In an article in Forbes business magazine today, Peter Ubel, begins to investigate the question of whether or not we should be striving for a world in which all transplant candidates should have access to LearJets so that they can place themselves on multiple waiting lists and have a greater chance of reaching the top of that list in time? No matter how you feel personally or professionally about this issue, an important point that he raises in the world of transplant is this: as technology (planes, drugs, etc.) improves and allows for greater possibilities of organs for a greater pool of candidates, how can we be sure that waitlists are always accurate and up to date.
Recently, I had the misfortune of sustaining an injury while running. Due to the nature of my injury I visited a total of five providers in the span of one week. The events that unfolded provided the perfect opportunity to reflect on the state of health information interoperability six years after the passing of the HITECH Act.
You finally found the perfect solution to problem of getting data out of documents and into your EMR or other system. It’s a system that automates this data entry and the workflows surrounding the entire document handling and quality assurance processes. Now it’s time to go ask for permission (budget) to purchase this solution.
As we discussed in our first outreach blog, step one is to establish a relationship with a provider or a network of providers through education or other interactions. Once you’ve created this relationship, you will want to capitalize on the potential additional volume for your program and institution, as well as be able to continue to provide the outstanding service your program is known for. In order to do this, you must be able to make working with you seamless and easy, without increasing the actual or perceived burden to the organization’s patients.
In our next series of blogs, we will discuss the concept of outreach and how programs can use it to improve not only their volumes, but also their outcomes. Outreach can be simplistically defined as the act of reaching out to a group. It may also be defined as a systematic attempt to provide services beyond conventional limits to a particular segment of the community. In this blog, we will concentrate on the former definition, namely, reaching out to different groups to grow our program.
The HITECH Act and Meaningful Use requirements have ushered in a new era of health information management that promises to deliver better care quality, greater efficiency and at a lower cost. It’s also putting more pressure on staff to get clinical data into the EHR data fields. As a result, already strained resources are being strained even more. The health data integration dilemma is especially acute when dealing with external data sources, such as clinical labs that often arrive by fax or are made available via portals.
When asked to evaluate workflow processes in transplant programs, we often here from hospital administrators that their transplant program is over-resourced and they do not understand why work-up time is so long, why patients complain that it takes so long to get a phone call returned or why the physicians always ask for more staff. " Do you know what your transplant staff is truly doing?", is usually the next question we ask. Not to our surprise, the answer is "of course".
Tracking Data is a Key Component of QAPI Programs, not only for CMS but also now with UNOS
One of the most challenging aspects of transplant program management is ensuring that your Quality Assessment and Process Improvement programs are measuring meaningful and actionable items that lead to program improvement. There are many factors that contribute to these projects but one thing in common is that they are all data-driven.
Case finding is a never-ending cycle of review and follow up. It’s an enormous manual effort to abstract data from patient files to populate hospital, central, state or the National cancer database to complete the case entry; as well as checking on the status of cases in suspense and quality control that binds it all together. Though I’m not a certified registrar myself, I definitely get the impression from those that I have spoken with that they continue to be fiercely devoted to the important work they do; and are steadfast in getting it right.
When you hear people talk about a Continuity of Care Document (CCD), funny enough, it’s actually usually a “document”. In reality, the specification for a CCD, according to Wikipedia, is “an XML-based markup standard intended to specify the encoding, structure, and semantics of a patient summary clinical document for exchange.” CCDs are important to patient’s treatment, but its original intention of being a way for pertinent patient information to be transferred one system to another has not yet been realized. So, when patients are referred to another physician or if CCDs are trying to be used to convert massive amounts of data from one EHR to a new EHR, the exchange of information is often not seamless.
Transplant care teams have enough challenges managing patient information arriving from outside their institution. It's already a full workload entering primary data from the transplant evaluation process. It's a never ending process of data entry for solid organ programs. EHR adoption is adding to that already heavy workload and is creating the need to enter more discrete data. Ask yourself: isn't it enough that your solid organ transplant teams sift through a large number of non-electronic patient details from their originating healthcare institution?
There’s been a lot of news lately about the 2015 NIH budget being flat, worrying researchers that the funding pinch will have a significant impact on current and future projects. Even Nobel prize winning researcher Craig Mello from the University of Massachusetts Medical School recently commented on the impact this could have on his ongoing work, noting that if he couldn’t get a grant he’s applied for he may have to reduce staff.
As we assist various programs around the country, one of the things we are asked is how does a program balance staffing constraints while accomplishing the many administrative and clerical tasks that are required and still deliver high quality patient care. Frequently when addressing staffing situations, what we find is that programs may have sufficient staff but everyone is doing so many other tasks that it detracts from their true function. Other times, we find that the program is simply understaffed for the volume or number of patients that they are caring for. While the scenarios seem to be different and one would think require different solutions, an assessment of staffing needs begins with an understanding of each role and what tasks that role is actually required to do (not just what we think they are doing). Once the tasks are defined, an understanding of the work flow processes and the current operational chains that each task requires is needed.
The ultimate juggling act: clinical labs in a hospital setting are required to maintain the highest operational standards. They complete their own inpatient testing while managing the logistics of send-outs and the returning results from reference and specialty labs. No matter where it’s coming from, comprehensive data needs to get back to the ordering physician - data required to make the best care decisions.
I was researching topics around data accuracy in healthcare the other day and came across this AHIMA article from 1997 (did we even have the internet back then? J). The article was focused on a growing demand for accurate coded data and as I read the article, I felt that AHIMA was ahead of its time and like I was in a time warp. They were stating the importance of data accuracy and consistent coding to speak about how “these data are used to assess resource utilization and outcomes throughout [accurate-data] the delivery system and to develop plans for the provision of more efficient and effective patient care.”
Let’s imagine that you like the features of your transplant database and your hospital is transitioning your department away from your comfortable and dependable software, into an enterprise application. You’ve likely heard this transition makes sense and will provide costs savings for the entire organization, but you might be wondering if the cost savings will benefit your department. There are obvious economies of scale with an enterprise solution, but you can’t help but wonder if this will create new problems for you. Having access to clinical data within the continuum of care is wonderful, but it hasn’t eliminated the need for a fax machine.