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Index - Major Sections
Site Map
Product and Services _______________ Index - Same Level Subject
Index - Child Subjects |
Introduction
In general, quality of health care issues has been defined as the absence of shortages of financial, material, and human inputs (De Geyndt 1995). However, not only is there a need to know the inputs that go into the care, there is a need for the evaluation of the actual process of care. This has not previously been done because it was thought too difficult and costly. De Geyndt in his paper made the statement:
“Outcome measures were not used in the developing country studies. Improving outcomes is a presumptive result of improving the process and is not documented mainly for lack of valid and reliable measuring tools and indicators, the expense involved and the tenuous cause-effect relationship between process and outcome.
Quality Assurance / Continuous Quality Improvement.
Today’s evaluation of “quality” is not dependent on “cost-benefit” but rather is dependent on a list (a list is bad because management tends to concentrate on this only). Lists may include (1) patient survey (2) employee survey, (3) etc. These are also lack support. "Satisfaction" is only one of many indicators of health care quality and research has shown that it is not a very good one. The development of the InHCc system has allowed data to be quantified objectively—a challenge which is widespread in many industries. The InHCc system uses this information to develop QA mechanisms that improve its data reporting, analytical reliability, and business decisions.
InHCc’s research (Mexico 2003) shows that even in very poor areas, a majority of clients are willing to pay for the services of a specialist even when the charges for these services are twice as much as the general practitioner. What is even more interesting is that these clients will visit a clinic that offers the services of specialists and by-pass clinics that do not have these services even though the other clinics may be closer.
“Perceived” quality of care may be the most import factor influencing clients’ choice of health care organizations. This observation may be extremely important when governmental organizations attempt to build health care facilities in very small rural towns and villages. If the quality of care in these facilities is not perceived to be good, then these facilities will fail economically and more importantly will fail to serve the needs of the local population. It may make little difference if these facilities are closer to the client or even offer the lowest price service; they will not be used. InHCc’s research has also shown that clients, in general, equate “larger” with “better.”
Many numbers that are calculated today to indicate “good quality of care” actually indicates poor management. As an example, the “proportion of health facilities that did not experience drug stock-outs” is a sign of very poor stock management. It is impossible for every facility to carry every drug and they should not be expected to do so. This is a waste of resources (overstocking of inventory requires additional money).
Historical Account The electronic record allows the healthcare professional to pull all historical information together and sort the data by date, problem, encounter, procedures and anyone of a number of other ways. Data can also be viewed of all the members of the family or household of the patient with ease and immediately. Data such as blood pressure can be viewed in a chart form as well as other laboratory values. Healthcare Intelligences can spot trends in data (read over a time period) and can automatically indicate that action needs to be taken.
This historical account is specially important when there many be more than one healthcare provider. Communication among Care-GiversWhile this benefit is one of the most quoted benefits...it does not go far enough. While physicians may communicate with other physicians....more importantly, it allows physicians to view the notes and procedures of nursing, respiratory, rehabilitation, and other health givers.
In today's hospital ,"the nurse, not the physician, is the primary integrator and coordinator of information and is often the primary deliverer and monitor of care." (Korpman)
Instead of waiting to make "rounds" to determine what has happened, all healthcare professionals on the team can view all the notes of all other care givers. This can benefit the physician by reducing his time that he physically must be at the bed side obtaining information. The physician can view in real-time all procedures and processes of the patient.
Individuals move from place to place and from healthcare professional to healthcare profession. Communication is required among healthcare providers. It needs to be immediately and complete.
Provides tools for the "Comprehensive Examination"A good HIS provides easy to use tools for the taking of a comprehensive exam by the HCP. All client history including a complete "System Review" is immediately available to all authorized medical staff. If sufficient time is not available during one visit, additional data can be collected during the next visit. There is no "separate notes" to try to find and read...
Anticipates future health problems and actionsA good HIS makes no attempt to separate the curative from the preventive. Both are integrated into one homogeneous component. A very easy to use education system is built into each of the modules thus making it very convenient for the HCP to use. A complete client history is solicited from the client giving the HCP an opportunity to provide education to the client. The calculation of “risk factors” furthers the chance for client education. Education is as much a part of the management of the client as drugs or medical procedures.
Screening examinations and healthcare education can be recommended base on the individual's health profile.
Healthcare Intelligence can be used to "predict" future health care needs of the individual and thus the Healthcare Professional is able to provide education is advance according to the needs of the individual.
Efficiency of Healthcare ProfessionalsYou only have to read the article: Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project to understand how important it is to have a good HIS.
Medical Audit and "ratings" have become major growth areas with Health Care....i.e. the % of patients who received aspirin with 30 minutes of their arrival at the hospital with chest pain....Medical Audit Committees can be established to audit retrospectively the clinical application of medical knowledge and compare the care rendered to the pre-set standards (De Geyndt 1995)…if the data is available to analyze. Standards are set by using evidence based medicine.
