Quick Results
In the language of clinical transformation, "quick results" or "quick wins" are
immediate improvements to the organization's financial performance or service
and safety levels that can begin to return value right away — often before
the enabling technologies are in place. Quick results may be cost savings or increased
revenue due to improving clinical or administrative processes prior to automating
them. Often, quick results are interim steps that can start to produce benefits
to the organization before a process goes online. Some quick results can be implemented
in a few weeks. Others may require a month or more before they can begin to create
benefits. These are very short time frames compared with the implementation of
a fully functional clinical information system (CIS).
Part of the initial planning process in any CIS implementation is to identify quick results and to estimate the value they can provide. The sooner a clinical transformation initiative can begin to return value to the organization, the greater its overall contribution. Quick results also help to provide the necessary momentum and buy-in by physicians and other clinicians. In addition to delivering value sooner, quick results can help to keep a large-scale CIS project on track (see Figure 1).
Figure 1: Identifying quick results and quantifying their benefits is part of CGE&Ys approach to clinical transformation.
Capitalizing on Process Change
Many quick results focus on the benefits of changing processes. Implementing extensive changes to IT architectures and developing new applications is a complex, time-consuming process. Changed processes can be implemented in a paper format to deliver benefits before they go online. Processes can be streamlined, duplication of effort reduced, and efficiencies realized by taking an expert, focused look at how patient care is delivered. Existing practices can be compared with industry leading practices. Teams look at improving core care delivery practices, not just ancillary functions such as finance and billing.
A central feature of an advanced CIS is the capability for automated physician order entry. Before the process can be automated, a consistent array of order sets must be designed, based on prior experience and leading industry practice. Physicians can use these improved order sets on paper before the computerized system is implemented. Benefits to the organization include better communication between physicians and other clinicians, less variation in treatment approaches, and improved patient safety.
Information sharing is a common theme for quick results. Even before the CIS is fully implemented, simply sharing information among existing departments using legacy information systems can increase revenue recognition and reduce operating costs. These benefits to the bottom line help to strengthen the business case for the clinical transformation and increase the system's lifetime return on investment.
"Direct" Financial Benefits
Quick results are derived directly from process changes and sustained through the technology-enabled transformation of core, clinical, and business processes within the first year of system implementation. These improvements begin driving value almost immediately upon implementation, and continue to improve performance year after year. These direct benefits are generally easy to measure using readily available, generally agreed-upon and understood measures of performance (days in accounts receivable, number of inventory turns, percentage of patients receiving pre-certification and insurance verification, etc.). Process areas that provide fertile ground for quick results include:
- Supply management
- Denial management
- Care/capacity management
- Physician order sets
- Patient access
- CDM/DNFB reduction
Supply Management
Automating supply purchasing (item master) and inventory processes illustrates a clinical transformation "quick result." Product standardization reduces practice variation and often entitles organizations to better pricing from a limited number of vendors. Automated purchase orders, tied to a vendor's automated invoicing system, reduce processing costs for both organizations. Such an organized method of purchasing allows healthcare organizations to take advantage of group pricing and other preferred vendor benefits.
Denial Management
Standardized, automated processes for performing accurate and timely insurance verification, pre-certification, and authorizations, often when combined with direct electronic communication with third party payers, results in decreased frequency of administrative and clinical denials.
Care/Capacity Management
Redesigning the key care management functions, initial/ concurrent review, care facilitation, payor communication and discharge planning will help improve length of stay, cost per case and decrease clinical denials. Improving patient throughput from points of entry to disposition results in decreased hours on emergency department diversion and decreased delays throughout the process.
Physician Order Sets
Standardized physician order sets decrease clinical variation, length of stay, and cost per case and improve care along the continuum. Order sets can be developed in paper format, implemented, monitored and evaluated to determine additional improvements prior to implementation in the CIS.
Patient Access
Automating the processes by which patients access clinical services — quickly acquiring accurate registration information, insurance verification, coverage options, and other billing information, and integrating this seamlessly with other patient data — helps providers collect revenue faster and more reliably. Meanwhile, the cost to capture and process this information decreases significantly. Linking this information to the patient's managed care company further improves cost recovery.
CDM/DNFB Reduction
An advanced clinical information system incorporates a "charge description master (CDM)," containing the thousands of drugs, supplies, and other consumable items a hospital stocks, and the price that the hospital charges for each. Standardization and streamlining of ordering methods results in more efficient use of resources and reduced operating costs. More efficient electronic record keeping with accessible, current medical records facilitates more expeditious billing. A properly implemented CIS dramatically reduces "discharge not final billed (DNFB)" patient records.
Real Results
Some quick results are the result of sharing information previously isolated into functional or departmental "silos." For example, one health care organization in the beginning stages of implementing a clinical information system discovered that outpatient case managers routinely produced assessments of elderly patients. This information sat on a shared drive, but its existence was unknown to the inpatient case managers. A quick result was simply to make the information on this shared drive accessible to both inpatient and outpatient case managers. Though the eventual CIS will routinely share all kinds of patient information throughout the enterprise, this quick result produced benefits in patient throughput and efficient use of scarce resources that will grow as a new, integrated CIS is brought online.
Better capacity planning is a quick result that can be of great benefit to hospitals where inpatient beds are often in critically short supply. Patients may have long waits in the emergency room before they can be admitted. Caring for these "in transit" patients can place a strain on already scarce resources. One proven method for improving inpatient capacity is to establish an "extended length of stay (LOS)" program composed of physicians, case managers, social workers, and hospital executives. The objective is to look at patients with extended LOS days and who have complex transition needs. Once a patient reaches a threshold number of days in an acute care bed, the extended LOS team, which meets several times weekly, evaluates the patient's case to investigate and explore post-acute care options. Patients are automatically evaluated once their length of stay exceeds a prescribed limit, perhaps five to seven days in a community-based hospital, or as many as 25 days in a large academic hospital. Earlier in the process, physicians can identify patients for whom the inpatient level of care is not medically beneficial, as a result of failed surgery or some other condition. These patients can be transferred to a post-acute care setting in a timely manner. Patient care, care delivery costs, and the hospital's throughput all increase as a result. In one case, implementing this quick result reduced the number of extended-stay patients from 56 to 36 within about a month's time. That's the equivalent of adding an entire new acute care unit to the hospital. Financial benefits can come from per DRG cost reduction and additional revenue from new admissions, demand permitting.
What Can We Do Now?
Clinical transformation is a two-step process. First, improve the clinical processes. Second, design the enabling technologies that will support and sustain the new processes. This helps assure that organizations aren't merely paving cow paths by automating sub-optimal manual processes. It also opens the possibility that the work of re-designing processes can deliver benefits before those processes are automated.
Once the doors to innovation are opened, new ideas for process improvement can be solicited and implemented. Executives need to motivate their directors and others to ask, what can we do next? Executives need to recruit sponsors for these new ideas and hold them accountable for implementation and ongoing success. Everyone involved in implementing a clinical information system must guard against technology paralysis — the notion that no changes can occur until the system goes live. The discovery and development of quick results is not an independent task, but occurs in parallel with other phases of the system implementation. In almost every department of the hospital, in almost every key care delivery process, there are quick results to be discovered and implemented. They represent immediate ways to provide lasting value for a health care organization in the process of clinical transformation.
