With the tremendous growth of hospitalists in recent years, healthcare has created some efficiencies and some new problems.
But this year's winner in the patient-care category of the Innovation in Healthcare Information Technology Awards has found a way to help solve one of hospitalists' fundamental problems: helping patients communicate with their primary-care physicians after they have been discharged.
IPC-The Hospitalist Co., a hospitalist management company based in North Hollywood, Calif., created the system, called IPC Link. The product is the brainchild of Chief Technical Officer Robert Singer and was launched in 1996, a year after his brother, Adam Singer, M.D., founded the company.
"The No. 1 problem of being a hospitalist is communication," says Adam Singer, president and chief executive officer of IPC. "Primary-care physicians need to be communicated with. They often don't know when patients are admitted; they don't know when patients go home. And the classic methods to communicate aren't fast enough. If you call a doctor, they might not document the call. Hospitalists also need to deal with pharmaceutical, home health, insurance and durable-medical-equipment companies."
IPC, which operates in five states, provides its hospitalists with hand-held personal computers into which they enter a patient's personal and medical information, including name, insurance company, primary-care physician, diagnosis, prescriptions, progress notes and specialist use.
Hospitalists send the data via modems to a communication server at IPC's home office. The data are uploaded two or three times a day by an Oracle server, which formats and faxes reports to the hospitalists, primary-care physicians and other specialists.
"It's easy to use; it's intuitive," says Kathleen Loya, the company's vice president of health services. "Even for those who are computer illiterate, the system is set up to work intuitively with minimum key strokes and many drop-down menus."
Nevertheless, doctors get training before using the device in a clinical setting.
"It's very critical physicians receive training on how to use the palm-top," Loya says. "Physicians receive manuals and hands-on orientation sessions for about two to three hours. When doctors start practices with us, they are teamed with another physician both for the clinical care they're providing and how they use this device." The information uploaded on the server is also used for trend and best-practices analyses.
"I have tons of information," Adam Singer says. "I know length of stay by doctor, admittance and readmittance rates by health plan, hospitalist, hospital or region. I can relate different fields in any way I want. This lets doctors compare themselves with other doctors. It validates performance and can be used for quality improvement."
By capturing information on a central database, IPC Link also allows IPC to follow up with discharged patients during their transition at home. Within 24 to 48 hours of a patient's discharge, nurses hired by IPC call the patient and administer a customized post-discharge management survey.
"The clinical discharge information (uploaded by the Oracle server) winds up being part of the customized survey," says Robert Singer. "We're asking questions that pertain to that person's case. Our software is smart enough to generate questions as if the doctor were on the phone. We then try to intervene when the patients have a problem. The computer will tell the case manager what to do.
"If patients don't get their medications or a walker, it's our responsibility to make sure they get it," he adds. "When patients don't get a walker, they're a candidate for readmission. Our software prevents readmission."
Of 1,726 patients who received the survey between January 1997 and June 1998, IPC revealed some 700 opportunities for intervention. "Virtually all cases met successful resolution," Loya says.
By improving communication and filling a gap in patient care, IPC says it has lowered hospital readmission rates for its patients. From January 1997 through June 1998, IPC documented 10-day hospital readmission rates of 1.6%, 70% less than the national rate of 6.8% because of transition management, Adam Singer says.
"I'm building the Mayo Clinic of hospitalists," he says. "Doctors who join us know they have to rise to a higher standard. The technology allows me to monitor and improve the performance of hospitalists in the company."