Using Health Information To Make A Difference in the Consumer and Management Domain

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Contents

Learning Objectives

This section covers a range of specific application areas where sensible deployment of IT can make a positive difference to operational performance and how that may be achieved. As with the last section planning, business case clarity, project management, benefits realisation and so on are all vital to a successful implementation and understanding how all this fits with each application area is a major goal of this section.

Another insight that readers of this unit will obtain is that there are a range of general business applications that can be useful in association with the usual clinically orientated applications.

Implicit also in this section is developing an understanding of the variety of application areas that can be useful in the operation of practices, hospitals and health systems.

The coverage in the section that follows is of especially useful applications. Section 6 and 8 covers the more general aspects of approaches in the areas under discussion.

Management Domain

Services And Facilities Planning

Hospital and service planning are complex matters that need to draw on a very wide range of information in order to reach the correct conclusions about the size, nature, service mix and so on that is needed and how a sustainable and practical plan of the right scale and scope can be developed.

Noting that, of course, design of both services and hospitals are specialist activities, it is important to consider just how wide and deep the categories of information required is and how it might be sourced and then utilised.

What will be needed is a variety of internal data about present activities in either the present or similar facilities, a range of external inputs and then a set of assumptions regarding things like disease patterns, demographic trends and so on.

Even the briefest consideration will highlight two key facts. Firstly that the chances of getting the various decisions that need to be taken correct will require significant information depth from a wide range of hospital systems. Second that the depth of modelling required to provide realistic credible scenarios as to demand, throughput, revenue, resources needed and so on is substantial.

The information sourcing, gathering and then processing and modelling are key activities which management needs to ensure there are feeding systems that able to contribute to the effort. The specialists have their role but general management need to make sure a hospital’s systems are providing what is needed to assist the decision making.

Supply Chain Optimisation

To quote Wikipedia, “Supply chain optimization (SCO) is the application of processes and tools to ensure the optimal operation of a manufacturing and distribution supply chain.[1] This includes the optimal placement of inventory within the supply chain, minimizing operating costs (including manufacturing costs, transportation costs, and distribution costs). This often involves the application of mathematical modelling techniques using computer software.”

Here is the full article.

http://en.wikipedia.org/wiki/Supply_chain_optimization

Inevitably this sort of process improvement again relies on systems which manage and distribute inventory and - critically - ensure that all important material needs for the delivery of care are readily available. To achieve this there must be well designed inventory control and purchasing systems which monitor the level and location of all important supplies, which ‘know’ what is needed and who the best and cheapest suppliers are. In healthcare there is also an issue of ensuring inventory is rotated so that it is consumed before expiry. (All this is what one sees in integrated inventory management systems).

As noted in the definition what SCO tries to add is additional sophistication which takes into consideration all the factors necessary to ensure reliable supply status at the best cost possible. Given the number of store items, the distribution of use and so on the complexity of this task in terms of information management and use can be considerable indeed. From the perspective of this introductory course the main thing is that the reader is aware of such capabilities and this can ask their supply managers what they are doing in this area to achieve the best results.

Marketing Support

Other that ensuring operations run smoothly key to a successful organisation is that establishes a positive image and reputation to assist with both patient recruitment, clinician recruitment and staff recruitment.

Part of this is to have a strong factual base of the quality of the hospital’s performance, ensuring that clinicians know the hospital’s capabilities and that the local community is aware of the good things that are happening. Again strong core information systems are needed. Hospitals with advanced systems often use these systems to assure patients of safe and efficient care from a marketing perspective.

Regarding staff recruitment having a good reputation is important as is having effective systems to manage advertising, job applications and later HR and payroll etc. It is worth noting that hospitals that use advanced computer systems are seen as more attractive by nurses than those which lack am advanced Health IT infrastructure.

This blog article provides a nice summary of a sound approach to the development and implementation of a sensible marketing plan.

http://www.healthcarecommunication.com/Main/Articles/10_steps_to_a_successful_health_care_marketing_pla_9450.aspx

Performance Monitoring

It is well recognised that if performance (in terms of safety, quality, efficiency or whatever) is to be improved the first step is to measure just what present performance is and - using historical information - to discover what trend is presently in place and what are the causes of any changes that are detected.

Also crucial in this discussion is that what is monitored and managed for a measures that are as closely related as possible to the business objectives. It is a bad mistake to measure just what is easy, and act on that, rather than utilise measures that actually reflect reality. Use of technology can improve the range of data collection possible and allow the use of indicators which are valid.

What happens once the appropriate systems are in place and the information is collected it is obviously up to management to make the best of what is available. Section 9.0 has a section on this area from a clinical perspective.

Research Domain

Clinical Trial Support

Clinical trials are an area where information management, information security, flexibility and sophisticated reporting tools can all be used.

