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Patient Relationship Management

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Background:

In today’s  21st century modern healthcare system it is important to stay ahead of competition and patient needs to attain overall patient satisfaction further keeping them engaged and loyal. Today’s patients are more informed regarding their options to obtain quality care and are ready to take a second opinion by switching providers, they expect convenience, instant response, and give priority to the end-to-end experience. Hence healthcare systems/ organizations must analyze barriers to consumer satisfaction and focus on patient-centric technologies to improve convenience, transparency, and speed of care delivered

There is a strong association between the patient experience, patient engagement, and clinical outcomes. Hence developing innovative systems in healthcare organizations has now become a priority. PRM stands for Patient Relationship Management System is one such specialized software system used to optimize and assist the Hospital staff to manage the Patient journey throughout the course of interaction with the healthcare system and its staff. Every time a transaction or a conversation happens between the patient and the hospital PRM assists by providing a systematic tool to record and store important Patient Conversation pointers which will help the hospital team to connect with patients on a human level. Just like deploying customer relationship management (CRM) has helped in building long term relationships by proactively understanding and serving the needs of the customers, healthcare providers can do the same by incorporating PRM.

There were good old times in India when you did go to a family physician, who probably knew your great grandfather had a seasonal allergy and has examined all your family members, probably seen 4th or 5th generation people in your family lineage.

The moment you walked into the clinic he/she kind of knew, most often, what was wrong with you. Just a gentle talk, a reassuring pat on the back, some syrup, a tablet, and a hot soup prescription, you are already feeling better by the time you walk out of the clinic.

The modern hospital is a complex environment. Corporate culture in management and operations management is more or less modeled by the hospitality industry. The look and feel you get in a five-star hotel are more or less the same as what you would expect in any modern-day hospital in Mumbai or Delhi or Bangalore.

The only problem is people go to hotels for leisure and entertainment, expecting good service. People do not want to go to hospitals but are forced to go under a lot of stress, staff in hospitals are constantly working under stress and are not trained in customer service, they are trained to save lives.

In the absence of a family physician, who used to generally bridge the gap between the hospital and the family of the patient, high attrition rates at hospitals where the front office receptionist and the nurse change every time a patient visits, adds to the tension and stress to not just the patient, attendants but also the hospital staff and doctors.

Now, most hospitals have a complex EMR or HIS or Billing system which records all transactions but does not necessarily have any information related to building trust, building relationships, building a rapport. That’s where a PRM plays an important role

Next obvious question is why do we need a PRM in Hospitals ?

As mentioned earlier, modern-day hospitals operations are evolving to be more robust and complex. In a race to meet the Occupancy rates, many hospitals miss the key factor, building trust and confidence among patients. At the end of the day, we need to realize we are dealing with human beings and not just a machine. In times of stress, People need a human touch. Building trust, building a rapport, building a lasting relationship, that’s what matters the most. That’s what is the differentiating factor in many cases between the extremely precise, highly objective treatment plan, equipped with state of the art high tech systems with the best of the best of the best Doctors losing to an average hospital with an average infrastructure, but a wonderful team of Doctors and Nurses who along with the objective metrics of treatment deliver care.  The PRM and proper training among staff throughout the organization shall bridge the gap and help in building a strong rapport between the patient and the hospital as an organization. 

Would it not be nice if the new front office receptionist can have a quick chat with the patient about the recent holiday they had while they are on hold to book the next available appointment with the doctor? Would it not be nice for the new doctor to have a quick informal conversation with the patient about the new car that was purchased? Would it not be nice for the nurse to have a reassuring chat about the long wait times to get to the lab?

 Building relationships and building rapports with the patients, record points for informal chats throughout the patient journey within the organization will empower the hospital to add a human touch to healthcare, showing that it’s care that is being delivered

ADVANTAGES OF PRM:

 

In one informal case study, it was observed that when PRM is used efficiently and effectively supported by proper staff training, sensitization of support staff within the hospital, pre and post-implementation surveys about 1 year apart indicated higher patient satisfaction metrics after the staff started using PRM effectively. The hospital staff would greet the patients well, behave more courteously and use subtle informal pointers to connect with the patients better compared to just treating patients like just another body  .

To conclude, hospitals spend their efforts on process improvement which can be measured objectively whereas patients give priority to the overall patient experience. Hence patient relationship management solutions can satisfy customer expectations within the demand of time.

 

Dr.Ashvath & Dr.Namrata Bhatta

MetahOS Helps Reduce Accounts Receivables for Hospitals

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MetahOS - Finance Head

The revenue cycle is the central nervous system of any healthcare enterprise. It communicates and coordinates information about the system’s most important relationship with Patients, Providers, and Payers. An integrated revenue cycle will help healthcare systems strengthen these relationships. MetahOS Helps Reduce Accounts Receivables for Hospitals. 

What Are Accounts Receivables (A/R)?

Accounts Receivables are simply money that has already been earned but not received by hospitals when a hospital bills its insurance companies (payers) for treating their subscribing patients, resulting in outstanding payments owed to the hospital by the payers.

Who are these Payers?

These Payers typically are:

  • Private Insurance Companies: Bajaj Allianz and any other Health Insurance Companies
  • Corporates & MSMEs: Industries, Railways which contract a hospital to provide care to their employees
  • Government Schemes: Employee State Insurance (ESI), ECHS, Ayushman Bharat, Arogya Bhagya, and countless other state and central government schemes.

Understanding Your A/R Report

A hospital’s Accounts Receivables report lists all inpatient and outpatient services rendered to patients during a given period. These reports are used to determine how much a patient owes the hospital for services and/or supplies. 

