SCENARIO

Doylestown Hospital, a nationally recognized medical facility in Doylestown, PA, is a 196-bed regional acute care facility that serves the greater Bucks and Montgomery counties in Pennsylvania and sections of Western New Jersey. The hospital has been a CareScience client since 1998 and handles over 12,000 admissions, 1,500 births, 34,000 emergency department visits, 38,000 visiting nurse visits, and 270,000 outpatient visits a year.

During the first year of implementation and use of the Quality Manager™, Doylestown had to create a special workflow to extract their patient data from their facility's proprietary hospital information system. Because the information system had limited interoperability with other vendor applications, CareScience had to engage a third party vendor to format batch extracts of clinical data for use in the Quality Manager. This additional interface made the quarterly download process cumbersome and inefficient and prevented Doylestown from getting timely access to their clinical data for analysis within the Quality Manager. Doylestown's challenging integration and implementation history made them an ideal candidate for the CareScience Clinical Information Architecture™, a state-of-the art data and communication platform that enables the secure electronic exchange of information between CareScience and its clients.

WHAT IT WAS LIKE

Before the advent of the Clinical Information Architecture, Doylestown's quarterly download process required several points of manual intervention and was multifarious in nature. Files had to be hand selected using menus within the hospital's information system and downloaded into individual reports. The generation of these reports took 48 hours to complete. The report files were then re-formatted using a third party vendor's software and formatted into 24 separate files. The individual files were then saved to a folder on the hospital's network drive, renamed, and zipped into one file to be sent off to CareScience via email or floppy disc. Once the data arrived at CareScience, a validation report was generated for each file and sent back to Doylestown for review. Doylestown then corrected the errors within the text of the validation file and emailed it back to CareScience. CareScience would then re-key the corrections to the original data files and move the data into production for analysis. Since this process also included a 30-45 day prerequisite abstracting component, the whole process took 60-75 days to complete and sometimes resulted in missing or incomplete data files.

THE OPPORTUNITY

In 2001, CareScience approached Doylestown with an integration partnership opportunity. CareScience wanted to deploy its newly released Clinical Information Architecture in a live clinical setting and Doylestown offered the perfect customer environment.

The newly installed Clinical Information Architecture would provide Doylestown with a real-time interface from its hospital information systems to CareScience. The integration project specifically focused on establishing connectivity and the validation of HL7 messages. The rational for the Clinical Information Architecture included technical benefits, business drivers, and patient care improvements.

Technical Benefits
The new data transfer approach would reduce Doylestown's ongoing data transfer burden, shorten the data validation process by enabling data validation to take place online, and ultimately reduce staffing costs associated with manual data transfer. By participating in the integration project, Doylestown intended to simplify its cumbersome quarterly download procedure, reduce its dependency on third party vendors for data interfaces, and build enhanced interoperability by using the HL7 industry standard and HTTPs communication protocol to securely transfer data.

Business Benefits
The real-time data access capability of Clinical Information Architecture would give Doylestown the ability to perform time-sensitive reporting and analysis within the Quality Manager environment. By gaining access to real-time data, Doylestown planned on strengthening their coding accuracy and physician profiling initiatives that were already in place, and measuring the impact of their performance improvements programs (coding procedural changes, new drugs, etc.) in a more timely manner.

Patient Care Drivers
The real-time data access and management capabilities of the Clinical Information Architecture would give Doylestown the ability to support care process changes at the point of care. As an integration partner, Doylestown wanted the ability to use real-time measurement and monitoring to effectuate changes in their care delivery setting at a faster rate which would benefit their patients at the individual level.

THE PROCESS

The first step to implementing the new Clinical Information Architecture was to discover which HL7 data elements were already in use at Doylestown and then determine what additional data elements and messages would need to be added. The CareScience integration methodology provided a traditional development cycle, including major phases of analysis, design, build and test. By following this methodology, the project proceeded according to plans and the schedules established early in the project.

During the design and build phase, the existing ADT HL7 interface was expanded to replace five report downloads. The billing accounts receivable (B/AR) HL7 interface was also expanded to replace 13 report downloads. By the end of the build phase, twenty-four downloadable reports were consolidated into four HL7 interfaces. The total interface development cost to accomplish this HL7 replacement was $17,000 and it took less than 6 months to complete. The new process for submitting and validating data went from a total of 60-75 days to a total of 35 days and followed these simple new steps:

Data Submission
Instead of having to submit quarterly data via email with a zipped file attachment, Doylestown begin sending their data electronically, via HL7, using a secure connection over the Internet.

