Information systems and financial operations in rural hospital administration

¶ … Corporate Health Care it System

Corporate health care information technology (it) systems are often complex in design, but must be simplified in function in order that individuals whose expertise and backgrounds that are patient focused can access and use those systems with knowledge and skills acquired through training and system orientation sessions. They will are kept up-to-date on system changes with continuing education sessions and system user manual updates. The system has to support the numerous elements of the overall hospital or clinic functions in admitting, discharge, accounting, billing, patient accounting, medical records, order charting, and the various hospital ancillary services. While each of these areas is separate in function, the overall system must be seamless in outcome of data input into the system so that the system can facilitate the important and multi-levels of accounting that are necessary for reporting and overall hospital financial health.

This paper is based on a live interview with a corporate hospital director of business office services. In that role, the interviewee, Deshay Scott, acts as a sort of middle-man for the multiple levels of hospital it functions, because the business office is responsible for admitting patients, discharging them on the system, collecting and reporting charges that are substantiated by medical record input, order entry, and ancillary services. Scott also is the link between the hospital patient care areas involving the entry of information as it is culled for the purposes of accounting functions. She works with the hospital staff, accountants, and it people to coordinate the needs and functions of the systems in a way that facilitates accurate input, analysis, and output of information for the various levels of individuals delivering patient care and administrative hospital functions.

The it system is an "in-house" one. It was designed by the hospital corporation, and implemented throughout the corporation's ten rural hospitals. The system is called Medicalis-3, because it is in its third revision. The it department is housed at the corporation's corporate headquarters in Florida, and hosts a staff of 15 it specialists. The system has been the basis of the corporation operations for twenty years. It has been updated to remain current with the state and federal hospital regulations and industry governances. The medical record component has been upgraded to reflect the necessary security components to facilitate the 2005 Hospital Insurance Portability and Privacy Act (HIPAA) (Smith, HJ, 1994).

Inpatient and Out-Patient Reporting

Scott is the director of business office services for a 90 bed rural corporate hospital. The hospital has an emergency room with an average daily patient count of 120 patients. These patients are examined and treated by a staff of three registered nurses, three licensed practical nurses, and, during the day, three physicians; and during the evening two physicians. There are also back-up physicians through the physician group that is responsible for providing additional physicians during times of high utilization. For every patient seen in the emergency room, a physician bill is generated from a physician billing service for the emergency physician group.

For every service that is delivered an emergency room patient, there is a specialty bill, radiologist, laboratory, pharmacy, and other services like social services. Every aspect of patient care is tracked at an inpatient or outpatient level of care; and it begins with patient registration for the emergency room, outpatient ancillary services, or the cancer treatment center, or the psychological services clinic. The registration level can be converted from an outpatient to an inpatient level of care from any other of the outpatient or ancillary service areas.

The input of patient demographics as inpatient or outpatient and the service charges are an inquiry-based function. This function can integrate the medical record function with a level of authority authorization. The charges are driven by the order entry on the units or in the emergency room. All of the ancillary, medical supply, and pharmacy charges are integrated into the system, and all entries can be viewed with the appropriate levels of authority. The charge master drives the charges that are reflected by the order entry functions.

The patient accounting staff has access to the system at inquiry and billing capabilities levels. The system accommodates the diagnostically related groups (DRG) with the charge master, and has been designed to allow the appropriate level of authority the ability to update the contractual reimbursement that automatically calculates the multiple managed care agreements. The system puts the DRGs into the appropriate revenue categories so that the information can be accurately accounted for by contract. Vitally important Medicare and Medicaid reporting elements are built into the system, and the once antiquated manual system of tracking Medicare charges as regards Part a and Part B and reimbursable vs. not reimbursable on the inpatient and outpatient levels of care has been updated to a process that is completely system driven and verifiable.

To comply with HIPAA, the system has a user tracking mechanism that can trace a user access to source, and levels of authority have been assigned to limit the access to records involving patient confidentiality and privacy.

The Benefit to Patients and Staff

Scott says that the system is efficient on a user-authority-need basis, and that this has facilitated more accurate reporting, and compliance with HIPAA. That is to the patient's benefit. Scott says that patients have an expectation of those things which the system ensures in patient care: accuracy, privacy, and comprehensive record keeping that assures the patient's history with the facility is compiled in a way that is designed to afford the patient the highest quality and safest possible delivery of care.

For the staff, the system is designed to accommodate their functions at the specified user levels. Ongoing orientation and education and training on the systems and its updates keep the staff abreast of changes that are in compliance with laws and regulations.

The system is an example of the maximization of efficiency within the integrated aspects and elements in the delivery of patient care.

Conclusion

Interviewing Scott was a learning experience, and I found her to be very well informed about the overall operations of the hospital and the system and the ways in which the various elements were integrated. My overall familiarity with what she was talking about was enhanced by my own participation in the course, which really prepared me to be able to engage in a coherent exchange, although I would say that she was certainly more familiar with the unique health care delivery language in her use of sliding in and out of acronyms and agencies that oversee health care.

Scott talked at length about the managed care process, and how it has changed the health care delivery of care, patient access to care, reimbursement, and, therefore, hospital information systems. Managed care and utilization review (UR) play an integral part in patient care and reimbursement (Mahmoud, E and Rice, G, 1998). Scott echoes it experts Brian P. Bloomfield, Rod Coombs, David Knights, and Dale Littler (2000), who say:

IT system enjoys what one might call a special relationship with Resource Management. Its role as depicted in the review is one centred on the improvements and furtherance of a 'balanced' dialogue between doctors and managers. A corollary of this is that it must be neutral politically speaking (see Bloomfield 1995). Thus the review authorizes the introduction of the new it system by subordinating it to the cause of dialogue between doctors and managers. The review represents the information requirements of hospital doctors and management and thereby portrays the it system as fulfilling a preexisting need. The narrative structure here is founded on the discovery of a state of readiness on the part of the hospital followed by the production of a detailed system architecture, specification, and implementation plan. The review presents Manex's own it system as the solution which bridges the gap between the current state of affairs and the implementation of Resource Management. In displacing the tensions or politics (seen as) inherent in the relationship between management and medicine, the 'politics' of it are also displaced. In other words, the presumed a-sociality of the 'technical' is deployed here as a resource (Bloofield, Coombs, et al., pp. 100-1010."

An it system alone is ineffective, it must be supported by knowledgeable it administrators and technicians when its use is integrated at the various and numerous levels of function that are found in a hospital it system. Scott says that her experience has led her to conclude that in addition to a system that can perform the necessary functions of business, system support is essential and the it technicians are integral to the day-to-day operations of business in a hospital setting. Scott says:

Believe it or not, problems arise each day that are new, never experienced before, and that is because of the nature of the service in patient care, and the complex laws of oversight, reimbursement, and industry standards that must be maintained by the system. Anyone can go out and get a "canned" system. That is, one that is intended to perform the functions of the business; but system support within the active uses of the hospital environment really dictate that the best way to go is with an in-house system and tech team. Without the immediate access and knowledge of the facility needs that is embodied in the in-house tech support system and team, business could not be conducted in a way that guarantees quality care and functions as it is now (Scott, 2008)."

The user needs is what ultimately guides the design and function of a it system in a hospital environment. The reporting requirements and the system integrity denoted by the serious nature of patient care make the hospital it system a vital element in the life of a hospital.