Case Study 7.1: Improving Infant Care Through Standard Based Electronic Reporting
Standards-based electronic reporting to newborn public health programs increases positive patient outcomes, saving time and money for hospitals. 1999 marked a watershed year for babies born in Texas. It was the year the Texas Legislature mandated screening of every baby for hearing loss, the invisible congenital disability that directly and personally affects children and families — as many as 15,000 children over a generation. Undiagnosed or late diagnosed hearing loss can affect a child’s language, learning, and long-term productivity. If hearing loss is identified at birth and children receive follow-up intervention services, they will learn language like their typically-developing peers and better that we can ever hope to teach it to them.
Reporting to public health and follow-up by public health have been in place, but studies have shown that follow-up can fail if contact information for the child is incomplete or inaccurate. In 2012, the state initiated a health information technology standards solution to this problem. The solution, based on the technical profile from Integrating the Healthcare Enterprise (IHE), is known as Newborn Admission Notification Information (NANI). NANI accepts automated Internet-enabled reporting of newborn next-of-kin contact information from Texas birthing hospitals’ electronic health record systems, paving the way for achieving Meaningful Use Stage 2. It sidesteps manual data entry that is redundant, inefficient and error-prone. The new standards-based message implementation does all this unattended. This frees up time for hospital staff to take care of babies and means more infants receive needed care.
Case Study 7.2: Physician EMR Use Creates Efficiencies
Installation and deployment of a fully integrated electronic medical records system and a practice management system has had a number of positive effects on a Central Texas family medical practice. The system provides the practice with electronic charge capture at the point of care which, when combined with integration to a claims clearinghouse, has reduced collection days (the time from date of service to receipt of funds) by more than 70%, from 72 to 20 days.
Additionally, with better charge capture, the practice was able to significantly reduce lost charges. Pre-EHR, they estimated that did not charge for about 32% of x-rays and vaccines. With the EHR that rarely occurs. The positive financial impact of the system allowed them to recover their initial hardware and software investment in 26 months and increase overall provider revenue despite an 8% to 12% reduction of HMO/PPO reimbursement.
With the paper charts gone, the medical practice was also able to reclaim and remodel their chartroom for clinical functions, allowing the practice to double the number of providers and patient encounters within the same clinic space and reducing the per provider rent overhead by 50%. Improved processes have made their staff more productive. As an example, two experienced insurance specialists handle the entire filing and reconciliation of EOB’s for 9 full time providers with spare time to help with the phones. With greater efficiencies and higher reimbursement, this practice was able to allocate more resources to the practice to foster retention and improve customer service and patient care.
Case Study 7.3: HIT Brings Improved Efficiency in Lab Reports Delivery
A not-for-profit, integrated health system with over 1,500 physicians, a medical center, seven regional community hospitals, 140 different service sites, a large multispecialty medical group and a nationally recognized health plan used a health information exchange platform to improve the delivery of lab reports and results.
The system’s goal was to develop a solution that could be directly integrated with physician practices regardless of where they were on the technology adoption curve, as some providers had adopted an EHR while many others worked in paper-based practices. In addition, they faced a significant number of unhappy physicians who were overloaded with faxes and constant callbacks. At the time, the system was sending nearly 6,000 faxes to 1,600 physicians every day and with no capability to filter faxes – which not only was expensive and inefficient, but left physicians with a significant workflow challenge.
To accommodate the multiple care locations and diverse levels of technology maturity that exist across the health system, the system leveraged HIE technology using the same data feed to provide information via the web and via auto-print to paper-based physician offices – while offering discrete data integration with a myriad of EHRs to providers who were farther along the adoption curve and had successfully automated their practice and clinical workflow.
At this point, more than 800 physicians in 12 counties across more than 100 practices have been integrated into the HIE. Over 80 of these practices – representing more than 400 physicians – have been able to turn their faxes off completely. This has had a significant impact on workflow, operating costs and improved relationships with physicians.