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

Until about four years ago the hospital staff photocopied and faxed patient records to caregivers and administrators who needed to review the clinical or financial information. For example, a patient would be admitted to the emergency room and then his information would be recorded and faxed to various locations. Clinical files would be photocopied, put into a folder, and filed. No one in the hospital's 100 service sites had access to each patient's clinical or financial record.

Now, when a patient arrives, his insurance card is scanned and logged into a central database accessible from any location in the hospital network. The insurance card contains the type of benefits a patient is eligible to receive and the extent of coverage that will be reimbursed. "In an age of managed care a hospital has to get authorization for procedures. The card is important to make sure the patient gets full coverage," says Galusha. In short, under managed care it's imperative for hospitals to stay away from expensive procedures not covered by the patient's health plan.

"Our number one goal is to provide better customer service," says Galusha. "Number two is to augment the existing hospital information systems that are today character-based systems with document component and other data types such as video and photos." The hospital's third incentive for implementing a document management system was to reduce costs. They estimate they are saving about $7 per visit, or $250,000 a year by cutting down on the paperwork that gets filed.

While many hospitals have benefited from using technologies such as document management, says SSI's Pyle, the IT initiatives are not without headaches. As a whole, the industry lacks standards for sending documents. "In manufacturing, ANSI is the standard for sending records," says Pyle. "We have a joke in health care that ANSI is the only thing that isn't standard."

In fact, there is little uniformity in the industry as a whole, not just in the area of delivery of documents, but also in the delivery of care. The criteria that one hospital uses to determine whether to allow a patient to undergo a type of surgery may differ greatly from another health-care provider's reasoning. Their lack of standardization carries over to other areas. For example, there is no standard medical lexicon, says Meta Group's O'Boyle. "It's difficult to exchange data unless you come up with an enterprise-wide data model. There's a move to try to create data standards across the industry using the same terms to identify things," he says.

This is an issue Florida Hospital's Galusha recognized and has tried to address within his organization. He says that if data isn't coded and structured within the computer system, then the computer doesn't know whether the word "cold" refers to a patient's condition, the room temperature, or COLD technology. "We're trying to achieve a coded and structured record where the verbiage contains the contextual information," he explains. The hospital hopes to get about 85% of its data coded and structured in the near term.