Interesting Study on Hospital Computing and the Costs and Quality of Care: A National Study

Hospital Computing and the Costs and Quality of Care: A National Study

David U. Himmelstein, MD, Adam Wright, PhD, Steffie Woolhandler, MD, MPH,
Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass; Clinical Informatics Research and Development, Partners Healthcare System, Boston, Mass.

ABSTRACT

BACKGROUND: Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization’s cost and quality impacts at a diverse national sample of hospitals.

METHODS: We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the “100 Most Wired” with others.

RESULTS: More computerized hospitals had higher total costs in bivariate analysis (r 0.06, P .001) but not multivariate analyses (P .69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P .0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r0.07, P .003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analysis, more computerized hospitals had slightly better quality. Hospitals on the “Most Wired” list performed no better than others on quality, costs, or administrative costs.

CONCLUSION: As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.

© 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009)

Is it Time to Wait?

The U.S. national average to see a general practitioner is 20 days, but in Boston it is 63 days. Seeing a dermatologist, on average requires a 22-day wait, but in Boston it is 54 days. Any city may prove to be an anomaly, but the data highlights the experience of consumers in selected locals: accessibility to providers is unduly long and, in some cases, an ordeal. (Note: The state of Massachusetts is one that guarantees coverage for uninsured patients through legislation enacted in 2006.)
Is this what we are in for with Health Reform? Will the increased access to physicians and services increase overall wait times for everyone? We were already projecting a need for physicians prior to Health Reform (see Figure 2 below).

The Complexities of Physician Supply and Demand: Projections through 2025. Center for Workforce Studies, November 2008. http://www.aamc.org/workforce

Hospital Statistics

The Centers for Disease Control and Prevention, in their division of Healthcare Quality Promotion indicates that there are 6013 hospitals in the United States today, with an aggregate bed total of slightly more than 1,000,000, broken down as follows:

• 500 beds or more, 326 hospitals representing 5.4% of the U.S. total
• 200-499 beds, 339 hospitals representing 22.3%
• 100-199 beds, 1426 hospitals representing 23.7%
• 99 beds or less, 2922 hospitals, representing 48.6%

Web Sites Galore

It is amazing how many web sites are available for consumers to compare medical providers, track medical history and check prices.

www.webmd.com
www.google.com/health
www.healthvault.com
www.myPHR.com
www.whynotthebest.org
www.pricedoc.com
www.practicefusion.com
www.revolutionhealth.com
www.nomoreclipboard.com
www.PassportMD.com
www.er-card.com
www.peoplechart.com
www.accessmyrecords.com
www.vitalkey.com
www.medkey.com
www.pehrtech.com
www.medicalsummary.com
www.accessmyrecords.com
www.tripmate.com

Serve Customers, not Patients

By Lindsey Jarrell, FACHE and Colin Konschak, FACHE


Have you ever sat in a hospital waiting room for an exceedingly long time feeling as if you were undervalued and underappreciated? For all the advances made in health care in the last decade, the efforts to introduce a high level of customer service are, to this day, lagging. While doctors today are more personable and engaging, and some nurses and technicians have followed suit, as an industry, much work still remains. U.S. hospitals everywhere need to take a customer-focused approach to patients and prospective patients, and to embrace established customer relations management tools and techniques.


The Elusive Art of Customer Service
Medical and non-medical staff alike attend seminars, read memos, and perhaps encounter constant reminders of the importance of customer service. Like teaching an elephant to dance, the same surly nurses staff the sixth floor, the same moody orderlies populate the second through fourth floors, and the same routines and indifferences prevail. Anecdotes from other industries help illustrate the fundamentals of a customer or client-focused orientation.

You and your spouse enjoy fine wines, for example. You entertain often and seek to have a continual source of new ideas about high-quality wines that your guests will enjoy. You retain the services of a wine broker. The broker calls every so often to tell you that two weeks ago he bought a Cabernet or that a new shipment of Zinfandel will be arriving.

You don’t have to maintain contact with the broker because the broker maintains contact with you. The broker, executing some type of customer relations management, undoubtedly calls all of his clients periodically to introduce or suggest what is new, exciting, and at a great price.

