August, 1996 Information warehousing within the CPR By Kenneth D. Rardin, President and CEO, IMNET Systems, Inc. CPR, EMR, CDR, PPR, CPRS... how many acronyms can we assign to healthcare information technology? While there is no argument as to what the acronyms stand for, the definitions for each vary. Let's take CPR or the Computerized Patient Record for example. The Institute of Medicine (IOM) defines the CPR as an "electronic patient record that resides in a system designed to support users through availability of complete and accurate data, bodies of medical knowledge and other aids." Healthcare analyst Jason Rosenbluth, M.D., of Volpe, Welty, & Company, refers to the CPR as "the ultimate goal of clinical information systems, affording caregivers the ability to access any clinical data on a patient and integrate it with clinical data repositories, clinical decision support systems, reminders and alerts, links to bodies of medical knowledge and other aids." Richard Dick, Ph.D., who some refer to as the "father of the CPR," breaks the definition of the CPR into smaller pieces. He defines the CPR as "a representation of all of the data found in the PPR (paper-based patient record) in a coded and structured machine-readable form, incorporating a messaging standard for common representation of all pertinent patient data." He further defines the CPR as a subset of what he calls the CPRS (Computerized Patient Record System). He goes on to say that the CPR combines on-line, coded, structured patient data with links to data in other formats such as text, image, voice, full-motion video and dictation. The CPRS collects data across multiple episodes of care and facilitates the data's collection and presentation through a clinical workstation. Regardless of the definition, there is little argument that most healthcare providers are seeking the same end result: to access all information in a delivery network whether that information is medical record-related or patient account-related. Many computer applications exist for Financial, ADT, Physician Support, Clinical, Radiology and other HIS functions. None of these systems alone can provide the information required for a complete computerized patient record. Because of the significant investment already made in HIS applications, healthcare providers require a solution that can integrate seamlessly with their existing applications. Who can possibly offer a solution which encompasses all of these areas? The answer is; no one vendor can do it all. To attain the best end result, providers must seek vendors whose solutions are based upon an open architecture, and which can be integrated with other HIS applications as the provider expands the solution throughout the enterprise. There must also be a support mechanism for capturing, storing and retrieving the information regardless of the information type or where it is stored. Only then can the provider pave the way to its ultimate goal of an integrated delivery system. Storing and retrieving original documents is time consuming and costly. There is also a risk of lost and misplaced files. Caregivers often cannot access the information required to prepare a proper diagnosis. In a capitated environment, this can be very expensive for the provider. Restrictions on the types of information stored may inhibit a healthcare facility's ability to offer efficient, cost-effective service to its patients. Often the information in a healthcare facility is stored in a multitude of locations, some on-site and some off-site. The resources required to gather the proper information, as well as the time it takes to deliver the information to nurses or physicians, are costly. The facility that can access all the necessary information through a single workstation will reap the rewards financially. In the race to become more competitive and efficient, there are important guidelines the provider cannot lose sight of when looking to install an information management system. These are: * Does a change or investment improve patient outcomes? * Does a change or investment improve customer satisfaction? * Does a change or investment provide cost reduction? Keeping these guidelines in mind, one solution that is starting to take hold is warehousing information which is completely integrated throughout the entire delivery network. The warehouse can allow access to all information by integrating current and historical patient information, regardless of where it is stored, with existing information management systems. It will allow the user to capture, store and retrieve scanned and/or microfilmed documents electronically, while structuring the flow of information to increase productivity. Hierarchical information storage management processes can be used to deliver necessary information on-line, and to access less essential information archived on more cost-effective storage. An electronic warehouse of information can be used to complement existing HIS applications by extending their range to include historical patient information and new information types. It can access information stored on magnetic disk, optical disc, microfilm, X-ray and paper, and support the electronic request and delivery of information from any of these media. Healthcare facilities are therefore able to reduce expenses by managing information more effectively. An example of a healthcare provider who incorporated an electronic warehouse is McLaren Healthcare Corporation. McLaren, a multi-hospital, multi-clinic healthcare system that includes McLaren Hospital, Lapeer Hospital and numerous outpatient clinics, has put together a full production, electronic, integrated delivery system. Like most other healthcare providers, McLaren had to improve efficiency and reduce costs. To do so, they elected to implement an electronic information solution that could encompass all of the required information and route that information to the proper individuals. Electronic information warehouse Like most healthcare enterprises, McLaren had a problem with the volume of paper involved in managing medical records and patient accounting. According to CIO John McDaniel, "Necessary information was not finding its way to medical records or patient accounting on a timely basis, and entire records were not always available to the clinical and administrative staff who needed to see them." McLaren selected the Electronic Information Warehouse (EIW) information management solution from Atlanta-based IMNET Systems, Inc. and HBO & Company's Pathways 2000 clinical repository product to solve their information needs. The EIW enabled the corporation to integrate easily with the HIS application and also offered them the option of choosing their storage media (magnetic, optical, microfilm, X-ray, paper). Under this system, information residing on any type of medium that is relevant to a particular patient encounter is entered into the front-end Pathways 2000 system "so that the physician can review it at the point of care," explains McDaniel. The information is then stored in the EIW so that it can be accessed for other purposes. McLaren started the process of electronic imaging in their Patient Accounts area, converting their backfile of paper vouchers. In the next phase, the Medical Records department was automated. Medical imaging was also added to provide a fully automated radiology department with images available throughout the enterprise. A significant reduction of staff members assigned to records maintenance allows McLaren a hard dollar return on their investment. They estimate that the system will pay for itself in the first year of operation. Equally important, the system speeds up the entire billing process, bringing the time for collections on receivables down an average of five days. The McLaren application is just one example of how information management technology is impacting the healthcare industry. As a result, information warehousing and the CPR are going to continue to be the trend in healthcare. Capitation contracts alone are forcing healthcare providers to seek new methods in which to access and distribute information. Time frames for implementation vary. Some say CPRs will be fully implemented by the year 2000, others think it will take considerably longer. Regardless of the time frame, CPRs are here to stay. Before providers make the decision to implement the CPR or CPRS as defined by Richard Dick, Ph.D., they must be sure that their solution addresses the following: * Complete access to patient information--data, text, document images, medical images, voice, video * Access to scientific knowledge bases * Flexible design and tailored reporting capabilities * Protection of patient confidentiality * Defined vocabulary and standardized coding * Documentation as a by-product of patient care * Connectivity with other local and remote systems * Electronic support for secondary users--payors, policy-makers, researchers In addition, the system must have the ability to grow with the enterprise, interface with existing applications and be cost-justifiable. Kenneth D. Rardin is president and CEO of IMNET Systems, Inc. IMNET Systems, Inc., develops and markets electronic healthcare information and document management systems that capture, index, store and retrieve financial information, clinical information and medical images resident on most storage media. IMNET's Electronic Information Warehouse (EIW) is a true enterprise-wide solution that integrates with software from most leading Healthcare Information Systems providers.
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