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For other articles and previous issues click here. November 29, 2004 Automated
for the People Few facilities have adopted automated discharge systems, but those who have taken the leap have uncovered impressive results. Thousands of patients are discharged every day from hospitals across the country. Despite the advent of digital record keeping and other high-tech patient care processes, many patients are still discharged manually, which means lots of paperwork, phone calls, and faxing. The paper discharge process is an anomaly in today’s “high-tech” hospitals, but the process persists. Most experts agree that paperless healthcare cannot exist as long as manual discharges continue. An estimated 25% to 40% of patients admitted to hospitals are discharged needing some degree of postacute care, yet only an estimated 300 hospitals in the country utilize automated discharge software. Benefits of Automated Discharge Each patient profile created for someone who is ready to leave the hospital and enter an extended care program is approximately 20 pages long. An average of three extended care providers are faxed the patient profile for a total of 60 pages per patient. Fax machine errors often require the refaxing of some or all of the pages. Some providers will ask for additional patient information, requiring more pages to be faxed. Once a patient has been accepted to an extended care program, 10 pages of acceptance forms are exchanged. Whoever is paying for the patient’s care needs to receive the entire patient file, which is usually another 20 pages. In contrast, automated discharge practically eliminates paperwork and reduces faxing to next to nothing. An automated discharge process enables case managers and other healthcare professionals to provide patient information to multiple extended care providers simultaneously via a HIPAA-compliant electronic transmission. Speeding up and automating the discharge process increases hospital throughput and significantly reduces the amount of avoidable days and losses due to reimbursement denials. Hospitals can build a database on automated discharge processing software to meet their needs and add forms based on the templates provided. “We feel an automated discharge process has helped us set a standard for our work and helped us be more efficient,” says Barbara Liegel, RN, MS, director, coordinated care department, University of Wisconsin Hospital & Clinics. “If one person was off work, one document could be missing or not available. Now with templates, everything is online.” The Extended Care Information Network’s (ECIN) patient discharge software helped Baptist Hospital in Pensacola, Fla., discharge patients out of the area in advance of Hurricane Ivan. “We had a number of discharges, more than usual, prior to Hurricane Ivan,” explains Mary Raisler, BSN, RN, CPHQ, Baptist Health Care’s director of resource management. “If we had spent our time on the fax or telephone [trying to discharge patients], we would not have had time to refer patients that were ready to discharge to other care facilities. Additionally, we facilitated a number of patient placements and DME [durable medical equipment] needs in the emergency department. ECIN allowed us to quickly obtain equipment and placement approvals, then facilitate the appropriate plan rather than an admission. We worked long hours before the hurricane to get those patients out ahead of it.” Automated discharge planning software contains a database of many thousands of extended care providers (ECIN has 85,000 in its database) and can identify dozens of extended care options for a particular patient in just minutes. A confidential patient profile is sent electronically to the relevant local providers, who then respond with a yes or no or request more information. The case management staff is then able to quickly put together an information packet for the physician, patient, and family to explain in detail the available extended care options. Automated discharge planning software provides more information to health professionals in a fraction of the time and still leaves discharge in the control of physicians and families. Reasons for Automating Discharges
Vary Automating the discharge process and streamlining it to maximize staff efficiency means that staff has more time for other tasks. “We were having increased capacity problems, and there weren’t enough beds on any given day,” Liegel notes. “A few beds usually opened later in the day, so we began to look at ways to support more effective throughput procedures. Someone suggested more efficient case management. At that time, there were only a couple of vendors on the market.” Baptist Healthcare chose ECIN for a number of reasons, but primarily because the software could automate discharge planning decisions. “This allows us to improve quality of patient care by reducing avoidable days, improving care across the continuum by improving information flow, and improving patient satisfaction through facilitation of care,” says Raisler. “Our staff was using manual processes that included copying and faxing records and spending a lot of time on the phone. It was very time-consuming and costly. Now we’re able to get reports about care providers. We’re able to show the patient his options. When I searched for an automated discharge product to assist us, I wanted a Web-based product that was complete and updated and a company that was very responsive.” Liegel adds that ECIN has helped her department standardize its forms through the templates provided. “It’s easier to say to a clinician, ‘Here’s what you need to sign,’ [and hand him or her a standardized, printed form],” she explains. “And in the past, we would get calls from a nursing home complaining about an aspect of the patient, such as, ‘You didn’t tell us the patient was TB-positive.’ But now that the forms are all standardized, we don’t get those calls anymore.” Challenges to Automating the