Data Validation and Correction
Doylestown no longer had to rely on an Information Specialist from CareScience to prepare hard copy validation reports that were triaged accordingly and sent back and forth until resolved. Under the new model, CareScience made Doylestown's data available through the Data Management Utility, an easy-to-use, browser-based interface that allowed key analysts to check data delivery status, run validation reports, and make corrections or updates to their data conversion maps easily and quickly. It also gave Doylestown staff the ability to map their data to CareScience standard code-sets online. With detailed error messaging, robust status screens, and rich query options that could produce detail summary reports by query data, time, and facility, almost all of Doylestown's data fixes were completely within their own control. CareScience would only have to get involved in very specific data type fixes (i.e., deleting records, updates to primary key fields and test results, etc.). This shortened the timeline significantly for data submission and validation.

Data Release
Once the records were received and validation reports generated, the records that did not have errors would automatically move into production. Only those records with errors were halted until data issues were resolved. This enabled data records to be processed continually, providing a more streamlined pathway of data to be populated to the Quality Manager for use and analysis.

Previous Timeframe for Reporting Quarterly Data Timeframe for Reporting Data Using the Clinical Information Architecture Back Log Activity = 60-75 days Back Log Activity = 35 Days Medical Records Quarterly Submission Process Medical Records Real-time Submission Process Abstracting < 30 days Verify complete abstracting Create and submit data file CareScience generates validation report Work validation report Re-submit corrected/appended records CareScience file to production Abstracting < 30 days Data submitted electronically online Errors corrected daily and re-submitted using an online Data Management Utility Data loaded directly into production Total=30-45 days Total= < 30 days of concurrent activity and<5 days of post abstracting activity

Key Findings

The integration partnership with CareScience and the implementation of the Clinical Information Architecture has proven to be a successful investment for Doylestown. Still in the initial phase of the project, they have realized the following important strategic and operational benefits that will enable them to continue to save time and money as well as improve their quality management processes.

Reduced Ongoing Data Transfer Burden
Doylestown reduced their total data transfer time and backlog activity from 60-75 days to 35 days, a total reduction of 50%. They were also able to reduce the amount of IS staff time required to create extracts each quarter and correct programming errors. This will have a positive impact on Doylestown going forward as their hospital information system goes through revisions and upgrades.

Automation of Data Extraction and Validation
As a result of using streaming data interfaces and using the online Data Management Utility for data validation, Doylestown was able to lower their human manual effort required to download, submit, and validate their data by nearly 50%. They were also able to obtain greater control over their production information , i.e., when patient records are released into production, and an easier and more flexible method for facility coding and mapping. This could translate into thousands of dollars in cost savings per year for Doylestown.

Lower Ongoing Maintenance Costs
The implementation of the Clinical Information Architecture has significantly lowered Doylestown's future interface and development costs. As they add additional interfaces for enhanced clinical data sets, they will require lower developmental and maintenance costs because Doylestown can maintain most of their interface work in-house. If they do have to farm out a piece of the integration work to a third party vendor, the build effort will be nominal because the HL7 data standard allows Doylestown to receive data in whatever format that is the most cost efficient for the third party vendor.

Regulatory Compliance
The Clinical Information Architecture has helped Doylestown meet its regulatory requirements with greater ease. The Pennsylvania Cost Containment Council, a state benchmarking system, requires a quarterly download of hospital inpatient data to measure morbidity and mortality rates by DRG. The online data management that is provided through the Data Management Utility has given Doylestown the ability to correct abstracting errors online, creating an easier HC4 dowloand from its hospital information system.

Overall Windfall Value: Extended Care Management Initiatives
By investing in the Clinical Information Architecture, Doylestown is set up to use HL7 messaging for all of their system to system communications, which corresponds with their greater IT strategy. And as they expand their infrastructure they will be positioned to use the Clinical Information Architecture to scale for extended care management initiatives which include: capturing data to build an extended clinical data set (lab results, pharmacy dispensing, and ambulatory data), setting up a data repository for enterprise-wide results reporting, and the kind of prospective care management functionality that will be available through the next version of the Quality Manager.