Skip to content Skip to navigation

Ambulatory and Hospital IT: Never the two shall meet?

May 10, 2011
by Pete Rivera
| Reprints
Differences in how each area views reimbursement has created challenges to navigate

If you have been around Healthcare IT for a few years you soon realize that there are two IT areas; Hospital and Ambulatory. When interviewing for a position, they want to know what side of the camp you have worked in. The dark side is always the other side of the fence. The primary reason this exists is the differences in how each area views reimbursement. This would include the reimbursement rate for procedures, professional fees, DRG’s, length of stays, and claim lag days. You also have admissions, discharge, registration, and demographics and insurance for episodes of care versus longitudinal care.

From a technology perspective, the line is truly blurred when you think about how ambulatory services has evolved over the years. Many procedures that required hospital admission and longer length of stays are pushed to the ambulatory setting. Some Healthcare systems have both hospital-based clinics and physician practice clinics. Information Technology departments have to figure out how the systems would be integrated in order to meet Business Intelligence and General Ledger requirements. Often, hospital based clinics flow their patients through their admissions process. Physician practices register their patients.

If you ever had to install an ambulatory EMR across a health system with a blend of both and maybe some community health clinics, then you get a crash course on all the nuances. Clinical systems that once only existed in the hospital setting are now deployed in the ambulatory as well. Ambulatory IT support now has many of the same CPOE, EMR, radiology, pharmacy and Lab integration challenges.

HIMSS has long recognized the differences of both hospital and ambulatory systems. One of the larger chapters of HIMSS, the Central North Florida HIMSS Chapter recently developed an Ambulatory Committee to reach out to its members in the Ambulatory market and help with career development and professional growth in that area.

I am curious about the technology challenges that others have experienced in navigating between both areas. I know I had a very difficult and frustrating challenge once trying to explain an ADT interface to a hospital interface analyst. It really was a demographic feed, but then again we get the generic ADT terminology from admissions, discharge and transfer. Old habits are just hard to break.

Topics

Comments

We see this routinely as we are working with clients to install our Compliance audit software. We work with one IT group and billing system to obtain the profesional bills, and a totally different IT group and billing/scrubber/clearinghouse systems to obtain the Institutional bills. The EMR is often a 'bridge' across the two areas. Conceptually the goals for auditing are similar, but due to differences in coding responsibility in the two areas the audit focus is often entirely different. Understanding the differences is critical to designing software that handles each effectively. We needed to pull together a focus group of development partners and work very closely with them over time to understand and design for these differences.

Excellent points Lisa. Maybe that is why the "Enterprise system" is still not truly for the entire enterprise.

Pete Rivera

Director Informatics, Hayes Management Consulting

Pete Rivera

@Gator_Pete

www.Hayesmanagement.com

 

 

 

 

 

 

 

...