Part two of a two-part series ... View part one here
Initially, healthcare information technology meant financial systems. More recently, much of the focus in healthcare has been on clinical applications.
But there are other computer systems serving the healthcare industry that help make provider operations safer and more efficient, systems that are neither solely financial nor purely clinical but draw on information used by both.
Vendor management and human resources tracking are areas in which software has helped smooth out operations while involving the business and clinical sides of the house.
Discharge planning is an area where computer systems have been applied to improve financial operations and patient care without being a pure-play financial or a clinical application. The software helps hospital staffers increase patient throughput and reduce the average length of stay while improving the patient experience at discharge, users say.
"Before we actually looked at a variety of systems, we were making our referrals to skilled-care facilities and nursing homes by phone," said Dee Mann Aust, director of care coordination for Swedish Medical Center in Seattle, which operates three acute-care hospitals and a free-standing emergency-care facility.
"It was not efficient," Aust said. "The facility or agency couldn't see a lot clinically about the patient and it was not standard in any way. We get a lot of patients from Alaska who come here for specialty surgery. They may not have a lot of needs; they just want a local place for their care."
Under the old paper-based system, "Let's say a family picked a geographical area; we'd have to call three nursing homes in the area and give them the (patient) information and see if they could handle the patient," Aust said. "You'd spend five or 10 minutes on the phone for each one. That was just the initial referral."
In addition to the hassle, "There was some perception we played favorites with certain facilities, and we really wanted to be fair in how we distributed business with those community partners," Aust said.
Finding patients a home
To address the problem, Aust said Swedish implemented in March 2006 a discharge planning system from ECIN, a developer of a suite of Web-based applications to assist hospitals in discharge planning and care management. Formerly Extended Care Information Network, the company claims installations at more than 300 hospitals and, as subscribers to its Web-based communications service, about 4,200 nursing homes, home health agencies and other long-term-care facilities, according to Charlie Jolie, an ECIN spokesman. In addition, the company maintains an online database of more than 80,000 providers of extended-care services.
The ECIN communication service provides a two-way link between the hospitals and subscribing care facilities. Hospitals typically recruit their local nursing homes to join them on the ECIN network, Jolie said.
The system works well facilitating routine placements and shines when it comes to hard-to-place patients with multiple conditions.
"We know we have some patients who are tough to place, and certainly it's very efficient to create one referral and to send it out to multiple facilities," Aust said. "We have one patient this week we sent out (referral requests) to 35 nursing homes, and three said they want to look into more information for that patient. So you can do searches within ECIN and their provider database to search if someone has an Alzheimer's unit. That's a big time-saver. You're not depending on what was in last year's entry in a guide. It's more up to date."
Swedish routinely uses the system to generate a list of at least three facilities for the patient or family members to choose from, Aust said. In addition, subscribing facilities can use the system to send prospective patients or their responsible family members a welcome letter and an information packet about their facility during the care-site selection process.
"The majority of the referrals we get back in two to three hours," Aust said.
Jolie said there are about 86,000 licensed nursing homes and related facilities across the country in its database, allowing hospitals an easy way to look up nonsubscribers.
Aust said, "We have other providers who we don't do a lot of business with and are farther out. They get the referral via fax and they call back. We log that response into ECIN" for more efficient tracking.
Aust also said she uses data generated by the system to track several key metrics, including staff productivity and "time of admission to first referral," she said. "In most cases, we'd like that to be done (having a completed referral) within 48 hours of admission. We've dropped four to six hours on that, and we're doing 1,500 to 1,600 referrals a month."
Getting the discharge site lined up early improves continuity of care by giving the nursing home or skilled-care facility more time to prepare, Aust said. This year, Swedish is installing an electronic medical-record system from Epic Systems Corp., and Aust said she's looking forward to interfacing it with the ECIN system to access an even richer mix of patient information during the referral process.
Martin Memorial Health Systems, which operates two hospitals in Stuart, Fla., has been an ECIN customer since 2000. Martin Memorial already has integrated its clinical IT system with the placement software and that streamlines the referral process even further, said Charlotte Spacek, the organization's director of case management.
"Case managers used to stand at the fax machine faxing the same information to different places," Spacek said. "Now, we just choose the information and it goes out to the different facilities. We've had a difficult patient and over the course of time, we probably sent out about 300 or 400 referrals. It really cuts down the work. There are a minimum of 10 pages and up to 20 to 25 pages in a document for a facility to look at and see if they can accept the patient."
Previously, nursing homes would actually send an employee over to the hospital to look over copies of that patient's records to see if he or she would be a good candidate for the facility. "That process took time, to get the information out of a chart, copy it and have that person come over and review it. That patient that we could get out now in a day would probably take an extra day. It's not unusual for us to send out a referral in the morning and have the patient gone by afternoon."
Spacek, too, said the computerized referral and discharge system has helped decrease length of stay and also saves time for the case manager.
"We actually have secretaries that do the referrals," Spacek said, freeing the case managers "to stay up on the floors with the patients. ... It allows them the time to be more complete and accurate in what they are doing."
In September 2004, the hospitals were hit by two hurricanes, Frances and Jeanne, and the patient-placement system helped the system cope. "They were three weeks apart," Spacek said. "Our main facility lost its elevator tower on the sixth floor. ... We attempted to move patients to our (Martin Memorial Hospital) South facility because they had more beds, but they also had injuries and we had patients stacked up in the ER."
Patients were sent to the north and to the west as well as Palm Beach and Broward County to the south. Once the computers came up midday after the first hurricane hit, Spacek said the transfer was easily accomplished. Having gone through it once, operating after the second hurricane was even less problematic.
"The system works," Spacek said.
This story initially appeared in this week's edition of Modern Healthcare magazine.
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