IT gets to the heart of health care - use of advanced technologies in the health care industry - includes related article on PacifiCare HMO document management system - Technology Information

Software Magazine, Dec, 1997 by Julekha Dash

It's no secret to the health-car community that analysts have long regarded them as a laggard in their use of information technology. "Health care has a reputation for being the backwater of IT," notes Doug O'Boyle, program director for the Meta Group's health-care information technology strategies. While a hospital might have the latest MRI, CT Scan, or Ultrasound machine, there's a slim chance that the clinical staff has PC or that patient records are stored anywhere other than in massive file cabinets.

However, as managed care has put pressure on hospitals to operate on a tighter budget, health care is turning more to technologies such as document management -- including document imaging, workflow, electronic forms processing, mass storage, and computer output to laser disk (COLD) -- to put clinical and financial data online.

"Hospital CEOs now realize that the only way to survive in a managed-care market is to gain control of informatiofi," says O'Boyle. Cost-cutting pressures have "led to a rush to automate many parts of the industry that have been paper-based." In addition, many hospitals are rushing to put not only documents online, but other clinical information --video, X-rays, audio, diagnostic images, and EKGs -- which are often categorized under the "document" umbrella.

Having to operate under a new business model has led to health care's change of heart. In the past, most health-care providers and insurers operated on the fee-for-service model -- with each individual test or treatment generating a fee. In a growing number of managed-care plans, however, the insurer pays a flat fee to cover the needs of each patient. Any costs incurred thereafter come at the provider's expense.

"It's an incentive to get the fat out of the organization," says O'Boyle. "The fee-for-service model didn't require them to be efficient."

According to Deborah Kohn, principal at Dak Systems Consulting, a national health-care technology consultancy in San Mateo, Calif., streamlining processes is only one way of cutting costs. Many health-care providers now realize that keeping proper documentation on patients and treatments can also have a big impact on their bottom line. Insurers often require documentation on procedures and patient conditions before they will reimburse the provider. For example, some insurers may not reimburse cosmetic surgery if the patient is getting a facelift, but they will pay for reconstructive surgery following a car accident. "Some payers may need to come in and look at lab data," says Kohn.

While insurers may applaud costcutting measures, others argue that they do a disservice to patients by denying them access to specialists and more expensive procedures. Hospitals, scrambling for a way to boost their image, have turned to technologies such as document management to deliver better service while tightening purse strings.

According to Stuart Pyle, director of the health-care practice at Software Services International (SSI), a software de: velopment and IT consulting firm in New York City, having access to realtime information about a patient's medical history enables clinical workers to provide better care. Naturally, a patient will feel she is receiving more attention if the caregiver knows something about her medical history and the number of visits she has made.

Kohn adds that having access to a central repository also makes it easier to track the health of patients over time and the efficacy of various treatments. Clinical workers can see, for example, whether the overall condition of a patient improves as a result of receiving outpatient treatment.

Many hospitals also need document management to handle the paper-intensive process of collecting and filing patient information. According to industry estimates, the average patient record consists of nearly 200 pages, weighs two and half pounds, and takes up one gigabyte of storage. "We probably cut down a forest a day because of health care," jokes O'Boyle. "Document management is needed because we have so much data on paper. We need to automate more."

The sheer volume of this documentation convinced the IS department at Florida Hospital to choose a combination of document imaging and optical storage technology to image-enable more than 2,000 business processes -- admissions, laboratory procedures, insurance claims, and general ledger -- and log them into a central repository. The hospital is using ApplicationExtender, a document imaging solution, and DiskExtender, for managing mass storage, from Optical Technology Group Software in Bethesda, Md.

With 1,500 beds, Florida Hospital is the nation's third-largest non-government hospital. The hospital is actually a network of five main hospitals and more than 100 service sites in the greater Orlando area. Fred Galusha, the hospital's CTO, says they wanted to create a single patient record that can be uniformly accessed by workers in their 300 cost centers, or by departments, such as radiology, accounting, cardiology, and information systems. Each individual record contains the patient's clinical and financial information, as well as a history of each of the patient's visits to the hospital.