A quality information system wish list’
Look for flexibility in information system
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
The contemporary operating environment in health care organizations is challenging. To survive, everyone must be well informed. To lead the organization, the senior executive team needs information on the organization’s current state and the direction it is heading. Managers need to know how their departments are performing. Staff members and physicians need information that allows them to do their jobs better. To advance performance excellence, quality managers must assist the organization in maintaining an information system that can track overall organizational performance and daily operations.
To be truly effective, the performance measurement (PM) information system used by a health care organization should allow for the development of a comprehensive, patient-centered computerized database — one that can communicate a complete picture of the care provided to each patient. You’ll want a system that can capture, store, and retrieve clinical and financial information from a variety of sources such as patient records, admission/discharge/transfer (ADT), billing, laboratory, pharmacy, blood bank, surgery schedule, and radiology. Plus, the ideal automated data system should be capable of handling an unlimited number of data elements for ongoing monitoring purposes and time-limited studies.
To avoid duplicative data entry, the PM information system should be able to "talk" to your organization’s existing information systems via interfaces. Such interfaces not only give you a continuously updated database but, with one-step data collection and entry, your staff will save countless hours of manual duplicative data entry.
This helps to avoid redundancy and ensure the integrity of the PM system.
For example, if the utilization management coordinator needs to know the results of a particular patient’s laboratory test, it should be retrievable electronically. Information system interfaces maximize efficiency and minimize the possibility of human error in transferring the information.
Through these interfaces, the ideal PM system can automatically retrieve patient information from whatever sources you designate.
Equally important, the interfaces will operate independently of one another so that you can capture information from multiple sources, as often as required, to keep your patient-centered database up-to-date. For example, you may wish to obtain ADT information once a day and laboratory results or surgery schedule information more frequently.
The ability to set performance expectations and evaluate gain attainment continues to be an important element of performance management. You’ll want an information system that allows you to set performance targets for individuals, departments, and organizationwide measures.
For example, the surgery department may have a target rate of 5% for nosocomial infections, whereas the target for the organization as a whole might be set at 3%.
And the ideal PM information lets you define when to apply your targets (monthly or quarterly, for instance). Finally, with regard to performance expectations, the system should give you the capability of linking an appropriate action to a trigger, e.g., trend the case or send the case for peer review. To do this, the system must have the logic necessary to accumulate statistics as you enter data as well as alert you when a target or trigger has been reached.
If you want to know if the patients of a particular doctor have more than 10 nosocomial infections in a six-month period, the system must be able to automatically keep track of each infection within that period, then alert you when 10 infections have occurred. The ability to process data in such an "if this occurs, do this" or "if this does not occur, do that" fashion is referred to a rules-based processing. It is one of the single most important capabilities you should look for in a PM information system.
Look for flexibility
The information system must be flexible enough to allow for concurrent and retrospective data gathering. Most systems track results from retrospective case reviews; fewer can support and facilitate concurrent studies, which are critical for monitoring quality issues and resource utilization. This is particularly important when it comes to monitoring compliance with practice guidelines and payer contracts. The ideal information system can do both. When a hospital- or payer-defined rule is broken, you can effect change immediately. This enables reviewers to take a prospective rather than reactive approach to performance management. For instance, rather than reacting to a payer’s query as to why a patient who meets discharge criteria still is hospitalized, the system would flag this broken rule, giving you the opportunity to discuss the case with the patient’s attending physicians before the payer questions the length of stay.
The system also should be capable of supporting Joint Commission and other regulatory reporting requirements. The ideal information system should provide you with outcome data and an automatic audit trail of activities that documents your process improvement activities — relieving you and your staff of a significant amount of manual paperwork. The PM information system should give you a hands-on, day-to-day tool with which to monitor and evaluate clinical and administrative processes.
To be truly flexible, the system must integrate comprehensive patient-centered information with rules-based processing. This enables you to detect when the rules you define are broken, indicating potential problems in the process or outcome of care — a situation that affects your organization’s ability to achieve quality goals. This capability gives you virtually unlimited opportunities for performance improvement because you can put in place externally defined rules based on practice guidelines for example, and any number of internally defined rules. As physicians and staff redesign processes, you can provide feedback on the effect of process changes on patient outcomes and operational goals.
As for the technical components of your PM information system, it should be a relational database. A relational database provides the performance, control, and connectivity required for integrated applications, and it can accommodate a multitude of data and users as well as a high rate of information retrieval and updates.
The ideal system allows multiple users to access the same database at the same time. The total number of users who could access the system should depend on your hardware capacity and not be limited by the program. As your needs change over time, which they most likely will, you should be able to increase the number of users as you desire.
The system should be an open operating system, which enables you to operate on a variety of different hardware platforms. As a result, you are not limited to a particular hardware vendor or, conversely, if your organization has a strong relationship with a particular hardware vendor, you don’t have to switch to use your new PM system.
Another consideration is the networking capabilities of the system. A network allows linkages between all the participants in your PM processes, facilitating the integration of those processes and improving communication. If your PM system is network-compatible, it is more accessible to end-users.
Information technology is an important enabler of performance improvement. This technology can range from something as elementary as electronic mail and messaging to electronic health records. Quality managers should seek out the best available information technology to perform their work and to gather and share knowledge.
Organizations that fail to invest in information systems lessen their ability to innovate and adapt to the ever-changing performance improvement environment.
The contemporary operating environment in health care organizations is challenging. To survive, everyone must be well informed. To lead the organization, the senior executive team needs information on the organizations current state and the direction it is heading.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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