The Benefits Of Interorganizational Healthcare Systems

Transcription

The Benefits of InterorganizationalHealthcare Systems

Alexander McLeod, Ph.D. San Antonio Fire DepartmentSan Antonio EMSUniversity of Texas at San AntonioUniversity of Nevada RenoTrinity UniversityTexas State University2

San Antonio Fire DepartmentEmergency Medical Services San Antonio Fire Department Fire Fighter, Paramedic, Lieutenant, Captain Address Directions Database State of Texas Trauma Registry MandateContract BillingMedical Director ReviewUTHSC Paramedic TrainingTreatment Quality ControlSTRAC Hospital Closure SystemBexar County 911 Dispatch SystemEMS Supply3

Only 107 Fields4

Paper Patient Forms NCR paper patient forms200 records per dayPicked up daily by supervisorsGreen copy to the hospitalWhite copy to EMS recordsYellow copy to EMS BillingPink copy to Medical Director5

6

Reporting Mandate National Highway Transportation Safety State Trauma Registries Regional Area Councils formed Texas Mandated Trauma Data Set Initially only 138 fields EMS Contract Billing Reporting Quarterly Move to Monthly Inadequate Bandwidth City of San Antonio Funded Case Reporting System EHR Florida Visit Contracted Developer Efficiencies Promised7

APPENDIX B - Mandated EMS Data SetField 30313233343536373839Field TYRESZIPRESCNTYSEXRACEMOTORVERBALDescriptionRun Report IDFirm NumberVehicle TypeDate of CallCall TypeRun TypeMutual AidResponse TypePatient Contact LocationPatient Contact Location CommentsLocation IDStreet Address of OccurrenceCity of OccurrenceZip Code of OccurrenceCounty of OccurrenceGPS Latitude of OccurrenceGPS Longitude of OccurrenceCall Received TimeDispatch TimeEn Route TimeArrive Scene TimePatient Contact TimeDepart Scene TimeArrive Destination TimeReturn to Service TimePatient's Last NamePatient's First NamePatient's Middle NameDate of BirthPatient's Social Security NumberPatient's Drivers License NumberStreet Address of Patient's ResidenceCity of Patient's ResidenceZip Code of Patient's ResidenceCounty of Patient's ResidenceSexRace / EthnicityMotor Response at SceneVerbal Response at SceneMax mNumNum8

Justifying EHR Costs Average documentation time withpaper form 26 minutes. Anticipated documentation timewould decrease. More ambulance availability Facilitation of Trauma Datasetreporting to State Ability to integrate 911 dispatchdata with EHR9

EHR Designed10

How to Measure ImprovementDispatch Time Stamps Bexar County 911 Dispatch System Each segment timestamped 10-96 Call Received/Enroute10-97 On Scene10-96 To Hospital XXX10-97 At Hospital10-98 Patient Delivered/Documenting10-10 Back in Service Difference in time between the last twostamps indicates documentation time.11

Predicting Electronic HealthcareRecord Completion TimesIndividual Performancein Units of TimeMaximum with firstuses of the new systemChange in performanceintroduced by new system253Performance reachesan equilibriumLearning AreaPerformance usingthe old systemOld SystemSystem Implementation164Difference in old system andnew system performanceTime to end of learningwith new systemNumber of DaysNew System12

Integrating Systems 911 Telephone Information SystemBexar County Geographic Information SystemCOSA Computer Aided Dispatch SystemEMS Billing Contractor SystemMedical Quality Control SystemAdministrative Support SystemEMS Supply SystemState Trauma Registry SystemATT Wireless SystemUTHSC Record Storage for ResearchCase Reporting System13

Electronic Health Record SystemCase Reporting System911 TelephoneInformation SystemWireless SystemMainframeGPS SystemComputer AidedDispatch SystemCase Reporting SystemBillingContractorMedicalQuality ControlAdministrativeSupportSupplySupportCase Reporting SystemUTHSC Data StorageIntegrated SystemState HealthTrauma RegistryCase Reporting System14

EHR PerformanceIndividual Performancein Units of TimeMaximum with firstuses of the new systemChange in performanceintroduced by new system253Performance reachesan equilibriumLearning AreaPerformance usingthe old systemOld SystemSystem Implementation164Difference in old system andnew system performanceTime to end of learningwith new systemNumber of DaysNew SystemPaper Completion time 26 minutesEHR Completion time 29 minutes15

Decrease in EHR Performance Average 3 min increase X 100,000 calls 300,000 minutes/year 300,000 minutes / 60 minutes per hour 5,000 hours 50,000 hours / 24 hours per day 208 days 1,000,000/208/365 569,863 availability costs16

Benefits of EHR Implementation No paper form pickupNo revisiting forms for handwriting clarificationNo storage of paper formsNo manual retrieval from warehouseNo record transcription by EMS BillingNo manual review by Medical Quality ControlNo copying of forms for law enforcementNo manual entry of medical supply usageNo manual aggregation for EMS AdminAutomated reporting to RAC/Trauma RegistryBetter dispatch information to MedicsLocation of ambulances known17

Many Benefits to InterorganizationalHealth Record SystemsCase Reporting System911 TelephoneInformation SystemWireless SystemMainframeGPS SystemComputer AidedDispatch SystemCase Reporting SystemBillingContractorMedicalQuality ControlAdministrativeSupportSupplySupportCase Reporting SystemUTHSC Data StorageIntegrated SystemState HealthTrauma RegistryCase Reporting System18

Questions?Alexander McLeod, Ph.D.Health Information ManagementTexas State Universityam@txstate.edu19

30 SSN Patient's Social Security Number 9 Char 31 DLN Patient's Drivers License Number 12 Char 32 RESADDR Street Address of Patient's Residence 30 Char 33 RESCITY City of Patient's Residence 20 Char 34 RESZI P Zip Code of Patient's Residence 5 Num 35 RESCNTY County of Patient's Residence 3 Num