home-grown data collection forms and Paradox software. (A number of other standard database programs, such as Access by Microsoft and Fox Pro, work in a similar manner as Paradox. All are available in most computer stores.)
The outcomes program produced results that could be used to improve patient care and present talks or papers at professional conferences. But it took as much as an hour or two to produce the Paradox reports, and they were just basic charts. As outcomes moved from the realm of academic research to the marketplace of payers and purchasers, physicians wanted something a little more glossy and easy to read.
None of the existing medical outcomes software fit the needs of the institute, which includes subspecialties in the field of neurology. So customized software seemed to be the answer. The software company, which Mahan-Moutaw declined to name, promised time-saving features and picture-perfect reports. "It was all so lovely," she recalls. "But in the end, it was a headache."
Initially, the software programmers provided valuable education to the institute's outcomes staff. For example, they taught the outcomes staff how to design usable data collection and follow-up protocols.
"The software company and its programmers limited us in various ways as to fields and records and variable length," Mahan-Mouhaw says. "In this part of development, they were more helpful than harmful, teaching us essentially how to put together patient databases that are useful."
As the project progressed through various beta or testing versions, the outcomes managers became concerned about limits on the size and number of possible variables, as well as the flexibility of the system to add new variables, such as medications, devices, procedures, or other treatments. "Each time we received a version, it became more and more disappointing as to what the program couldn't do," she says.
Furthermore, the customized software wasn't actually a database program. "We had to hire an engineer to develop a program to move the data in our [patient] databases into the outcomes program, and for a variety of reasons, this challenge was never met," she continues.
Despite the problems, Mahan-Moutaw says the institute was just days away from implementing the software when the outcomes managers learned of new medications that needed to be added. Mahan-Moutaw called the company and asked for the programming code to add the new variables."They said it would cost more money. We just said forget it." She finally put the disks in her desk drawer, where they remain.
"We had to pay for every single change we were going to make to our database," she says. "Medicine is dynamic. If you have a new drug, then you would have to pay a fee to program it in." The institute was facing a limitless amount of money to maintain the outcomes software.
Despite this experience, Mahan-Moutaw doesn't want others to be discouraged about launching an outcomes program. The institute's physicians and patients have benefited greatly from the data, she says. For example, an epilepsy patient wanted state-of-the-art surgery that had been shown to cure the condition. His HMO balked. But when physicians sent the surgery outcomes from the epilepsy database, the HMO eventually approved the surgery.
She also doesn't want to downplay the effort required to use software such as Paradox. It's a tool, but not a ready-made one. Someone must program it to process the data collected on outcomes forms.
For example, the institute developed disease-specific forms to collect variables the physicians thought would be useful. On an epilepsy form, the physicians circle the category that applies for type and frequency of seizure, medication, and other issues. The form is coded by number so data entry clerks can type in 1 for an SPS seizure and 2 for a CPS seizure, making data entry quick and easy. (See sample form, p. 60.)
"It does take some forethought to plan and design a usable database," she says.
Physicians must assess their information needs and decide what variables they would like to track. A computer programmer can help modify the pre-packaged software to collect the data. It could even be done by a staff person trained to use the database software. "Just get started and don't be afraid," Mahan-Moutaw says. "Take the plunge. Eventually you're going to see some data that's really exciting."
[Editor's note: Have you had experience with outcomes or computerized medical records software? We'd like to hear your story - good or bad. Please call or e-mail Michele Marill, (404) 636-6021. E-mail: [email protected]. Or Francine Wilson, (404) 262-5416. E-mail: [email protected].]
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