The medical record provides support to medical education. Students and other Healthcare professionals can be used for "case studies", what works and what does not work. Client Care. The Client is given better care through the HCP having immediate access to Standardized Protocols and References. The Client is given better care through Standardized Screen data requirements (i.e. the blood pressure is a required data entry) Monitoring standards of care across clinicians. IT systems can provide immediate feed back to the HCP to ensure that the he provides only the best of care. Audits are automatic and do not require "sampling" of medical notes...All records are reviewed for omissions and rule based validity checks. Medical audit is becoming a major growth area. Healthcare professionals can also use these records to study the factors influencing their own management decisions and compare these to the outcomes of their patients. Decision support incorporated into the ordering process includes order sets and templates, specially designed screens for every type of order (medication, blood products, etc.), extensive use of defaults based on Evidence Medicine, automatic displays of relevant patient information and alerts, warnings and other ordering suggestions. In all cases “Standards” will be developed and available over the Internet. All Standards will include a measurement that indicates standards compliance and be available daily to management. Protocols. Monitored for compliance. Standardized treatment protocols can be designed into the system such that a physician or nurse will have easy access to the information. In many cases, a check list can be created such that all items must be checked before the system will allow the information to be entered. This ensures that the client is receiving evidence based treatments. Launch quality improvement projects. Without the tracking of indicators no program can be developed for quality improvement. Prevent of unnecessary procedures.
Certification Programs Almost 90% of Certification and Accreditation programs depend on "policies and procedure" manuals being established and procedures in place to measure "quality". While these organizations report that it is not necessary to have an electronic system....I am not sure if it is possible. Medical Audit A good HIS system provides the data needed by the medical audit committee to evaluation the “Quality of Care”. The HIS can provide this information be measuring actual performance against evidence based medicine and other standards.
Reference Data Access to all source of healthcare references. Embed activating triggers/reminders/best evidence data The ability to develop protocols for triaging clients to appropriated interventions provides a method to check that the client is receiving the procedures and treatments that the symptoms and diagnosis dictate. Inappropriate interventions such as sterilization can be identified more rapidly. Certain Healthcare Professionals who stress certain procedures over others may be easily identified. By documentation comparison of specific procedures (time, outcome, cost) cost-effective methods of providing care can be provided. Alerts and Warning: .
Check lists and structured data sets:
Other Access to Health Care Services will be improved. Through simple questionnaires taken by Healthcare Professionals, data can be analyzed to determine how to best use health care resources. The analysis can determine locations for new or improved services and can determine the best "scheduling" of staff in order to minimized the waiting time of clients. Data can be analyzed to determine what type of specialist are needed, how many, at what locations, and at what times of the day. Our research has shown that Clients have a very fixed "visit" patterns (time of day, day of Week) With scheduling systems, the waiting time of the client will be reduced and an effective method of ensuring that the client is seen by the health care worker is guaranteed. Pre-registration reduces the time that it takes to obtain the client's records and to schedule laboratory examinations. Patient referrals are easily tracked.
Contraindications will be easily identified. By having built in checks, drug usage can be tract more closely over time. When a treatment is prescribed, a check can be made automatically again any contraindications. It is impossible to check contraindications for a client unless a history is obtained of that client across time and locations. Without the knowledge that he or she has received other medications from another physician, no dosage limits or time limits on medications can be implemented. Follow Up on Patient Care: Since all data is available to every Healthcare Profession, local medical staff can monitor all referrals to a higher level of service or specialist. The first thing that must be done is be able to track the patient.
