Healthcare providers keep watchful eye on KM advances

Ever vigilant, the medical profession looks to technology not only to improve diagnostic and therapeutic equipment and the quality of treatment, but also to hasten and enhance the delivery of medical information. The ability to instantly access patient records from wherever they happen to be is crucial to the livelihood of caregivers and to the survival of their patients.

Among the challenges facing the healthcare industry is integrating important information from disparate systems in various formats. As more and more hospitals merge, so too must their knowledge. A KM-based enterprise system can help pull documents together from different systems and different formats.

“With hospitals buying hospitals, who knows what the system will be at the next hospital you buy?” says Dave Hinz, director of business alliance for Cypress. “Each page of a record has to essentially be its own mini database.”

Many doctors are becoming more technologically savvy, and they want to be able to access patient records from the Web and hand-held devices. That presents another challenge, because the government is mandating stricter privacy rules for patients records, requiring hospitals to closely guard information and track the people who view a patient's electronic file.

The security of patient records is mandated by the Health Insurance Portability and Accountability Act (HIPPA), which became law in 1996. The act includes a set of federal regulations regarding privacy and confidentiality of patient information. Any organization with patient information must prevent improper access to electronically stored records or the interception of electronic transmissions containing patient information.

The majority of healthcare organizations that fall under those regulations must comply by February 26, 2003. While it is unclear how the Bush administration might change those regulations in the future, the final privacy rules were released on December 20, 2000, and the remaining regulations are expected to be released in 2001.

Interaction Meanwhile, patients are eager to get more involved in their own healthcare, and they want access to their records quickly and efficiently. Providing the patient with online access to the information while maintaining confidentiality is an issue facing many IT departments at healthcare organizations. As consumers use the Web for everything from buying books to balancing their checkbooks, they want to be able to interact with healthcare professionals online as well. They want to gain access to their latest test results and even schedule appointments online.

But providing patient access to data such as test results without any other information can raise more questions from the patient, which doctors and other medical professionals must be prepared to answer. The trend, therefore, is not simply to provide raw data but also offer the patient some interpretation of the results and support materials online.

"We're leveraging the Internet as a way to share knowledge among medical professionals as well as patients," says Hank Barnes, VP of strategy for Eprise, a provider of Strategic Content Management solutions. "We have to think about how these records are made available from the perspective of the user, whether that is a patient or a medical professional, not the knowledge creator."

Providing staff and patients with access to data is the driving force behind the information technology projects underway at Providence Health System. The organization implemented an electronic medical record system a few years ago and is now looking for ways to expand it. One way to broaden use of the system is to link patient records with an electronic database of physician reference guides.

"We've accumulated 15 to 20 key references and we've made them available online for our doctors," says Erik Sargent, enterprise application architect for Providence, which uses systems from Eprise, among other technologies. "Now there is no reason for them to subscribe to any sort of general medical journal, and that alone is a savings of thousands of dollars a year. The next step is to figure out how to tie together the reference information and the health reference library."

Saving Lives Linking medical records with other enterprise systems has the potential not only to save money, but save lives. Sargent explains, “If you link the patient records to some sort of disease database, it will help the doctors evaluate the patient’s symptoms. Based on the patient’s symptoms, there is an 80% chance that they have the flu, but a 3% chance they have the Ebola virus. It is a one in a million chance, but it can serve as an important reminder to the doctor to consider all of the possibilities.”

KM systems can also provide consistent information to the patient, Sargent says, especially when they are discharged from the hospital. Specific instructions are given to the patients based on the types of procedures performed and drugs they are prescribed. By linking to a repository of documents stored online, the hospital can reduce the chance that something is missed.

“We’re looking to increase automaton in a way that helps improve and control costs, but also improves quality,” says Terrell Edwards, president and CEO of PerfectServe PerfectServe.

“Many of the changes in technology are being driven by recent statistics. The number of deaths due to medical errors has risen. Employers are looking for providers, hospitals, as well as physicians, with integrated delivery networks. A centralized record database on prescriptions, for example, will show that drug A will cause a problem if prescribed along with drug B,” he says.

The ability for that information to be accessible to any doctor treating the patient was made clear in a recent case of an enlistee who died at an Army post. Due to a medical condition, the man was supposed to get vaccinations periodically.

“Over the course of time, the fact that he needed the vaccination periodically got buried in his Army medical file, and he died,” says Larry Albert, healthcare practice leader for Integic.

A rise in the use of standard databases such as Microsoft SQL is making data sharing among different systems easier, according to Edwards. “The medical industry is moving toward open standards that were a given as of three or five years ago in the corporate world,” he says.

With a knowledge-based system, the physician could have received a prompt in the form of an e-mail or other electronic message that the patient was due for a vaccination. In addition, the patient could have been reminded, perhaps via e-mail, to make an appointment for the vaccination.

The adoption of standards-based systems will also make it easier to put the information out on the Web for patients as well as healthcare professionals to access. What has many doctors worried, according to industry observers, is providing the information to the patient without any analysis or explanation.

“Putting test results into a patient’s online electronic record database without providing them with any idea what those numbers mean may only alarm the patient and result in more phone calls to the doctor’s office,” says Integic’s Albert.

Also, such information as lab results needs to be in a different format when communicating with a patient than with a physician.

“The information you provide to the patient has to be relevant as well as understandable. And you have to be proactive,” Albert says. “You might see that a patient is a father with teen-age boys. At first glance at his individual medical records, you wouldn’t think to send him information on the latest treatments for acne because he’s not a teen-ager. But when you dig deeper into managing the relationship with the patient and learning more about them as well as their families, providing that kind of information is appropriate.”

Providing the patient with backup information relating to his or her particular medical needs is vital, but not always easy. Albert says, “This kind of integration is not for the faint of heart. You have patients seeing different doctors, for different ailments, some in the hospital, some on an outpatient basis. It is very difficult to bring that all together under the umbrella of one patient record.” While providing top-quality patient care is a significant benefit of KM systems, the cost savings of those systems are not to be overlooked.

“We mail out explanations of benefits to members, physicians and hospitals every month,” says John Early, VP for e-technologies and partnerships at Empire Blue Cross Blue Shield Health Choice. Working with Xerox, the organization has developed a more efficient document management and printing process. Empire is also working on electronic forms for enrollment as well as online billing procedures.

“Whatever we can do to eliminate the paperwork means greater efficiency and more time spent on patient care,” he says.

Kim Ann Zimmermann is a free-lance writer, 609-448-7509, e-mail kimzimmermann@home.com.