QI solves problems with disparate computers

New systems eliminate duplicate efforts, errors

"Like jumping on a train moving 60 miles per hour" is how the team leader describes the daunting task of updating Southeast Georgia Health System’s (SGHS) information management systems. With demands for information coming from dozens of internal and external customers, and the frustration of "getting a different answer" depending on which data source was queried, the hospital performance improvement council knew something had to be done.

Quality leaders chartered an information development team in April 1994 that eventually transformed the disparate systems into cohesive, accessible information systems that eliminate duplication of effort and speed outcomes data to pertinent users. They began by identifying the facilities’ information needs and developing a strategic plan for fulfilling them.

According to Kelly Florian, RN, BSN, CPHQ, director of quality management, SGHS was experiencing new requests for information from:

• payers, who were requesting patient-level, population-based, and outcomes information;

• the Joint Commission on Accreditation of Healthcare Organizations, the Health Care Financing Administration, and other regulatory agencies;

• physician practices with which the system was trying to contract;

• the quality management department;

• the marketing and contract management departments;

• clinic leaders who wanted to track patients over time and the continuum of care.

"Because everything we do is based on information, it became very apparent how important the information services [IS] department was becoming. We had to get sophisticated and educated really quickly," Florian says.

A system here and a system there

An assessment of the various systems among the facilities didn’t look good. The hospital had a mainframe system and mainframe-based medical records, radiology, and pharmacy packages from Atlanta-based HBO & Co. The system handled charges and patient demographic information, explains Jack Sinopoli, director of operations and information systems.

Team members also found disparate computer systems all over the hospitals and clinics. Quality management, radiation/oncology, tumor registry, and the maternity center all had their own packages that fulfilled different needs, says Carole Boone, RRT, clinical business analyst and team leader. The maternity center package, for example, was used for registration, point-of-care documentation, and optical recording of fetal heart monitoring.

These systems did not interface or communicate with the mainframe; therefore, a lot of information had to be entered twice — once in the maternity system, for example, for registration and patient records, and again in the mainframe for billing. The duplicative process not only wasted time, but opened the door to errors that could undermine the accuracy of any report pulled from any of the computer systems, Boone says. If a clerk made a typo in entering a patient in either system, the records could never be merged.

Team members had other factors to consider as the information train barreled down the track, including:

• the need to educate staff on how to use the systems available to them;

• maintaining confidentiality and security while allowing for timely and easy access to data;

• bridging the technical, clinical, and financial gap.

Next, they researched types of information currently available within the system and users’ information needs, and identified and prioritized 36 emergent issues facing their health system, Boone says. Work groups were spun off from the team and applied the plan-do-check-act (PDCA) cycle to each issue. Following are the PDCA cycles for three of those issues:

Managed care financial, quality, patient satisfaction, and cost accounting data:

— Plan — researched, tested and evaluated various systems;

— Do — conducted a site visit, purchased, tested, and implemented the DKD/MedStat Group Ascent package;

— Check — ran parallel programs, corrected issues, conducted beta site interfaces;

— Act — brought Ascent live, providing contract management information to business development.

Comparative databases and indicator measurement systems:

— Plan — assessed readiness for participation, determined means for participation;

— Do — purchased and installed the Joint Commission’s Indicator Measurement System, interfaced it to the managed care package, and decided to participate in three cooperative studies;

— Check — successfully tested the comparative database, received feedback, and made necessary changes;

— Act — submitted data quarterly, used reports for internal process improvements with physician feedback/education.

Physician access network:

— Plan — researched desire/need to provide access to mainframe patient information;

— Do — purchased the HBO & Co. enabler, established criteria for participants, performed hardware analysis and made recommendations to participants, provided initial education for participants, implemented;

— Check — received customer feedback;

— Act — the system went live with seven participants.

Other emergent issues addressed include:

• knowledge-based data such as on-line access to expert medical research literature;

• physician practice management;

• outcomes data on the top 10 DRGs;

• information management education;

• telemedicine;

• bar-coding expansion;

• integration of the hospitals, clinics, and the stand-alone packages;

• marketing/patient origin/product line development data;

• improving manual processes such as communication;

• systemwide automated scheduling;

• migration to computer-based medical records, computerized patient records, and longitudinal patient records;

• point-of-care documentation;

• concurrent coding.

The team is particularly proud of its integration of physician practices, clinics, and acute care facilities within the health system, Florian says. In addition, it decreased duplication in data collection, storage, and analysis, and improved data validity.

Most of the projects have been turned over to a reorganized IS department, which includes three new employees with clinical backgrounds who act as liaisons between the IS department and end users. The team dissolved itself in favor of an information systems advisory committee; which consists of business analysts, the IS directors of operations, client services, and network/desktop services; and the assistant vice president of fiscal services. [Editor’s note: For more information, contact Kelly Florian, Director of Quality Management, Southeast Georgia Regional Medical Center, 3100 Kemble Ave., Brunswick, GA 31520. Telephone: (912) 264-7000.]