Show me the numbers! But first you need an information system

Experts offer key questions to ask yourself and vendors

How many of your female patients who had regularly scheduled mammograms were diagnosed with breast cancer in the earliest stages? What was the impact of using a cheaper antibiotic to treat otitis media?

You could find out with a few taps on a keyboard if you had the right computer software and database. Yet finding the program or system that works for your practice can be a daunting task. Some practices purchase a system but never use it to its fullest potential. Others invest thousands of dollars, only to discover that they can’t get the data or reports they want.

"There are commercial products out there that say they collect outcomes. But who says what outcomes are?" says Jonathon Seltzer, MD, senior director of health systems research for Premier Research Worldwide in Philadelphia. "Who says they’re interested in the outcomes I’m interested in?"

The bottom line: You can’t buy outcomes software just by pulling it off a shelf, unwrapping, and loading it. Your search will likely require months of research of vendors and their products.

Patient Satisfaction & Outcomes Management asked health care information experts to share their advice about selecting outcomes management software. Here are some key questions they say you should pose before you buy:

1. What are your information system needs?

If you’re not sure what you want your outcomes software to do, you may need to spend time upfront analyzing your measurement needs.

Before you can determine what you want your outcomes software to do, you need to determine your practice’s requirements. "You always start at the end and work backwards," says Robert Eberle, president of Clinical Information Consultants, a Raleigh, NC, firm specializing in outcomes and information systems. "What information do you want to collect, why do you want to collect it, how are you going to use it?"

Some practices may want to focus on financial or claims information that can be captured from a billing system. If the goal is clinical outcomes, you may want to retrieve patient-based rather than transaction-based information.

In others words, you may want to capture data outside of a specific patient visit, such as lab, pharmacy, or X-ray information from other sources. That system clearly will be more sophisticated.

In a large practice, various physicians or staff may have different ideas about what outcomes they want to measure. Your software search should include their input, experts say.

"If you don’t involve them, whatever system you put in will fail because they won’t like it and they won’t use it," says Bernard. "They’ll pick out the 10% [of attributes] the system doesn’t have, and they’ll say that’s what they want."

Don’t be wowed by technological wizardry if those are items you don’t need and probably won’t use, cautions Seltzer. "It’s easy to be very impressed with all the bells and whistles," he says. "The real question is simply, Does it do what you need it to do?’"

You also will have to be practical. Outcomes management technology is still evolving.

"There is nothing out there that will do everything you want it to do. End of story," says Bernard. "And nobody can build you a [customized] system within a reasonable time frame a year that will do everything you want it to do because your needs, while they’re building it, will change."

"The first step in the selection process is identifying the software that will do most of what you want it to do," he says. "From there you select the hardware that the software runs on."

2. How much money and time are you willing to spend?

Even if you found the perfect system, could you afford it? Cost and value clearly enter into this purchasing decision.

Investing in an electronic medical records system which some experts feel is essential to measuring outcomes effectively illustrates how time and money spent upfront can translate into a long-term investment to help the practice. Investing in an electronic medical records system may be the most ambitious and costly choice you can make. Yet, some experts say the electronic medical record is essential to manage outcomes effectively.

An electronic medical record can provide reminders to physicians, alerts about drug interactions, managed care guidelines, disease management, and analysis of the cost and benefit of treatments. It generally works through personal computers that are linked in a network via a centralized server. (For more information on benchmarks, see related story, p. 4.)

Vendors typically charge a per-user fee for the electronic medical record software $2,000 to $3,000 per doctor. Prices vary, however, depending on the system installed and the size of the practice, says Chris DeLuca, vice president of sales for Advanced Health Med-E-Systems, a software firm based in Chicago that offers an electronic medical record.

Establishing an electronic medical record may require additional hardware, such as a file server. If you have offices at multiple locations particularly if some are in a different city or state you may need to invest in a communication system, such as a frame relay network that connects dedicated local lines without per-call charges.

Of course, converting to computer-based medical records requires some staff time, as well. DeLuca says his company’s system can transfer patient demographic information from the billing system, and physicians can begin their files with a current health history from the patient. Transferring previous medical information can be time-consuming, he concedes.

"There’s no good source of data other than taking the paper record and putting it in manually," he says.

^{But who will do the work?}

Be aware that frequently systems require someone in the practice to create templates or screens to collect information, says Eberle.

The physician may be too busy to take the time, and the nurse is even busier. The resident would rather see patients. Interns or volunteers may make an effort but not understand the practice well enough. "[Practice leaders will] say the system isn’t working and throw it out," says Eberle.

Yet ultimately, spending time and money represents an investment in the future of the practice. Reminders, guidelines, and outcomes information on the electronic medical record may help you improve patient care and provide valuable information to managed care companies.

You may find less expensive, one-size-fits-all outcomes management software. But it will have little or no flexibility to meet your practice’s specific information needs, says Eberle.

"If cheap is what you want, cheap is what you’ll get," says Bernard. "I believe that the software, if you use it, will pay for itself. I consider more relative costs than I do total costs. How much does that product cost relative to another?

"You can probably buy most of these things and put them in for less than you can buy a new Mercedes and finance it over the same period of time," he says.

3. How will the system function within your current practice?

You may find a system that is impressive in its scope and versatility. It can produce reports on everything from functional health assessment to most beneficial treatments. But, you have a host of questions to ask before you know whether this system will work for you. Will you collect and input the information during the office visit or write it on a form and assign someone to input it later?

"I need to implement the collection of information so it doesn’t affect the management of the patient or the delivery of services," says Eberle. For example, outcomes management software shouldn’t require a new layer of paperwork that duplicates other forms that contain the same information.

Will you need computers in every room or will you use portables? Will your current hardware work with the new software? What billing system and other systems do you currently have? Can the billing system communicate with the electronic medical records software?

If they don’t, "for a price, you can make them communicate," says Eberle. "That’s another cost factor."

4. What is the track record of the vendor? What training and support will the vendor provide?

Health care computing experts agree that practices should work with established vendors. In this ever-changing field, a vendor may not last long. "You want to pick the company that has the best chance of being here five years from now," says Eberle.

That means doing your own consumer research. What is the company’s financial status? What do other practices have to say about the software? What kind of support and training will the vendor provide?

Eberle suggests creating a grid to record your information. On one side, you should list all the performance points that you have determined are important for your practice. For example, you may want a system that interfaces with your current billing system and that can communicate with other entities, such as labs or pharmacies.

Along the top of the grid, list the software companies that you have identified by collecting marketing information and talking to colleagues. "Start coloring in like Consumer Reports what each of them does so you have a cross reference," he advises.

If you do your homework, you won’t be disappointed, he says. "You can get a system that will work within the framework of your expectations only if you work with those systems that will meet or exceed your expectations," says Eberle.