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News and Trends

August 1, 1998
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SAVED BY THE NETWORK

UNOS Unites Patients and Organs

SIXTY THOUSAND PEOPLE IN THE UNITED STATESneed a replacement organ, and they trust the United Network for Organ Sharing’s (UNOS) computers to find them one. Considering that 4,000 people die each year while waiting for a compatible organ, UNOS’ 40-member IT department holds a major responsibility in keeping the network that unites patients and organs functioning properly.

UNOS manages the nation’s entire organ procurement and transplantation activities by administering the Organ Procurement and Transplantation Network (OPTN), under contract by Department of Health and Human Services’(HHS) Health Resources and Services Administration division. The organization maintains databases containing organ-specific "wait lists" of all patients needing organs in the United States, as well as the U.S. Scientific Registry, a colossal database that tracks the progress of all patients who have received solid organ transplants since October 1987.

Organ sharing begins with an organ procurement organization (OPO) locating an available organ. The OPO dials into UNOS’ proprietary donor management system via modem and the AT&T Interspan network service, enters characteristics about the organ and donor and launches the match program. Using sorting algorithms based on physical characteristics and the current procurement regulations, the match program, written entirely by UNOS’ IT staff, pulls potential recipients from an organ-specific "wait list" and produces a rank order list for the OPO to use in distributing the organ.

All patient data resides in an Oracle relational database running on Digital Alpha 2100 servers at UNOS’ Richmond, Va., headquarters. To ensure that the network is up at all times, UNOS maintains an exact replica of the system at a site 40 miles away on a different power grid. "The network must be extremely fault tolerant because it truly is a lifesaving function," UNOS IT director Berkeley Keck says.

Under current procurement and transplantation rules, when an organ becomes available, it is first given to a patient nearby--within the same HCFA-designated OPO. If the organ is not needed within that OPO area, it is made available to a patient in one of the other 62 areas. Recently, however, HHS has initiated a major policy change as to who should first receive an organ when it becomes available, complicating the organ matching process for those who are trying to expedite it.

HHS argues that the policy unfairly allocates organs based on "accidents of geography," and that organs should be assigned based on medical need, regardless of geographic location. The new rule is currently open for public comment until Aug. 31, and is scheduled to take effect on Oct. 1, 1998.

UNOS opposes the new regulations under the premise that sicker patients often need repeat transplants, ultimately limiting the number who receive transplants, UNOS spokesperson Bob Spieldenner says. "It literally could cause more people to die."

Fortunately, the new government regulations will not pose a problem for the IT department, Keck says. "The system is fairly dynamic because transplantation is dynamic. We are in the process of system revisions anyway, and if required, we could make the change with new implementation," he says.

The revision Keck refers to is actually a complete overhaul of the system that will make UNOS’ network Internet accessible. The new program, written in Visual Basic, will feature a Microsoft Access front end with an SQL Server database storing patient data. "It will allow wider access to a larger number of people," Keck says. "In turn, it will speed up the organ distribution process, which will improve the outcomes of transplantation."

Government Networking

IN CELEBRATION OF ITS TENTH ANNIVERSARY,Federal Computer Week magazine selected and featured the top 10 Federal Computer Systems. Including UNOS (United Network for Organ Sharing), other top systems included the FBI’s National Crime Information Center for catching wanted felons and the EPA’s Toxics Release Inventory database for identifying commercial polluters.

Though not on the list, there’s a new government network for the medical community to watch called PulseNet, a national network linking public health laboratories specifically for stopping "foodborn" illnesses--E. coli, for example. The network provides the laboratories with access to the Center for Disease Control’s (CDC) database containing DNA models of bacteria and pulsed-field gel electrophoresis, a molecular technology for identifying the food contaminants. When a foodborn illness is identified, epidemiologists share the information with their colleagues over the Internet to determine the outbreak’s scope and identify possible sources.

Administered by the CDC, PulseNet has also brought the U.S. Department of Agriculture and Food and Drug Administration laboratories online. Networking state public health laboratories to the CDC began in 1995 with Massachusetts, Minnesota, Texas and Washington. Each state is required to provide services to surrounding states. With the official launch of PulseNet, 12 states are now connected to the network.

--Jeffrey Elliott


CHIM SURVEY

Defining the CDR

"WHAT IS A CLINICAL DATA REPOSITORY?" THAT’Sone of the questions the Center for Healthcare Information Management (CHIM) intended to find out with its survey of 317 CIOs, physician executives and nurse executives on their perceptions of the CDR and current CDR activity in their organizations.