Patient Discharge Process Raisler notes that implementation challenges for Baptist were hardware deficits and a lack of technology knowledge for her 27-member team of case nurses, social workers, and utilization review and appeal coordinators. Some of the team had never used computers or e-mail, and although they were willing to try it, making time to teach these new users was a challenge. In addition, hardware was not available and wiring for hardware had to be completed before implementation. “They were very willing to try it. We were all very enthusiastic and embraced the technology,” Raisler recalls. “We made it [the ECIN learning process] a very positive experience, so any negative thoughts anyone had on their mind were bombarded by positive thoughts.” The week of implementation became a celebration and every small step was rewarded with blue ribbons, inexpensive gifts, and luncheons. At the University of Wisconsin Hospital & Clinics, the challenges to automating were convincing people who preferred to use the telephone become computer savvy and how to handle situations involving patients with complex medical cases. “Some of the patients’ needs are very complex,” says Liegel. “We can’t depend on automated discharge processing to take care of them. We need to talk with someone at the nursing home or care center about some patients’ needs.” The only drawback that Liegel has noticed is that case management initially took longer when ECIN was first launched because everyone was just learning how to use it. “It changes the way you do your work,” she explains. “We got through all of that by trying to improve our communication. I see us continuing to evolve with the product. We now have criteria sets to help us determine if the care level is better for a patient at a nursing home or someplace else.” One company has not had much success with its automated discharge processing software and is actually phasing its product from the market. Axiom Internet Commerce has noticed a reluctance of the healthcare industry to change what has always worked: manual discharges. Growth Is Slow but Steady “Our growth is 50% a year. It’s still a very small percentage, but it’s going to take time for hospitals to adapt. We hope we’re setting the standard,” he says. “We’re now doing a study with Cleveland Clinic that we hope will prove the value of automated discharge for large hospitals.” The Cleveland Clinic began its trial study of ECIN in July and has already increased productivity and discharges, according to Keyes. Most facilities can expect results within the first 60 days of using automated discharge processing. Liegel’s staff has tracked most of its throughput measures, including the percentage of days over target. She reports that the department went from 20% of discharge days over target to being under target. The previous target was 6.2 days, but it’s now at 5.6 because of a high case index. Many hospitals have yet to realize and acknowledge the capabilities of automated discharge processing, according to Keyes, and this fact, along with many hospitals’ reluctance to adapt to new technology, is holding them back. “Initially, we had thought that ECIN would eliminate fax machines. Our system provides organizations with a more efficient method to communicate, without using patient names,” he says. “When you have referrals to send a provider, it’s much better to send patient information with ID than to fax all records. Also, a date/time stamp is stored if there is ever a question about it. In a fax environment, you have no idea who’s seen the fax. All information on ECIN can be accessed only with a user ID and password. All data is encrypted at the highest levels of security. The user has the option to provide patient identification information. Initial referrals mask the patient ID.” Liegel believes the low number of automated discharge processing users is due to the large number of small hospitals across the country, many of which may not feel the need to go online for discharge processing. (For the record, University of Wisconsin Hospital & Clinics is home to 471 beds, while Baptist Hospital hosts 492 beds.) Until they realize the benefits of increased efficiency and patient throughput, they won’t see the need to automate their discharges. “We’re all moving toward automation. I think it [automated discharge] will become the standard, probably within the next eight to 10 years,” she says. Raisler sums up the reasons why automated discharge planning is invaluable to her team at Baptist. “We’re able to standardize documentation, facilitate care planning, and get responses quicker, thereby facilitating discharges quicker,” she says. “In cases of trauma, we can link with facilities across the U.S. to find a facility near the patient’s home or one that better meets a patient’s needs, with the click of a button. The first day we went ‘live’ [online with ECIN], one of my case managers contacted 100 facilities online for a difficult placement. We received answers by page within one minute of sending the referral and the beeper continued to go off all night. The next day we had several responses from interested facilities. Multiply that by the time spent to copy, then fax to 100 facilities, then by the hourly wage of that nurse and you realize the savings [automated discharge] can provide.” — Laura Gater’s medical and business trade articles have been published in Medical Imaging, 24x7, Podiatry Management, Veterinary Forum, Corrections Forum, and other national and online publications. |
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