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The Envelope Please

June 1, 1998
by Lisa Paul
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No matter how you look at it, managed care is affecting the creation of new information technology products. Many of the buzz words in this new era of healthcare--outcomes, case management, disease management--are coming together as new clinical information systems hit the market. For payors, this convergence means lower costs and less risk; for providers, it means better care and improved outcomes.

One of the biggest challenges to healthcare administrators and IT executives is getting the most for their money. To help solve this problem, a number of healthcare organizations are teaming up with software vendors to create new tools for the healthcare IT marketplace. The Henry Ford Health System, Detroit, started the Healthcare Innovations in Technology Systems (HITS) Partnership in Technology Award program several years ago in an effort to recognize and commend these unique business arrangements. Last year, judges chose a winner and runner-up from three different categories: home healthcare, clinical information systems and telemedicine. This article profiles the clinical information systems category.

The Henry Ford Health System, the National Managed Health Care Congress (NMHCC) and InfoCare(former sister publication to Healthcare Informatics) sponsored the competition.

HITS winner:

Clinical pathways have been on many nurses’ must-have lists for years. Today, some case managers create clinical pathways manually; and some don’t use them at all. Still others fall into the same trap as many physicians--seeing pathways as the next best thing to "cookbook medicine."

In addition to the systematic approach to providing care that some nurses and doctors oppose, another roadblock to clinical pathways has been the different terminology used to describe different episodes or patterns of care. PROGNOSYS, Phoenix, formed in 1992 with a goal of creating a clinical vocabulary for setting clinical pathways in the inpatient hospital setting. With the creation of Pediatrax--winner of the 1997 HITS Award for clinical information systems--and with help from five pediatric hospitals and one community hospital, the PROGNOSYS clinical vocabulary database debuted to the public in 1997.

According to Adam Zauder, the company’s president and CEO, the complexity of illnesses of hospitalized children is one of the reasons pediatric nurses and case managers in inpatient settings often desire a useful system for setting and tracking clinical pathways. "Kids in children’s hospitals tend to be much, much sicker than adults in regular hospitals," Zauder says. "It’s almost like 100 or 200 beds [in a pediatric hospital] would be ICU patients in an adult hospital."

For the consortium of six healthcare organizations that helped develop Pediatrax, three of the most attractive elements to this project were:

  • All of the participating hospitals develop their pathways with the same clinical vocabulary. PROGNOSYS maintains that database of terminology and updates and amends it as the users dictate.
  • The pathways’ formats are flexible. They can be customized for individual patients in individual situations.
  • The data collected are clinical--not financial. Thus, the information is based on real patient encounters--not on information used for billing purposes.

Case managers and nurses at the different healthcare organizations use different methods to create their clinical pathways. At Miami Children’s Hospital in Florida, for example, Linda Marzano, director of patient and family services, explains that nurses collect data for clinical pathways manually at the patients’ bedsides. After seeing the patients, nurses input the data into the Pediatrax system. Once the data are in the system, they are available via Internet-based technology to anyone in the consortium. For security reasons, the data are available only in aggregate form for comparisons outside the originating hospital.

Marzano was one of the people involved in the PROGNOSYS partnership. For her, the challenge of getting buy-in from her organization on clinical pathway usage also was her motivation. Though winning the HITS Award has brought attention to the product and to Miami Children’s, Marzano says it did not have the impact she was hoping for. "I was hoping for more support in the use of the product and the whole concept of clinical pathways." However, she maintains hope that the concept will catch on. "I think the whole process of clinical pathways typically takes a couple of years to come to fruition."

Besides Marzano, the consortium Zauder put together includes representatives from: Children’s Memorial Hospital, Chicago; Columbus Children’s Hospital, Ohio; Egleston Children’s Hospital, Atlanta; Le Bonheur Children’s Medical Center, Memphis, Tenn.; and AtlantiCare Medical Center, Lynn, Mass. These case managers, nurses, administrators and systems specialists joined forces nearly three years ago to crank out a universal clinical vocabulary to help manage patients and compare clinical processes across the continuum of care.

Each of the hospitals participating in the project uses and manages its own clinical pathways. On an organization-by-organization basis, it seems the product is working great. "We use coordinated care plans," explains Del Joiner, senior vice president for quality and patient services at AtlantiCare. "We put those coordinated care plans into the system and our case managers can see what should be happening to a patient’s care on any given day."