STEP BY STEP - Diamonds in the Rough

Experts offer tips for mining HIS/RIS data for the valuable information it contains

By Renee DiIulio

If information is today's most valued commodity, then institutions—particularly those in the medical community—should be mining their data for gems that will improve their business. If analyzed, the information contained in the HIS and RIS can lead to improvements in patient care, safety, and satisfaction; greater efficiency and productivity; and increases in market share, revenue, and the bottom line.

Of course, the data has always been there, but compiling and analyzing it by hand made it nearly impossible to exploit to its fullest extent. Even today, hurdles exist, whether they are related to realizing that the tools even exist or to acquiring the technology that allows flexible analysis.

"Many institutions are managing the obvious things—patient demographics, patient encounters, insurance tracking, relationships with referring physicians, billing, documents, and employee productivity," says Tim Kulbago, VP of product innovation at Merge eMed for Merge Healthcare (Milwaukee). "The biggest benefit is seeing the trends that are happening in real time—for instance, why is this referring physician not sending as many referrals? Or, why are we doing so many PET/CTs?"

Tracking information in real time can provide immediate information on productivity and workflow. Shown here is the FUSION RIS product from Merge.

But there is more to be gleaned from the data. "The information provides sound, unbiased business metrics that can be used to manage the business," Kulbago adds.

So the data can be used not just to provide a picture of what is occurring in the institution, but also to help make business decisions. "An imaging center can market itself better, and a hospital can use [the data] to make workflow efficient and control costs," says Ken Rosenfeld, worldwide general manager of information management solutions at Eastman Kodak Co (Rochester, NY).

Adds John Kampfhenkel, sales engineer for the Eastern region of Raintree Systems Inc (Temecula, Calif), "It's basically unlimited what can be tracked."

Looking to take advantage of the data contained in your HIS or RIS? What follows are some ideas to do so gathered from six information experts.

Keeping it Safe

When HIS and RIS communicate, data does not need to be manually entered twice. As a result, technologists perform less data entry and have more time to focus on patient care, says Dave Jones, senior product manager for Misys Healthcare Systems (Raleigh, NC).

Randall Swearingen, president and CEO of Swearingen Software Inc (Houston), says that better tracking of patient data leads to better care in general. With one general record, caregivers have access to all of the relevant information stored in it. Providers can see if a patient suffers from claustrophobia or drug allergies; they can note which intravenous sites have been used previously; or they can check relevant lab results.

Jones notes that with the national EMR proposed by President George W. Bush, patient data will be consistent throughout the country. "Sharing of data is not error free, but 98,000 Americans die annually as a result of medical error. The synchronization of data can be leveraged to reduce this number," he says.

Urgent needs also can be more readily addressed. "For instance, a physician might discover that his patient is pregnant and, by creating a report from the information systems, can see how much radiation she has been exposed to," Swearingen says. In another example, a hospital needs to determine who is taking a specific drug that has been recalled. Hemant Goel—VP of sales, radiology, and clinical imaging for Cerner Corp (Kansas City, Mo)—mentions one client who, by running a report, located within a short time frame roughly 143 patients taking a recalled cholesterol drug.

Information also can advance treatment. "We have become better and smarter because we have a feedback mechanism to look at treatments and trends. We can ask such questions as, 'Which works better: a chest X-ray or a CT scan?' " Goel says.

Use of the appropriate exams improves not only care but also efficiency. "Departments feel that many orders are irrelevant, and they want to know why," Goel says. "If you increase relevance, you are in greater compliance with

evidence-based medicine. Who is sending patients with the wrong diagnosis? You can analyze relationships not just for identification but also for quantity and quality."

Polishing Efficiency

The ability to deliver text and images in formats convenient for physicians improves their workflow and satisfaction.

Goel suggests that institutions can track the information used for a medical diagnosis. "How many times is the EMR accessed, and how often does it help to change the diagnosis?" he asks.

Being able to track the data makes it easier to show compliance with standards, such as those endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO of Oakbrook Terrace, Ill), Goel notes.

Linking the systems also creates efficiencies. "With RIS systems, a lot is appointment-centric—booking appointments for specific procedures. With that procedure comes paperwork, documentation, signatures, and billing needs," Kampfhenkel says. One of Raintree Systems' clients has linked scheduling to checklists so that the protocol and procedures for both the patients and the technologists are available from the file.

The system also can be linked to billing. "The technologist does not need to know the billing codes, but can just identify the procedure—for instance, an X-ray on the left knee," Kampfhenkel says. "The system narrows down the procedure code, reducing the possibility of operator error and improving efficiency for new staff."

