Integration inspiration: Lowell General Hospital achieves scheduling, patient registration, materials management and billing efficiencies with the right IT choice - What Works: Scheduling - uses Unibased Systems Architecture's periOperative Resource Management - System

Health Management Technology, Dec, 2001

Seemingly small changes can make a huge difference. While a community hospital may engage in an ongoing and successful effort to improve efficiency, all it takes is one disparate scheduling system to compromise and damage the outcome. Similarly, all it takes is one right move to put the efficiency effort back on track.

Problem

Lowell General Hospital in Lowell, MA is a 200-bed independent hospital serving residents of Greater Lowell, a suburb of Boston. Each year, our surgical services department performs more than 8,000 procedures in an 11-room, hospital-based surgical suite and a three-room ambulatory surgery center.

The surgery department used a disparate standalone scheduling system that did not integrate with the hospital's main system. Our staff scheduled appointments with doctors' offices over the phone and entered bookings into the system. In many cases, we received inaccurate information from the admitting doctor's office, but because we weren't connected to the hospital's main system and because our system didn't require any specific information or flag errors, surgical bookings were scheduled without detailed information about patients' conditions or the procedures required.

In short, our staff learned to behave as if gathering patient information during the scheduling process was not a priority but getting the room booked was. On many occasions, they even created generic names for patients and added them to the system with no clinical or surgical details--all to expedite a faster transaction and to book operating space for the surgeon involved.

Surgical scheduling could be processed by anyone in the department at any time--although the system did not track who entered the information or where it came from. Without tracking capabilities, on some occasions we were left searching for data, retracing steps, and even having to repeat the entire scheduling process.

Once the patient arrived for the specific procedure, we collected the outstanding information and entered what we could into our system. After completing that process, patients often had to supply much of that same information to the hospital registration staff for entry into their system, since double keying was a fact of life at Lowell.

The old system also hampered our ability to process insurance information and billing information in a timely manner. Since the standalone software didn't include a coding system we had to enter information manually using a complicated coding chart. There was no access to medical records or other essential patient data.

Information that we did enter into the system had to be processed and checked by hand, and uploaded and sent to the billing department via a tape archiving system. The entire process took between five and seven hours a day to complete, and often longer. The process became more time-consuming when our information differed from the information the billing department had received from the patient's registration.

Starting in late 1998 and early 1999, as we were opening our new three-room ambulatory surgery center and strategizing over the fact that our old system was not meeting our requirements for accurate patient identification and information, we decided it was time for a surgical scheduling system that would integrate with the hospital's system and provide us with reliable patient identification and accurate patient information in the surgery scheduling process.

Solution

A selection team assembled that included our OR manager, the CIO, the information systems and OR project leaders, the hospital's informatics nurse and the manager of ambulatory care. While the team evaluated several options, integration remained our primary criterion for selection.

The hospital was already running on the Resource Management System (RMS) from Unibased Systems Architecture, Inc. (USA), and after looking at three additional vendors, we decided that USA's periOperative Resource Management System (ORMS) would be the best fit.

In March 1999, initial training started with the ORMS system, and physician lists, preference cards and other information were processed into the system. In July, the system went live. In the coming months, our surgery ORMS project leader realized how much the system could accomplish and added additional coding options and other tables. By October, the surgical scheduling system for both facilities was completely integrated with the hospital's RMS system.

Results

Today we use the new system for scheduling, patient registration, perioperative charting and case management reports.

Now when doctors' offices call to schedule a procedure, the system flags any problems. Where our staff used to be able to complete a booking with no mandate for collecting patient information, the ORMS system requires that we collect specific information to complete a booking--and won't complete the transaction without that information.

The ORMS system provides us with the ability to view patient records, which helps staff collect and enter patient-specific information. The system provides a graphical scheduling and availability feature and wait list management data.