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Operations or Outcomes?

March 1, 1998
by Charlene Marietti
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As healthcare executives recognize the competitive advantage lurking in their clinical data, they are demanding more sophisticated clinical decision support systems. Improvements in organizational infrastructures, advances in data capture and retrieval and increased cultural acceptance all contribute to make it not only a cornerstone for business decisions, but also for clinical decision-making closer to the patient.

All clinical decision support systems enable users to more effectively manage resources and productivity--but not all clinical decision support systems are created equal. The impetus to mine clinical data to business and clinical advantage has resulted in two separate decision support system types. Systems incorporating clinical data may be billed as clinical decision support systems whether they function by incorporating clinical data with financial information to derive costs and profitability information, or whether they are designed as active knowledge systems for use by caregivers nearer the point of care.

Cost- or care-based
The very name, clinical decision support system, can be fuzzy. Seemingly, if clinical data is incorporated into the system in any way, it qualifies as a clinical decision support system. Unfortunately, the name does not designate whether it is a system focused on business issues or on medical outcomes. Both types play significant but very different roles.

Business-focused systems tend to highlight cost accounting, cost allocation and fixed and variable costs, among other capabilities. Systems that focus on medical outcomes tend to use such terms as "knowledge-based" and "point-of-care." Although serving different purposes for different users, the two systems are not mutually exclusive. The closer the medically focused system is to the patient, the more opportunities for clean and direct data input to the repository, resulting in timely access to more accurate clinical data for use in business-focused applications.

Breaking traditional ties
The ties that bound traditional financial and administrative decision support systems to a single department--finance--and to a handful of users are broken. John Nunnelly, vice president and general manager of the Amherst Product Group, HBO & Company, Atlanta, reports that the move has been very rapid and has resulted in a radically different situation than just three to four years ago, as all members of top management--CFOs, CEOs and COOs--are now demanding the decision support system on their desktops. Once upon a time, such systems were used by the organization’s financial analyst who mined the data, ran the reports and delivered them to top management. Now it is not uncommon for organizations to have several hundred decision support system users.

Most institutions have already taken advantage of the operational gains through departmental staff management and resource management, says John Nunnelly. "The greatest opportunities now are in finding new, more efficient and more effective ways to treat patients and to direct them to appropriate settings of care. Unless the organization can take a broader, vertical view of the market, it can’t really see the opportunities to put patients in alternate, often less expensive settings."

Decision support systems have also become more user-friendly--many have a Windows look-and-feel common to other applications in daily use. As a side effect, this has resulted in the demise of the traditional executive information system, says Martin Grey, VP, JJO Enterprises, Miami, Fla., a decision support vendor. The whole concept of the executive information system is not cost efficient because, more often than not, the decision support system generated the information for it.

Costing operations
Financial and administrative decision support systems are well-established, allowing managers to attach value to the products and services and identify business opportunities through analyzing the data and past performance. Adding clinical data to the equation enables users to glean valuable risk-sharing and profiling information from organizational data, as well as to coordinate the often complicated work-flow requirements within the managed care environment. Market penetration for decision support systems among very large healthcare organizations is high, says Alec Karys, vice president of software development and technical services, InterQual, Inc., Marlborough, Mass., citing company statistics that indicate 80 percent to 90 percent of those organizations use the tools to manage resources and internal business operations.

Most vendors agree that the entrance of managed care into the local market, bringing a dramatic shift in revenue drivers, usually spearheads the implementation of a clinical decision support system that is capable of merging clinical data with financial data. But it is not the only one. If it is not managed care, it usually follows some other critical event that highlights the need for critical decision-making information, says Grey.