We Know How to Take Care of You – Suppose you pull your car into an auto repair shop you haven’t patronized before. Maybe a friend recommended it, you received discount coupons in a mailing, or you happened to be stuck and it was close by. The shop personnel seem sufficiently professional and friendly. Your car goes up on the lift, and soon you receive a diagnosis: this is what your car needs. Next comes the part you weren’t expecting. In addition to offering the service that your car needs, this particular auto repair shop – having your car’s engine plugged into their diagnostic computer equipment – prints a roster of the current health of your car’s engine, what you’re likely to need in six months, 12 months, and thereafter.

You didn’t know this report was coming and you didn’t ask for it, but you can’t help but be impressed. Even if you can readily locate your owner’s manual and its suggested maintenance schedule and you keep your own records, it’s still impressive when an auto repair shop takes a proactive approach in offering you car repair services.

The next time your car needs maintenance, perhaps something minor, you head back to that shop. Suppose you need to have your tires inflated? They do it without making you wait. You ask what the charge is, and they say “no charge.” You say thanks and can’t help but offer a tip though none was sought. You leave thinking that when your car needs anything else, you’re going to return to this shop. Back home you now read that report they gave you last time to see what you can do to head off trouble.

Dentists do a decent job of treating patients like customers, in part because the U.S. health care reimbursement system enables them to do so. The dentist will say to you, “We want to keep watching number six, and you may have to consider a crown for number 18.”


Lessons for the Taking
Hospitals can take lessons from wine brokers, auto repair shops, dentists, and everyone in business who takes a proactive approach to serving their customers, whether it’s calling regularly, making suggestions, maintaining a database, printing out suggested repair schedules, and so on. Some wine brokers, auto repair shops, dentists, etc. do such a good job of providing customer service that even when customers move 20 to 30 miles away, they remain loyal to their provider because the task of traveling those extra miles is far less than the task of finding a new provider who offers the same level of attention and appreciation: customer service.

Customer relations management is not a timed campaign and certainly not a one-time event. Nor is it a management “flavor of the month” approach to treating your patients to see if more business results. Customer relations management is an all-out, soup-to-nuts approach for dealing with customers (patients), requiring the ever-present recognition that in today’s globally ultra-competitive environment: nothing less will do.

Your customers and prospects patronize a variety of other service providers and product vendors. From health spas, to boutique eye doctors, to airport gold key clubs, customers have a keenly developed sense of which businesses know how to get it right, versus all the rest. All else being equal, when a hospital in your region provides an enhanced measure of customer service and yours pales by comparison, it’s only a matter of time as to who gains more loyal, long-term, and hopefully lucrative customers.

Implications for Your Hospital – As large a task as it may seem, developing a customer-focused orientation can start with tiny steps. From the time that people first contact your facility to the time that they are discharged, countless opportunities for providing customer service exist.
* What information do you collect about the customer the first time he or she makes contact with you?
* At first, contact is likely to be a voice on the other end of the phone. So, how skilled are the people who answer the phones for you?
* If the first contact comes via registering on the Web, how completely and utterly user-friendly is your registration form?
* How effortlessly can a first-time visitor and prospective customer navigate about your site, quickly gain answers to questions, avoid endless loops and dead ends, and obtain real-time instant messaging or phone service for answers when all else seems hopeless?

Information Week's Top 100

BayCare Health System was named a Top 100 company in Information Week's 21st Annual Ranking of the leading users of Business Technology. They were names for the implementation of their Palm Vein Scanning Technology implementation which was featured in this blog earlier this year. Congratulations are also in order to the following hospitals and health system who also made the top 100!

• Cincinnati Children's Hospital Medical Center
• UPMC
• Beth Israel Deaconess Medical Center
• Sentara Healthcare
• Christus Health
• University of Arkansas for Medical Sciences
• UMass Memorial Health Care
• Montefiore Medical Center
• Advocate Health Center

The Internet of Things....Think About it.

Everything...and I mean everything will be wired one day.

http://www.slideshare.net/inakitxu/tweakfest