To Centralize?

June 24, 2011
As hospitals seek to capitalize on the advantages of centralized patient documentation, health directors are faced with operational and budgetary

As hospitals seek to capitalize on the advantages of centralized patient documentation, health directors are faced with operational and budgetary challenges hindering their ability to provide care.

In what may seem at first to be a great resource for patient tracking, a centralized information system may not provide all the functionality of core local systems, such as obstetrics charting systems. Directors are faced with the challenge of finding a way to interface the systems or losing the functionality of the local system.

Regional health information organization (RHIO), electronic medical record (EMR) and electronic health record (EHR) initiatives add to these interfacing requirements with their directives to share data. It is in this gap that niche providers have invested the research to devise tailored approaches to integrating EHRs.

Labor, delivery and dollars
For example, labor and delivery (L&D) units have struggled to overcome the belief that it is not possible to easily extract data from their local systems. Traditionally, these systems have been islands of information within hospitals and sometimes go unnoticed by the IT department. Considering that L&D is usually not a profit center, it becomes a target for hospitals to demand the "interface or change" ultimatum.

The best solution to this rising obstacle is technology that can extract data and interface with internal and external systems. This would open options that could address many past problems. First, if the data were accessible, it could be interfaced to the central hospital information system without replacing the existing obstetric electronic charting system. This could amount to more than $500,000 of savings in areas such as training, hardware and infrastructure changes. It would also allow the L&D staff to retain the functionality inherent in their systems.

Second, the data could be leveraged via other interfaces to streamline patient care from pre-admission through discharge. L&D departments could create closed-loop systems that include labs, pharmaceuticals, and NICU to allow the tracking of complete mother-baby outcomes. Tying these systems together would allow nurses to have single-point data entry, which reduces the administrative nightmare of entering data into, and reconciling with, multiple systems.

Third, beyond cost reductions there lies the potential to increase revenues by building direct interfaces to the hospital billing systems. By automating this paper-based process, the hospital gains the cost savings mentioned above, but it also has the opportunity to add system functionality to help identify items not charged properly, tracked properly or missed altogether. For example, nurses could receive an e-mail from the interface system asking if the user meant to indicate a VBAC on the chart of a patient who had just delivered vaginally, but had also indicated a prior C-Section.

Are these interfaces possible?
The good news is that these interfaces are being built today but not by the major healthcare vendors. Because of the difficulty in extracting data and the historical lack of profitability within L&D units, the big players largely ignored this area. The L&D system vendors may occasionally get involved with these interfaces; however, their main focus is to build the functional robustness and technical compliance of their core systems.

It is the smaller, boutique companies specializing in this area that have taken new approaches to the technical problems faced by L&D departments. Already, early users have proven that extracting this data is possible at reasonable costs.

Brian Olah is CTO for Strategic Thinking Industries, a Columbus, Ohio-based provider of labor and delivery data extraction services.

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