Aaron Berdofe, MHI – Health Informatics

I have repeatedly stated in my prior posts and my clients generally get tired of me stating that EMRs are only implemented in order to make data in a healthcare setting transparent.  However, generally when you ask a Practice Manager or even a CEO what data they would like to see out of the system you get a blank stare.  There are some bits of data that I have found can be generally enlightening for organizations and I have posted them below.

Patient Demographics by Dx:

Know thy customer.  Beyond all of the ideology of healthcare, physician practices are business.  The best way to maintain and grow a business is to know the customer and deliver what they need and want.  From an organizational standpoint, you can break your customer base into groups by diagnosis.  These end up being your channels of care.  Yes, some overlap and intertwine, but these are basically your pipelines.  A practice management system will be able to show you how much money is coming in to the organization per diagnosis.  You can find out the typical coding level for your visits regarding a specific diagnosis and also any additional procedure codes billed on that visit.  What an EMR cannot deliver is the cost associated with treating those patients with that diagnosis.  That information needs to be obtained by other means.  Those two sets of information will allow you to further analyze each pipeline of care to identify areas of improvement.

In addition to the financial demographics of the customer base, epidemiological information is also helpful.  The average BMI, Blood Pressure and age of patients having a certain diagnosis can then be compared against the national averages. This can be combined with health tracking information (i.e. Patient reminders) to develop measurable goals to improve patient health.  In addition to this, hopefully patient behavioral information is also being captured.  All healthcare organizations deal with DM Type II NIDDM, Cardiovascular disease and Hypertension at a large and growing rate.    Since behavioral changes could greatly assist in reducing the occurrence of these problems, it only makes sense to track what the patients are doing already.  Behavioral health is a huge growth area in the area of preventive health that can not only be explored to generate more income for a healthcare organization but also deliver astoundingly positive results for patients as well.

Office Efficiency

How efficiently is each physician practice operating?  Does anybody know what goes on in each practice from day to day?  In a paper world, these questions are nearly impossible to answer unless someone is lurking in the offices every day.  In an electronic world, this information can be delivered live.  Customer service is at a huge deficit compared to other industries in both airlines and healthcare.  The idea of the Waiting Room has become a joke in America (because we know there are really two). Beth Israel, in Boston delivers realtime ER wait time results to a color changing orb; green for good, red for bad and variations in between.  The same concept can be applied to physician practices.  When does the patient arrive and check in?  When are they seen by the Nurse or MA?  When are they seen by the doctor? And when do they leave?  Just in tracking these time captures, a healthcare organization would have  a big advantage over their competitor.  Their patients/customers might appreciate it as well.  How appealing is it to a future customer to see an advertisement for a physician with a great average patient wait time?

Other information that should be reported on should include the every day tasks of the office staff. The distribution of tasks like calling for referrals or prescriptions or calling to remind patients of appointments should be measured.  Then you can ask how the process can be automated.

Concerning documentation, physicians are responsible for producing signed documents of a patient’s visit.  With an EMR, the speed at which a physician can produce this output can be measured.  A physician that bills and signs their visits in a timely manner is more valuable than one that does not.  Forget the physician that tries to see 80 patients a day.  Value the physician that sends in the bill faster and more accurately.

What Business Is Being Lost?

Physicians refer to other providers or order procedures to be performed at locations outside of the organization’s daily.  A healthcare organization should be able to measure the loss of business.  Reports can be generated to determine what percentage of referrals or orders are sent within the organization or exported. From there, action can be taken to improve the percentage of items sent out to items that stay within the enterprise.

Remember…

Of course, EMRs generally store their data hierarchically.  That means you need to dump your data into a relational database.  Without the merging of data from different spectrums of the business, the data is inherently flat and boring.