The Value of Integrated Outcomes Information for Performance Improvement Initiatives - Industry Trend or Event

Health Management Technology, July, 1999 by Matt Brine

Comparative outcomes data provides healthcare organizations with the information they need to succeed in today's competitive and turbulent environment. Many hospitals are utilizing cost accounting and other computerized systems containing the data necessary for performance improvement (PI) initiatives. However, oftentimes hospitals fail to seize total PI opportunities because they lack a key ingredient - integrated outcomes information.

Outcomes Information and Integration

Outcomes are measurable results as a consequence of the processes used and decisions made in providing care. Contrary to popular belief, they are not just clinical. Healthcare outcomes encompass three areas: cost, clinical and patient satisfaction. When improving care, it is inevitable that by changing one outcome variable, another will be impacted. This could lead to impaired decision making and missed PI opportunities. To obtain the real value of PI initiatives, a hospital should integrate outcomes information, or in other words, consider monitoring the three areas simultaneously.

Healthcare organizations across the nation are boosting their PI efforts but are not integrating their disparate outcomes information. So, what we see today are healthcare organizations conducting PI initiatives in silos of interest and responsibility. Accountants want to cut costs and physicians want clinical improvement while executives want to show high patient satisfaction scores.

In other instances, PI staff attempt to lead their hospitals to improve cost, clinical and patient satisfaction outcomes, but often fall short in accomplishing this mission due to a lack of department-to-department communications. For example, the accounting department may be using a decision support tool that is generating information that would be valuable to the PI efforts in pharmacy. Yet, because of the lack of communication, the data is not shared.

The healthcare organizations that have realized the importance of integrating information are experiencing substantial benefits.

For example, take Memorial Hospital of South Bend, IN, a 393-bed tertiary and specialty care referral center for Northern Indiana and Southwestern Michigan. It has saved more than $1.S million per year for the last two years by reducing costs while improving its patient satisfaction scores. Parkview Hospital, a 539-bed hospital located in Fort Wayne, IN, has saved more than $16 million dollars since 1994 using integrated information to develop clinical pathways that reduce practice variation, improve resource utilization and enhance clinical out-comes.

Managing Disparate Outcomes Information

The major sources for healthcare outcomes information include administrative records, general ledger, medical records, diagnostic results (laboratory and radiology) and post-discharge surveys that collect patient satisfaction and functional status information. For most healthcare organizations, even the thought of linking this abundance of disparate information conjures up images of nightmarish proportions. One of the major challenges facing hospital executives today, especially CIOs, CMOs, CFOs, and quality directors, is how to access and manage disparate outcomes data.

Currently, comparative data systems typically utilize "fat-client" technology. In a fat-client system, a conglomerate of hardware, software and data resides on multiple information systems--software applications and data are located on desktops scattered throughout the organization. The only way to link the information is to take the pertinent data and export it into a single database.

The future of outcomes management systems is "thin-client" technology. In essence, thin-client technology consists of a browser located on the desktop that connects the user, via the Internet, to applications and data in a central data warehouse. All functionality is driven through that browser; it's all done behind the scenes, so the healthcare professional can focus solely on PI activities.

The spread of thin-client technology will enable healthcare organizations to conveniently and economically store their disparate outcomes information in one easy-to-access data repository. Most healthcare information management companies are moving to the Internet, but very few have the ability to extract data from key hospital information systems and integrate it in one location so it can be easily accessed. This move to thin-client systems is a huge stride towards successfully integrating outcomes for PI initiatives. But what about managing and storing this data?

Current trends show that because most healthcare organizations do not have sufficient resources to handle the enormous job of storing and managing outcomes data, hospitals will increasingly outsource this task to a third-party information management company. This is especially beneficial for multi-hospital systems conducting intra-system comparisons.

What Does the Future Look Like?

The Balanced Budget Act of 1997 has put hospitals under intense pressure to reduce expenses. At the same time, patients are demanding better care. The rise of consumerism in healthcare is not due just to the proliferation of information on the Internet; it is also attributable to pent-up dissatisfaction with healthcare in this country.