Connected information networks take the paper burden off your shoulders
Wisconsin network generates managed care efficiencies
It’s been said that health systems are built on paper gobs of it piled on desks, stuffed into cabinets, and in some cases, even shoved into boxes and hidden under desks. Think for a minute how much time and effort is spent shuttling those reams of paper from one location to another. The cost is immense.
Now imagine doing away with much of that paper, as well as the physical transfer of hard copy. Such thoughts aren’t just daydreams. Already a handful of health systems around the country are doing away with paper shuffling by transferring the information through cyberspace via community health information networks (CHINs). In essence, these networks function as mini-versions of the Internet. Only in this case, the term intranet might be more appropriate.
While any health system can benefit from such speedy transfer of information, the benefits appear to be particularly valuable in a managed care environment where efficiency has become almost its own religion. The time savings are significant, and the cost savings can quickly reach the six- and seven-figure range, according to studies by the Wisconsin Health Information Network (WHIN) in Brookfield, WI. WHIN is one of the nation’s oldest and largest CHINs, linking 14 hospitals, 1,100 physicians, seven insurance companies, eight clinics, four home health agencies, four private billing services, three ambulance services, and at least one lab.
"There is little doubt . . . that the economic impacts of WHIN are both real and substantial," says Kathy S. Lassila, PhD, who conducted the studies while working for the University of Wisconsin School of Business Administration in Milwaukee. Savings potential range from $400,000 to $1.1 million or more per health system, depending on the volume of information responses eliminated by WHIN use, Lassila found.
Preliminary results from the studies show cost savings in a variety of areas. For primary care practices, these include:
• eligibility determination for patient visits;
• precertification for tests and procedures;
• referral requests;
• claims inquires and follow-ups.
For specialty practices, the benefits include:
• referred patient eligibility and authorization;
• precertification and preauthorization;
• claims inquiries and follow-ups.
For hospitals, the benefits include:
• insurance verification and patient admission;
• medical management and utilization;
• claims inquiries and follow-up;
• insurance inquiries and customer service. (For a complete listing of costs and savings, see table, inserted in this issue.)
Integration communication
Not only can CHINs help speed transfer of information, saving large amounts of money, but they also have beneficial applications when health systems merge or acquire satellite facilities. Often when this happens, the various entities have disparate computer systems that don’t communicate well with one another, says Michael Jordan, president and general manager of WHIN.
"Integrated delivery systems, as they grow, need to be able to communicate electronically between facilities," he says. "WHIN can help them solve that compatibility problem."
That was a problem faced by Milwaukee-based Aurora Healthcare, one of Wisconsin’s largest managed care health systems with more than 100 facilities, including 14 hospitals, that blanket the eastern part of the state. "When a new facility joins our system, it isn’t feasible to say to that facility, Tomorrow you are going to turn off all of your old computer equipment and use this new hardware and software,’" says Jim Jeffery, manager of imaging systems development for Aurora, which is part owner of the WHIN network.
Instead, a new facility subscribes to WHIN, which provides the computer interface that allows the different computer systems to send and receive data. This is similar to the Internet, which allows, for instance, both Macintosh and IBM-based systems to communicate.
Eventually, says Jeffery, the goal is to have the same hardware and software at all the facilities in the Aurora network. "But that is going to take time to accomplish," he says. "During that transition, WHIN is certainly proving to be a big help."
Quality of care and costs
The core of Aurora’s electronic transfer data system is its computer-based patient record, a massive electronic archive that will eventually hold the records of all patients in the Aurora network. When the patient record database is complete in a few years, "an Aurora patient will be able to show up at any Aurora facility and the medical staff at that facility, no matter where it is, will be able to get that patient’s record electronically," Jeffery says. "We won’t have to deliver the paper chart, which is both time-consuming and costly."
Aurora is also developing WHIN linkages to out-of-system facilities. The pilot project involves a pathology lab. "In the old paper days, we’d send a specimen to the lab, and then the lab would send a paper report back to the physician, which was then put into the patient’s paper record," Jeffrey explains. "Now, with the lab connected to WHIN, they deliver the reports electronically, and they go directly into the computer-based patient record." (For more on handling security issues, see related story, on right.)
Aurora is also working with outside pharmacies so physicians can electronically deliver prescriptions, but this is still in the developmental phase.
WHIN members subscribe to the service, with the average fee for a physician’s office running about $50 a month. Hospitals that make their databases accessible to selected parties can pay up to several thousand dollars a month, Jordan says.
Improve practice patterns
Networks such as WHIN would be convenient repositories for managed care information that allows providers to identify best practice patterns, says Jordan. "To succeed in a managed care environment, you need to understand the medical procedures that are taking place, and you need to analyze those to make efficient use of medical resources," he says. "I see a natural evolution where these networks become repositories for data on procedures, policies, and outcomes that will let providers figure out the most efficient steps to take to treat a condition."
Michael Jordan, President and General Manager, Wisconsin Health Information Network, 450 North Sunnyslope, Suite 90, Brookfield, WI 53005. Telephone: (414) 792-6172.
Jim Jeffery, Manager of Imaging Systems Development, Aurora Healthcare, 3031 W. Montana St., Milwaukee, WI 53215. Telephone: (414) 647-3546.
WHIN also has a Web site explaining the network. The Web address is www.whin.net/whin 07.htm.
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