Trust, technology big issues when merging

Don’t be limited by present capabilities

Faced with combining processes and technology to offer seamless access through an integrated delivery system, don’t think in terms of what you can do, think of what the system should look like, and figure out a way to get there.

That’s the advice of Tabitha Warner, MHA, who as project manager for seamless access at Providence Health System in Portland, OR, is helping her organization through the throes of merging operations of three acute care hospitals, 200 physicians’ offices, numerous clinics, long-term care facilities, and a managed care plan.

"Make sure your processes drive your technology development rather than the other way around," Warner says. "Don’t say, ‘Our systems don’t allow us to do that right now,’ or ‘We can only do this on our screen.’ If it needs to be done in admitting, we’ll figure out a way to get it done there."

One of the biggest challenges the health system faces is data sharing, she says. Projects are under way that will link clinics to the hospital via an electronic medical record, through which both clinical and demographic information can be transferred, Warner says, "but the most basic step is getting everyone on e-mail so they can begin sharing information."

The challenge of seamless access

Achieving true seamless access — in which patients move through the health system without having to repeat information — is a daunting task, says Barbara Wegner, CHAM, regional director of access services at Providence. Technology is a huge piece of that challenge, she notes, as are the accompanying concerns about maintaining patient confidentiality on such a large scale. (See related story, p. 77.)

"Typically, the doctors are [using] software that’s clinical, with a demographic piece," Wegner says. Because their systems are PC-based, not on a mainframe, the clinical information would come along with the demographic, meaning it would be accessible to registrars, for example.

How to "blank out" that information is one of the issues Providence is dealing with as it works with its development partner, Atlanta-based HBOC, on Encounter Management, a system for enterprisewide registration.

"In terms of the physicians’ offices themselves, they are reluctant to let us see their [patient] information," Wegner notes. "Even though they’re employees of the health system, they believe they own the information. We have many diverse people working on that aspect."

Patient privacy is a must

Establishing trust and keeping communication channels open between the acute care facility and the physician practices is crucial to the process, Warner adds. "We have not found [physician control] to be a large barrier, once we sit down and talk about the benefits of their being able to get information [from the hospital] about their patients and go back and forth." She concedes, however, that their concerns are allayed only by the assurance that their patients’ privacy will be protected. "You can’t sell [the idea] unless you guarantee that the information is confidential."

From an access management point of view, Wegner says, the other side of the equation is that when a patient goes to the physician’s office and then is sent to the acute care facility, "we need to have confidence that the [registration] information is correct at the point of entry so we don’t need to ask the patient again."

With the development of Encounter Manage-ment, personnel throughout the health system, including receptionists in physicians’ offices, will have the ability to make changes in the Providence Health System’s master patient index — a repository that will hold the records of some three million people, including the entire enrollment of the system’s own Good Health Plan.

To ensure accuracy under such conditions, the system is instituting "all kinds of quality controls," Wegner says, including hiring a quality and training manager and drawing a "dotted line of accountability" from all the registration points back to her office.

In addition, she says, Providence has established a new training department with responsibility for training and orienting every employee in the health system who has anything to do with registering patients. The curriculum will vary, depending on the particular registration area and position involved.

In looking at ways to streamline the physician referral process for patients, Providence studied how primary care physicians (PCPs) and specialists share information and how that information is brought back to the health plan for authorization. Because of the need for an authorization number, managed care has turned a clinical process into more of an administrative exercise, Warner says.

"We’ve tried to redesign the process by removing that barrier," she says. "The hurdle is building trust between the PCPs, the specialist, and the health plan. Because of the incentives in managed care, it’s important for the PCP to trust that when he or she sends a patient to the specialist, only services that will be appropriate in the eyes of both [physicians] will be performed."

Once the health plan saw that trust had been established among the clinicians, she says, it removed the authorization requirement.