Going Mobile— From Square One

 The greater New York metropolitan area-based Saint Vincent’s Catholic Medical Centers consists of two hospitals and several outpatient facilities and employs more than 1000 affiliated physicians, including 70 fulltime and 300 voluntary attending physicians. The healthcare organization is anchored by St. Vincent’s Hospital, Manhattan, a 758-bed tertiary care teaching hospital, Level 1 Trauma Center and Critical Care Center.

 A new management regime was in place and they understood that information technology could have a dramatically favorable impact on their day-to-day business operations. ”We knew that the future viability of our organization depended on our ability to rethink everything from how we deliver care to how we charge for it,” former director of medical informatics at St. Vincent’s, Ken Ong, M.D., M.P.H., says. “It really was a case of survival.”

Renaissance of a System

 After filing for bankruptcy in 2006, St. Vincent’s Catholic Medical Centers quickly reorganized and emerged six months later. From a business perspective, the top priority for the organization was to improve the accuracy and completeness of the physician charges it recorded. For too long, physicians at St. Vincent’s endured a flawed process for capturing physician charges for patient encounters that were recorded on paper and note cards. “Our physicians were writing down their visits on scraps of paper and tucking them into their pocket,” Ong says. “They might not enter the correct codes for the procedure, or forget what transpired. Or they simply might lose the paper in the laundry. That’s no way for a 21st century healthcare organization to run its revenue capture,” he says.

 Instead of waiting hours or days to get lab results on paper, clinicians can simply tap a couple of keys on the PDAs or Smartphones and have access to that information instantaneously.

 Those practices were creating lengthy payment delays and outright lost charges resulting from either misplaced paper slips or claims that were rejected because of tardiness. “It made no sense to us that our charge capture was an entirely manual process,” Ong says, and he adds that the reorganizing healthcare provider also had to address a paper-based system for lab test results and access to other important patient information, as well. “We were committed to improving the workflow for our clinicians and applying IT to accelerate those processes,” Ong says. The clinical workflow for access to this vital information was another focus area for St. Vincent’s, and automating this system would also help to increase efficiency and control costs. “This would make life easier for our professional staff—but more importantly, it would positively affect patient care,” Ong says.

New Automation Brings Dramatic Improvements

 Laying the foundation for these initiatives, St. Vincent’s deployed a pilot implementation of new mobile technology from Newton, Mass.-based PatientKeeper Inc. to help its doctors quickly and easily record charges for inpatient services. That same mobile platform—which leverages ubiquitous standard PDAs and Smartphones for clients—also provides a multipurpose point of access to clinical information and workflows, including not only lab results, but also medication lists, allergies, patient lists and demographics, and still others.

 From a business perspective, the top priority for the organization was to improve the accuracy and completeness of the physician charges it recorded. For too long, physicians at St. Vincent’s endured a flawed process for capturing physician charges for patient encounters that were recorded on paper and note cards.

 According to Richard Roistacher, M.D., medical director at St. Vincent’s, the mobile solution has had a major impact on the clinical staff at the hospital and is a tremendous improvement to have access to demographics and labs anywhere, at anytime. Instead of waiting hours or days to get lab results on paper, clinicians can simply tap a couple of keys on the PDAs or Smartphones and have access to that information instantaneously. The technology also makes it easier to stay informed about his patients, Roistacher adds, and generates significant productivity savings through enhanced capabilities to capture charges. To him, it’s clear that mobile technology is playing a key role in improving the financial viability of the hospital for, at the very least, the near-term future.

 Roistacher emphasized that St.. Vincent’s has achieved significant enhancements to the levels of efficiency, quality of care, access to patient medical histories, lab tests and results, as well as improved access to insurance and other relevant information. This level of functionality significantly improves the quality of care at St. Vincent’s by enhancing their ability to accelerate proper treatments. “We now have several hundred physicians using this system and that has sent a very strong cultural signal throughout our institution that we are committed to re-establishing our hospital as a first-class healthcare destination, for both patients and clinicians,” says Roistacher.

 According to Ong, one of the key reasons they selected the PatientKeeper solution was because the vendor had excellent references that were very satisfied with the results they saw from PatientKeeper products. “In healthcare,” Ong says, “that means a lot because this technology can affect the quality of patient care.” Using the integrated PDAs and Smartphones, hundreds of St. Vincent’s physicians now have real-time access to essential patient clinical information, including chemistries, hematology, microbiology, radiology and other laboratory results.

  After finishing the implementation, Ong says the new automated system provided the capability to pull lab data from their SoftLab application and display  it on the wireless PDAs or Smartphones. “We pull our medication lists from Cerner PharmNet and interface with Siemens’ Radiology Management System to display radiology reports,” Ong says. “In the future, I expect St. Vincent’s will pull PACS images from the Philips system, but currently that remains only one of a number of possible directions that may be pursued.”

Capturing the Charges Efficiently

 St. Vincent’s has begun to rely on the PatientKeeper platform to drive a much more efficient charge-capture process. The rollout was the first step to completely transforming its charge-capture operations, and taking the facility from a paper-based process to an automated one that it expects to dramatically improve both cash flow and top-line revenue.

 The two-dozen physicians who currently use the charge-capture application now capture nearly 100 percent of their charges and get them into billing systems immediately. As a result of this technology and other process improvements, St. Vincent’s physicians have increased collections by a substantial amount within the first three months of use. “With managed care, timing is everything,” Ong says. “If you’re late with charges, the hospital doesn’t get paid. Before, it wouldn’t be unusual for our doctors to submit charges that were a month old. With this new system, not only are we capturing all of the charges, we’re submitting them within five days, which is accelerating our cash flow. That’s changing the culture at St. Vincent’s and setting a new standard and expectation, and for a hospital coming out of bankruptcy, that’s a very positive change.”

AUGUST 2007