OREM, UT – In a recent survey conducted by the Healthcare Financial Management Association, the top three capital investments now being undertaken by hospitals are information technology-related, not facilities-related.
“Hospitals are taking full advantage of technology solutions,” said Rick Gundling, vice president of HFMA.
Financial managers are interested in electronic health records and want completely integrated IT systems instead of standalone systems, he said.
“Financial managers are seeing more tangible ROI with clinical IT systems,” he said, through medical error avoidance and staff retention and recruitment, to name a few.
Because there are multiple electronic medical records systems on the market, the need to link EMR systems and patient accounting systems with a standardized data exchange format has resulted in the development of CLAIM (CLinical Accounting InforMation), an XML-based data exchange standard for connecting EMR systems to patient accounting systems.
The current version, 2.1, contains two modules, including data related to registration, appointment, procedure and charging. CLAIM 2.1’s successful 2001 implementation in Japan has led some in the industry to call for CLAIM to be used as an effective data exchange format between EMR systems and patient accounting systems.
Despite these developments, interoperability standards are still approximately six to seven years away, Gundling predicts. In the meantime, clinical IT systems vendors are creating core systems that provide both clinical and financial data, he said.
Gundling said hospital financial managers are more comfortable making that leap of faith in clinical IT systems’ increasing benefits.
Adam Gale, COO of KLAS Enterprises, agrees that hospitals and integrated delivery networks are looking for a single system that merges clinical and financial data. He also believes the industry is past the point of proving that clinical systems can provide a return on investment.
A growing trend is to implement a core clinical system that also has a patient accounting system, which enables an organization to benefit from charge capture without causing a significant disruption in workflow.
Most vendors have both, Gale said, although major differences and interface challenges abound. Cerner, Epic Systems and Meditech have true integration of their clinical and patient accounting systems, while other major vendors are building integrated systems, he said.
A single underlying database is the foundation for Epic’s entire suite, which includes clinical and revenue applications. “Clinical, administrative and financial data is part of a single patient record in Epic’s system,” an Epic spokesperson said.
EpicCare, Epic’s clinical system, collects and triggers charges based on orders, entry in flowsheets and inpatient medication verification, dispensing or administration documentation. In its 2004 Davies application, Epic client Evanston Northwestern Healthcare noted a $2.5 million increase in revenue as a result of charges being directly linked to orders.
Steve Tobin, industry analyst for healthcare information technology at Frost & Sullivan, emphasized that financial and administrative capabilities in clinical IT systems should not be confused with business intelligence.
Administrative and financial applications track inventory and supply-chain management, whereas business intelligence dashboards monitor metrics and help executives make strategic decisions in real time across the enterprise. While business intelligence has a financial impact, he says, they are not the same.
Tobin believes that putting financial parameters on business dashboards inside clinical IT systems is “an interesting idea.”
The bottom line, Tobin said, is that talk of complete integration is somewhat premature. To be able to pull financial or clinical data in real time, a hospital has to have a solid digital environment.
“So much clinical IT still needs to be put in place,” he said. “Merging clinical and financial data is the next step, and when we get there, it will take time.”