Also, steps within the department can be linked. Transcriptions do not need to be couriered daily. Some institutions have set up the system so that the provider completes the dictation and it automatically appears on the transcriptionist's to-do list. "One institution outsources the transcription to India, resulting in even greater cost savings," Kampfhenkel adds.

Stepping Up Production

More efficient procedures and personnel will naturally result in greater productivity, but information systems can be used to track this data as well as locate areas for improvement. Swearingen says that the systems should be able to track the productivity of every step in the chain, including the work of radiologists, technologists, and transcriptionists.

Workflow can be improved through the analysis of historical data and department bottlenecks. "How long is a patient file in a certain area, such as with the transcriptionist? How long does it take the radiologist to sign off?" asks Swearingen, who suggests that questions like these can help determine where the hospital is shorthanded.

Workflow analysis also can result in improved protocols. Swearingen cites a facility that found higher-than-average repeat rates that did not differ by machine, product, or technologist, but rather by procedure. The institution retrained the staff, and the repeat rates dropped to normal.

Making Best Friends

LANGUAGE BARRIERS Just like people around the globe, instrumentation and equipment can have a hard time communicating in the same language. Ken Rosenfeld of Eastman Kodak Co notes that at one facility, the Kodak RIS interacts with 17 other systems in the facility, including scheduling, billing, the laboratory information system, and email. Standards, such as IHE, HL7, electronic data interchange (EDI), and DICOM, help to overcome this barrier by providing a common language for the systems to speak to one another. Administrators should ask about this interoperability before purchasing a new system. If a system uses HL7, problems typically are minimized. "Generally speaking, compatibility issues have been resolved. IHE protocols work out the mechanics of integrating the systems and frequently get an institution 90 percent of the way there," says Tim Kulbago of Merge Healthcare. "In some instances, it's an extra hurdle for the last 10 percent, but the vendors can work together to overcome this." Closed, proprietary systems are more likely to present greater obstacles for data mining, particularly if they do not use HL7. "But if you have the DDF [data definition formats] files and knowledgeable people with experience, you can still create reports," says Randall Swearingen of Swearingen Software Inc. The question becomes more important for what is essentially a replacement market. Institutions are in various states of technology and do not tend to acquire systems in the same order. "A hospital needs to ask before buying whether it wants a clinical system or a business system. If their needs are purely clinical, integration might not be so important," Kulbago says. But as more value can be mined from the data, clinical needs are less likely to be the sole criteria. — RD

The customer experience can be tracked to measure both physician and patient satisfaction. From the patient perspective, the institution can look at such factors as how the paperwork is filled out, how long the wait is, and if patients can find their way or are getting lost.

Reports can be compiled to respond to provider concerns—for instance, a referring physician complaining about wait times can see data showing how long his patients have waited.

These reports can be delivered in a variety of formats, including through secure mail, the Internet, or on CD, and can combine textual data and images, resulting in quicker and more satisfactory service, says Kodak's Rosenfeld.

Panning for Gold

Happier physicians will refer more patients. Analysis of referrals can provide information that shows who is referring the most patients and revenue, as well as who is not. "If a doctor isn't sending patients for scans, maybe he doesn't know about the new MRI machine. If patients from a nearby ZIP [code] are not coming to you for a certain procedure, that group of referring physicians can become a marketing focus," suggests Misys' Jones.

Targeted marketing campaigns can be developed to appeal to both the referring physician and the patient. Demographics can reveal exam counts and revenue by age, sex, or other specifics. "If one group is weak, draw them in with targeted advertising or marketing, such as a billboard or ad," Swearingen says.

Similarly, if business drops off, the institution can see the negative impact and how it can be combated, Jones says.

Business analysis can determine where resources should be applied. "Which areas are successful and could draw more patients?" Swearingen asks, noting that waste also can be targeted. He notes that a report can be created to show month by month how many exams, in revenue if desired, were referred for appropriate versus inappropriate criteria. "Since inappropriate exams are not reimbursed," he says, "identifying these and reducing them can result in less wasted cost."

Waste also can be identified in other ways. HIS and RIS systems can be used to track equipment downtime and repairs, as well as evaluate service contracts and history—information that can be used to make better decisions regarding the acquisition of new equipment and service contracts.

Just tracking information can improve the bottom line. Swearingen cites one instance where a client implemented a RIS and found a $220,000 discrepancy in charges that had been lost in the HIS.

The systems can track what has been billed and collected, time for reimbursement, and insurance breakdowns. Efficient billing will result in an improved bottom line, even without new revenue.

"Information is power. These systems can prevent loss of money through the cracks. With multiple views of the data, you get a better image of the business," Swearingen says. Properly used, data mining will provide this multifaceted view.

Renee DiIulio is a contributing writer for Medical Imaging.