Properly executed clinical trials rely on careful planning, subject recruitment (where social media can play a part), information management of all relevant patient details and in individual subject level, trial progress monitoring, regular issues reporting and a whole lot more. Along with this there needs to be great care paid to individual information privacy, security and indeed information protection (it could be an expensive disaster is trial information was lost or destroyed.)

This is definitely one of those application areas where computerised support is not just an enabler but without decent systems major large scale trials would simply not be possible.

There is a useful article on the area here:

http://en.wikipedia.org/wiki/Clinical_trial_management_system

Post Marketing Surveillance

Post marketing surveillance is an important activity in the pharmaceutical industry where medicines that have been approved for patient use on the basis of clinical trials and overseas use experience, where available, are monitored in the subsequent years to ensure that there are no unexpected consequences of the usage of the medicine in the real world.

The approaches that are adopted are quite diverse. It can include having practitioners report unusual reactions to a central registry, data mining EHRs, or patient surveys and so on. A range of techniques like data mining are also crucial as is data linkage of major payment and prescription databases.

It is also important, as well as undertaking regular surveillance, to keep a close ear on the clinical grass-roots to identify issues that might be researched to confirm or deny potential issues. As ever it is clear that clever deployment of technology is vital if answers are to be found and safety enhanced.

There are some international systems of PMS discussed here.

http://en.wikipedia.org/wiki/Post-marketing_surveillance

Consumer Domain

Customer Relationship Management

All organisations that will prosper need to pay attention to how they are perceived by the users of the services and to establish effective means of both gathering attitudes and views as well as staying in touch and preserving awareness of the service.

In hospitals it is an oldie but a goodie that the customer is not the patient but the doctor as it is the doctor that usually decides which hospital the patient is referred to, but clearly with the GP the patient is front and centre as the customer of the practice.

Patient surveys, conducted on discharge, by mail or on-line can be very helpful in tracking satisfaction and getting early warning of things going wrong.

However clearly hospitals cannot afford ignore the patients, both for the possible effect of word of mouth and the need to often pursue donations!

Using patient data bases is a useful way of developing customer data base that can then be used for postal and e-mail contact - as long as the appropriate consent is obtained proactively. Regular contact between hospitals and their clinicians - especially when new services are being added or improved is also vital.

In recent times, the emergence of social media has also made it important for both hospitals and practices to develop an appropriate presence on social media as well as also monitoring such media to ensure an appropriate response to both positive and negative feedback.

Electronic consumer relationship management can be a distinguishing and valuable addition to a hospital’s capacity.

Patient Portals

In the United States the second phase of the ‘Meaningful Use’ incentive program requires a reasonable number of patients have access to their clinical records on line. This requirement, along with the success of the Kaiser Permanente patient record access program (My Health Manager) , has seen a major expansion of the number of patient access portals in that country.

The portals typically offer a range of functions to users who have an established relationship with a hospital, practitioner group or integrated health system.

The functionality offered can be seen at this web site.

https://healthy.kaiserpermanente.org/health/care/consumer/my-health-manager

In late 2013 an interesting systematic review of the area appeared.

Here is the abstract.

19 November 2013

Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes: A Systematic Review

Caroline Lubick Goldzweig, MD, MSHS; Greg Orshansky, MD; Neil M. Paige, MD, MSHS; Ali Alexander Towfigh, MD; David A. Haggstrom, MD, MAS; Isomi Miake-Lye, BA; Jessica M. Beroes, BS; and Paul G. Shekelle, MD, PhD

Ann Intern Med. 2013;159(10):677-687. doi:10.7326/0003-4819-159-10-201311190-00006

Background: Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.

Purpose: To systematically review the literature reporting the effect of patient portals on clinical care.

Data Sources: PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.

Study Selection: Hypothesis-testing or quantitative studies of patient portals tethered to a provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization, attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were included.

Data Extraction: Two reviewers independently extracted data and addressed discrepancies through consensus discussion.

Data Synthesis: From 6508 titles, 14 randomized, controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and 6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use.

Limitation: Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.

Conclusion: Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.

Primary Funding Source: U.S. Department of Veterans Affairs.

Here is the link:

http://annals.org/article.aspx?articleid=1770672

It seems likely that this study may have been compromised by taking a 20 year period, or at least not dividing the old from the recent studies. One might suspect we might find that the richer functionality portals now in use (with messaging to docs, appointment making, repeat prescriptions etc.) might be a good deal more successful.

What this study may very well suggest is that non / low-functional portals (like the PCEHR) are not all that useful.

This is clearly an area where continuing research is needed given the levels of investment being made in the technologies.

Review Questions

  • 1. What do you believe are the major non-clinical general applications that can make the largest positive difference in the health sector?
  • 2. What do you believe are the key steps health sector managers need to take to ensure they maximise the overall Return on Investment (ROI) on an organisations overall IT portfolio?


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