If a good referral system is in place, the patient may be more likely to select the lowest level consistent with her needs. A second opinion is now available. With the ability to carry on a conference with higher levels, additional information can be gathered and acted on. Education is : All manuals are immediately available and updated with current information and procedures on-line. Information is updated immediately by downloading new versions of procedures and protocols. This leads to the ability to have all current information in which to make a decision immediately by the physician or nurse. Resources more rapidly available: Since inventories are maintain, a patient can have the drug or service that is recommended, not the drug that may be on the shelve or the service that the health care worker "likes." An organization can create protocols or “Component Temples” that address specific problems or situations. These individual component can then be combined to create larger protocols…. Reminders and Help Screens: incorporate instructional text to avoid the omission of appropriate information and/or help screens to display "how to" instructions without having to deviate from normal procedures. Education of the Client: By being able to identify more easily those patients in need of education and their locations, it is possible to create "clusters" with the health care worker going to the location that is most convenient for those patients in need. Increase time spend on Client Care: Increased knowledge of the clients allows the health care worker to focus on the reasons for non-use of service and on the beliefs and values of the target population. Decrease paper work by the physician and nurse gives more time for client care. Visualization: The ability to graphically to display data increases the ability to "see" trends and evernts that are above or below normal values Population Management
ProtocolsMedical Audit Committee: Audits can retrospectively examine the clinical application of medical knowledge and compares care rendered to the pre-set standards or have warning notices appear during the actual entre of data if a "contradiction" occurs. Standards are set using Evidence Based Medicine and Not by what a HCP may think about the best way to proceed. Quality of Care MeasurementsQuality of Care will be determined though the use of regular medical procedures. This "Medical Knowledge Flow" (MKF) is as follows:
The Quality of Care can be determined by answering the following questions based on the "Medical Knowledge Flow:"
This Workflow produces a better Diagnosis leading to better treatments and outcomes Continuing care
Chronic Care Chronic Care of an increasingly aging population requires masses amounts of data. Without the ability to coordinate care among a team of care givers, it is impossible to effectively treat the patient. Other Quality Control Data
Patient Safety While it has been reported that in some cases (25%) of medication errors in 2006 involved computer technology as a contributing cause, it is more likely that the cause of these errors was the "neglect" of the healthcare professional. Computers are NOT responsible for anything....only the care giver. Computers are a tool to "help" the care giver, not to make decisions for them. If we are saying that the "computer" caused the problem, we are saying that the care giver didn't know enough to be able to tell the difference between the correct thing to do and the incorrect thing to do! Blaming "alert fatigue, screen fragmentation, terminology confusion and lack of appropriate defaults" on the computer is not appropriate. The question is what would have happened if they did not have the computer to help. In this case, there would have been even more mistakes. The correct analysis should be "how many less mistakes were made using the computer"...not how many were actually made. However...it is true that with a well designed system fewer mistakes should be made... A good Data analysis system aids healthcare professionals in analyzing and identifying clients who may be at risk for health related problems. Other benefits are:
Provides Preventive Education with Curative careThe InHCc System makes no attempt to separate the curative from the preventive. Both are integrated into one homogeneous component. A very easy to use education system is built into each of the modules thus making it very convenient for the HCP to use. A complete client history is solicited from the client giving the HCP an opportunity to provide education to the client. The calculation of “risk factors” furthers the chance for client education. Education is as much a part of the management of the client as drugs or medical procedures.
The InHCc System provides the information needed by the medical audit committee to evaluation the “Quality of Care.” The InHCc System provides this information be measuring actual performance against standards developed by physicians for physicians. Examples are:
Monitoring of Quality of Care indicatorsQuality of Care indicators can be automatically tracked on all patients as they enter the healthcare organization. The real time measures of the patient can be compared with the Quality of Care indicator to ensure that the patient is within normal limits of this care. Alerts can be thrown when any patient is out of these normal ranges. Business intelligence can analyze an individual's history and risk profile to determine the likelihood of increased resource consumption based on client profiling. Adverse Events and Problem ManagementAll adverse events must have a root cause analysis and must include consideration of any relevant literature. Minimizes the time taken to use dataIt was once asked of the author of this paper, “how long does it take to collect the data?” Not only is this question inappropriate but it shows a lack of understanding of why data is collected. The correct question would have been “how long does it take from the time of the event when the data is collect to the ability of the managers to be able to use the information.” Data has no value until it is used. If data only takes a few seconds to collect, but then must by summarized, transferred, and finally after six months or so used; how useful is this information even if it is “easy to collect.” The InHCc System makes data available to managers in real time. Maximizes the use of information while minimizing the cost to collect dataIt was said in one paper that “users can often develop a short list of indicators that require only modest investments in primary data collection. Costs can also be minimized by developing short lists of indicators that need to be collected only every three to five years. ” This is a waste of money and time! Any investment should be evaluated by calculating the returns based on the inputs and outputs; it is NOT evaluated by how much it costs to implement or how easy it is. Indicators that are not used to manage and effect changes… return nothing; the return on investment is zero. It makes no difference how easy or cheap data are to collect if the data can not be used to create useful information to manage. InHCc research shows that people are willing to pay for good health care; it is the same with data collection. If you do not use it, do not collect it. Good data can be, but not necessarily so, a large cost, but in the end the rewards are even greater.
Quality of DataMeasures to improve the quality of patient-based information have focused on timeliness, relevance, and accuracy. Where “relevance" depends on who is using the information, data available in real time becomes more relevance. The InHCc System collects information that can be used by managers to manage. In the past, it was considered sufficient to create indicators for “performance evaluation”; the InHCc system creates data to be able to manage these performance indicators, to be able to change them. Coding rules are built into the InHCc system that help prevent inconsistent data. All codes are entered automatically into the database based on a descriptive selection of the user. The user does not know or need to know the codes. There is no need for “coders”. Misc Benefits
Research You cannot give better care if there is no research. Research can be improved by recording the "standardized atomic description of diseases and their processes." Masses databases with this data can be analyzed automatically and record relationships and events that may be too uncommon to view without this ability.
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