Did CHIM get the answer it was looking for? Not exactly. "We found that the CDR is more of a concept than a product," CHIM spokesman Brad Casemore says. "Rather than defining it, we’re describing its functionalities and limitations." The survey results, intended primarily for CHIM’s membership of healthcare IT vendors and consultants, outlines what healthcare organizations want to collect, store, analyze and report patient data across the enterprise, he says.

Other professionals agree the CDR is often misinterpreted, particularly in how it relates to the CPR, or computer-based patient record. "A lot of people are still confused," GartnerGroup healthcare IT research director Mike Davis says. And without a clear-cut definition of the CDR, he feels vendors have a way of adding to the confusion.

The CDR in actuality represents the storage portion of the CPR, providing current and relative clinical data to support the patient code process, Davis says.

Is it a Data Warehouse?
The CDR is not to be confused with the data warehouse either, Davis says, which stores an aggregate of data from all information systems in a healthcare organization. In the survey, CHIM asked the three respondent groups if there was a difference between a CDR and a data warehouse. Forty percent of the physician executives answered "yes," 10 percent answered "no" and the remaining 50 percent said they "don’t know." Forty-three percent of the nurse executives answered "yes," 4 percent said "no" and 53 percent responded that they "don’t know." By stark contrast, the CIOs on average took a more authoritative stance on whether there was a difference between a CDR and data warehouse: Sixty-nine percent believe there is a difference and 23 percent say there is no difference. Only 8 percent of the CIOs say they don’t know, "but that’s still a little scary," Davis says.

--J.E.


PATIENT COMMUNICATION

Read Two Web Sites and Email Me in the Morning

PHYSICIANS, STAFF AND LAB PERSONNEL HAVE similar complaints: Not enough time, too many interruptions and too much information slipping through the cracks. Patients, on the other hand, don’t understand wellness plans, miss their appointments and take medications incorrectly, costing the healthcare industry billions per year.

Patient information, once limited to blurry photocopies from the doctor, has become a booming market powered by dual demand. Providers want easy access to updated, accurate medical resources and lab results reporting features. Patients want simple information quickly.

Developers are answering with patient service systems that automate the bulk of patient call-ins and computerize educational materials--saving providers time and money.

About 90 percent of all patient calls are related to lab results, appointment confirmations or prescription drugs, says Alfredo Garcia, president of AudioCARE, a division of MUMPS Audiofax, Wayne, Pa. "If you can automate responses to these questions, you’re off-loading a lot of interruptive phone calls," he says. "Besides, a lot of people can’t call in 9-to-5."

Computer telephony
Telephone-based systems have matured from isolated applications into module packages that can include appointment reminders, lab results reporting, prescription information and even patient-to-doctor messaging. The latest trend is to charge providers on a patient usage basis, somewhere between five and 25 cents per call, Garcia says. AudioCARE’s RX Info provides prerecorded medication descriptions and interaction warnings on demand. The system’s informational database, provided through a licensing agreement with Medi-Span, Indianapolis, Ind., is updated twice yearly.

SmartTalk, Boulder, Colo., automates routine scheduling tasks with its SmartReminder module. The system tackles the no-show problem by reminding patients of upcoming appointments and notifying groups of patients of scheduling changes, while consuming minimal staff time.

Lab reporting modules, such as SmartTalk’s LabTalk or AudioCARE’s AudioLAB, allow doctors to record lab results or treatment messages on the system at their convenience. Patients dial in to the system and use a patient ID number to retrieve the information.

The drawback to telephone-based lab reporting systems has been their passive nature--the burden was on the patient to request the information. But SmartTalk and AudioCARE recently have improved their systems to complete the communication loop: If a patient doesn’t call in for a lab result, the system will call the patient. "Providers are under the gun to make sure patients get their lab results," says SmartTalk’s President Brian Higgins. "Most of the regulatory agencies and third-party payors won’t sit still any longer for the ’no news is good news’ excuse."

Education materials
Other developers are tackling the educational materials market, hoping that detailed, patient-specific information will be a better alternative to mass-produced medical leaflets. "Patient education is supposed to extend the physician’s brain directly to the patient, and consumerism demands customized information," says J. Peter Geerlofs, a 15-year physician and president of Medifor in Port Townsend, Wash.

