An hfm Web Extra

Because of advancements in the stability and security of Internet-based applications, SaaS solutions give healthcare organizations the opportunity to access new and innovative technologies without the enormous capital costs previously associated with software acquisition. What are some examples of types of applications for SaaS solutions, and what kinds of healthcare organizations are using them?

Healthcare organizations of all sizes have taken advantage of web-hosted applications to reduce capital investment in IT infrastructure and ongoing maintenance costs. These applications address virtually every aspect of healthcare operations, from clinical to financial.

Quantros is a decision support software and services provider for the healthcare industry in the area of safety and quality improvement and offers applications for infection and medication surveillance, accreditation compliance, and clinical quality and performance improvement. Quantros applications offer a comprehensive view of a healthcare organization's clinical landscape via the capture, management, reporting, and analysis of data associated with quality, safety, and compliance. Decision makers use this information to improve clinical performance and provide a safe, high-quality environment of care.

Allscripts also provides support through applications that address a range of organizational needs specific to health care. Their care management system includes applications for discharge planning, documentation, audits (e.g., RAC, MIP), utilization management, and custom reporting. Allscripts integrates with Quantros safety and risk management applications to enable users to relate care management processes to quality and safety.

Among the physician practice management applications offered by athenahealth is a web-based electronic health record (EHR). athenaClinicals is integrated with the company's billing and practice management system to streamline back office functionality and enhance productivity. However there is also a decision support component in the form of an integrated clinical rules database that includes pay for performance and Physician Quality Reporting Initiative standards, formulary information and meaningful use criteria.

The integration of information from across the organization is key to driving the decision-support functionality of these and similar applications. To make decisions that protect revenue and enhance quality, stakeholders must take into account the co-dependence of data from all organizational domains. Discharge disposition for readmissions versus original admissions, for example, would impact both clinicians and CFOs. SaaS applications with built-in integration such as athenahealth's web-based EHR and Allscripts care management system provide a start in addressing this need. However vendor-agnostic applications such as Quantros IRIS that pool data from various feeds and make them available for reporting and analysis will become an increasingly valuable tool for healthcare organizations looking to maximize the return on the wealth of digital data that they are collecting.

For finance leaders, the immediate concern is to understand the complexities surrounding integration and ensure that steps are taken up front to translate and normalize data for use across the enterprise. How can data of one type be translated for use in connection with data of another type?  

Pay for performance is on its way to becoming the dominant reimbursement schema. More than any other initiative, pay for performance makes imperative the transformation of clinical data into information comprehensible to the financial team. Core measures data, for example, must move beyond their historical role as an area of interest primarily to clinicians to being associated with a dollar value.

The cost of noncompliance is clearly spelled out in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, clearly gaining and keeping CFOs' attention. However, the formula at the service or patient level isn't simple, mainly because the additional costs related to core measures compliance/noncompliance make a one-to-one relationship difficult to document. Costs incurred through increased length of stay, readmissions, health-care acquired infections, and other potentially nonreimbursable expenses can be associated with noncompliance with core measures processes, however.

Analyzing length of stay for the top diagnosis-related groups (DRGs) (by volume) by provider, for example, and then cross-referencing this with compliance with core measures will provide a more nuanced view of a care environment that today heavily influences reimbursement revenue.

Correlating patient safety data with demographic and cost data also typically provides clinicians and administrators with identified aspects of care that must be improved. The analysis of falls, with their associated harm, yields relevant contributory factors that, when ameliorated with fall-prevention programs, reduce costs associated with injury from the fall.

Role-based application architecture operates on a many-to-many principle, where data from multiple sources are distributed to many individuals, each of whom has a specific profile for data access and permissions. This type of architecture allows users to customize their environment to monitor metrics critical to their role across financial, operational, and clinical domains. This type of construct can empower decision makers and guide them toward the most financially prudent and clinically sound options. What are some examples of different sets of metrics that can be used in making the types of decisions that can promote value?  

Core measures compliance data is a resource for both clinical and financial decision makers. The usefulness for clinicians at the point of care is obvious. If a particular nursing unit has a low compliance rate for providing pneumonia patients with antibiotics within six hours post-admission, for example, increased attention will be paid to ensure that this standard of care is met. Fortunately applications such as Quantros Care Insight that generate automated, time-sensitive notifications can help clinicians achieve best practice and adhere to core measures and other regulatory requirements. In an environment dominated by pay-for-performance reimbursement initiatives, core measures data are of equal importance to a finance-based stakeholder. CFOs will be interested in core measure performance and the correlation of these process metrics to the financial ones. For example, for those pneumonia patients who don't receive their antibiotic on time, is their LOS longer than those that do receive it?

Compliance data as it relates to reimbursement data can be finessed and presented to the finance department in a format intelligible them. Noncompliance with particular core measures, such as heart failure, may result in extended stays and fewer reimbursements based on DRG volume and other factors that would not be relevant to clinicians.

Sanjaya Kumar, MD, is president, CEO, and chief medical officer, Quantros, Inc., Milpitas, Calif. 

For more information, see Sanjaya Kumar's "What Finance Needs to Know About Using Technology to Improve Value," hfm, January 2011.

Publication Date: Monday, January 03, 2011

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