Medifor’s Patient Ed system approaches education from the point-of-care, allowing physicians to select from hundreds of templates on medical conditions and prescription drugs and tailor the information to each patient. The Windows-based software system can store the chosen information, print a copy for the patient’s chart and generate prescriptions and detailed health instructions for the patient, including anatomical illustrations.

Using the Web
Already aware of the potential for automated education systems in the disease management arena, developers are focusing on how to incorporate another piece of the puzzle: The resources and interactive capabilities of the Web.

For developers, the challenge is sorting through the mounds of online information to pinpoint sources doctors will trust enough to use with patients, and then finding fast, confidential ways to deliver the content. They are exploring the possibilities of encrypted email and Web links. Even patient-specific, interactive Web sites posting personal home health regimens and feedback links may no longer be a far-fetched idea.

The ultimate patient education system, developers say, would give patients access to their accounts, latest lab test results, prescriptions, ongoing treatment plans and educational materials on health maintenance. Physicians would have access to a wealth of information from electronic medical reference libraries and drug databases and be able to incorporate the delivered educational information and results reporting into the patient’s record automatically. "Medicine actually does very little in the course of a lifetime to make an impact on your health," Geerlofs says. "It’s the decisions patients make that matter."

Pamela Tabar is a freelance writer in Cleveland.


PROVIDER INTEGRATION

CFOs Play Key Role in IT Purchasing Decisions

INTEGRATION ISN’T A PROBLEM JUST FOR THE ITdepartment trying to synthesize information systems and deliver data across the enterprise. It’s a problem that affects the entire organization in the wake of intense provider consolidation activity.

Although consolidation has afforded the healthcare industry a way to raise profit margins by pooling resources during a time when competition from managed care has hindered providers from raising rates for healthcare delivery, the value of consolidation is easily lost due to poor decisions, says Sandy Lutz, a healthcare finance consultant with Pricewaterhouse Coopers in Dallas. "Providers clearly underestimate the integration process." In many cases, the CFO is left with financial chaos when several proprietary healthcare provider organizations are combined.

Research conducted by the Healthcare Financial Management Association (HFMA) indicates that CFOs’ role in healthcare has changed considerably over the last few years. In addition to the traditional role of the financial expert that manages risk and cost, CFOs must demonstrate skills as business advisors and leaders in light of heavy industry consolidation. "CFOs need to get out of score-keeping and into the coaching staff," HFMA president and CEO Richard Clarke says.

As a result, top financial officers are becoming more directly involved in IT purchasing decisions, particularly when evaluating tools that will improve financial decision support. "Finance is a very heavy user of IT for accumulating data," Clarke says. As the executive with the most knowledge of IT--after the CIO--most CFOs have a clear understanding of the value of technology for protecting capital assets, Clarke says.

Clearly, information systems must focus on the CFO’s decision-making needs. However, most applications are failing to provide effectiveness for the CFO. "The problem is that companies define its product as a solution," Clarke says. "CFOs need, but often are not getting, complete solutions." He challenges systems developers to provide the CFOs with what they really need: Tools that help them position their organization strategically. "That translates into what the patient needs," he says.

--J.E.


HFMA Highlights

ABOUT 3,000 HEALTHCARE PROFESSIONALS attended HFMA’s ANI (Annual National Institute) at the Opryland Hotel and Convention Center in Nashville, Tenn. The conference featured sessions on compliance issues, managed care contracting and information technology as it relates to finance. Here are some announcements made at the ANI:

  • HFMA announced a new for-profit subsidiary that will provide corporate compliance training to healthcare organizations. HFMA Learning Solutions will send on-site trainers to lead healthcare providers’ financial staff through classes on patient financial services, information technology, medical records and other process subject to rules and government regulations.
  • QuadraMed, Richmond, Calif., anounced the release of the SmartLink Healthcare Data Mart, a data warehousing system that serves as a central repository for current and historical data. Multiple facilities within an integrated delivery network can access the Data Mart, which operates on Microsoft’s SQL server running Windows NT.
  • Lawson Software, Minneapolis, in partnership with Ernst & Young, released the Performance Indicator Suite, a data warehousing application that provides performance measurement tools for top healthcare executives. The product was developed around 150 best practice business indicators. Lawson and E&Y are working with clients to develop additional indicators specific to the healthcare industry.


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