A mid-size hospital’s A/R is typically 1-year of EBIDTA, and, in some cases, it might go up to 2-years of EBIDTA.

Root Cause Analysis: Why Does A/R Increase?

An increase in Accounts Receivables starts when the patient is admitted and multiplies each day for every mistake across the patient journey. Most often, the delay in Receivables is due to lapses at the Hospital end.

 

Metahos Healthcare Operating System Integrated Receivables Management System Increase in Accounts Receivables

Below are the 6 common root causes of delay in A/R

  1. Patient Admission/Registration

    1. Unavailability of Patient Checklist for Eligibility
    2. Efficient Screening Process
    3. Staff Training Issues

  2. Ward

    1. Delay in Updation of Records
    2. Incomplete File

  3. Reports

    1. Delay in Radiology Reports
    2. Delay in Lab Reports

  4. Billing

    1. Random Selection of File for Bill Processing
    2. Delay in Investigations Report

  5. Government & Validation Desk

    1. Unavailability of Patient-Centered Counselling
    2. No Requirement to Enter a Discharge Summary

  6. Claims

    1. Absence of Process Monitoring
    2. Shortage of Man Power

How to Overcome These Pitfalls

Hospitals need to bring in change through the following 6 drivers.

  1. Revenue Realization

    • Improve revenue growth by decreasing A/R

  2. Increased Productivity

    • Decrease time taken to submit claims by at least 50%

  3. Service Delivery Improvement

    • Measures to improve the flow of documents between departments

  4. Cost Reduction

    • Reduce cost by enabling single entry, multi-use

  5. Treatment of Operational Risk

    • Reduce PEOPLE dependency; increase PROCESS dependency

  6. Compliance

    • Stay compliant while improving processes, training, and enabling technology

Risk Awareness and How to Mitigate

Knowing your risks is half battle won! As Sun Zhu, the author of Art of War, says, “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.“

Some of the common risks include:

  1. Systems are not interoperable nor integrated, thereby creating duplicate transactions on multiple systems.
  2. Too much dependency on Human Resources rather than processes.
  3. Unaware of daily vital statistics to the running of a hospital.

Recommendations for Operational and Financial Gains

Identify Bottlenecks and Fix

Like a supply line in a manufacturing company, the files move in a predefined order. Still, every process creates bottlenecks if the implementor does not understand the Theory of Constraints.

Baseline Performance Profile

For consistent data to assess action areas, proceed with data collections, and Revenue Cycle improvement.

IT Optimization

An ongoing process that uses best practices and solutions to remove gaps. Also, initiate Continuous Improvement Process (CIP) and award best practices.

Patient-Centric Revenue Cycle

A Patient-Centric Healthcare System would improve care delivery and provide seamless integration across scheduling, registration, arrival, care delivery, billing, post-care, collections, and be key for revenue integrity & market leadership.

Hospitals can now benefit quickly from MetahOS Integrated Receivables Management System (IRMS), as it can work alongside any Health Information System (HIS). Along with IRMS, you also get

  1. End-to-end transformation

    Deliver comprehensive revenue cycle services, including process redesign, technology enhancement, organizational design, and performance management.

  2. Revenue cycle business intelligence

    Conduct root cause analysis of revenue leakage to identify net revenue, reduce bad debt, and accelerate collections.

  3. Charge integrity and reimbursement

    Drive net revenue improvement through an enhanced mid-cycle process.

    • Meta hOS Accounts Receivables Simplified

  4. Revenue cycle systems implementation

    Plan, design, and implement technology systems.

  5. Revenue cycle tools

    Automate workflow processes and enhance reporting capabilities through IRMS.

Currently, 80% of all Hospitals are not utilizing the power of the Integrated Receivables Management System.
The lack of integrated tools leaves hospitals frustrated with not getting paid on time and with no time to handle their receivables. This is where MetahOS Helps Your Hospitals Reduce Accounts Receivables.

The Role of Health Information Technology in Post Acute Care

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Post Acute Care and Health Information Technology

Introduction
In the British Medical Journal post ‘The Stress of Sending Patients Home’, physician David Oliver recalls how he was publicly threatened by the relative of a patient in the supermarket. Seemingly, the patient had suffered from complications after he had been sent home, and the relative was unhappy with the doctor’s decision to discharge the patient. Oliver goes on to state post-discharge problems are a growing concern.

Although Oliver admits that there is no single solution to solving such problems, he suggests that post-acute care could be a panacea for improving patient care outcomes. In this context, this blog highlights the problems in post-acute care and suggests how post-acute care strategies can be developed effectively using health information technology.

Post-Acute Care
Post-acute care is defined as the ‘rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital’. After the hospital stay, a trouble-free transition is essential for ensuring that readmissions are low. However, at present, a disproportionate focus is placed on the quality of care received by the patients during the hospital stay, and post-acute care tends to be overlooked.


[Transition in Care. Adapted from http://ahhqi.org/images/uploads/Revolutionizing_Healthcare_Pam_Duncan_Article_05-08-13.pdf]

Data Integration
For ensuring the smooth transition between care settings, providers undertake the process of discharge planning. This includes outlining activities ranging from follow-up tests and appointments to the usage of exercise equipment for the patients. However, fragmentation in data systems prevents providers from getting a comprehensive picture of the patients’ requirements. In order to overcome this problem, providers could use an integrated Electronic Health Record functioning across different care teams. At the same time, a real-time communication channel between different care teams could help in the meaningful interpretation of data present in the EHR. This would allow providers to get the necessary information to plan the discharge process.

 

Follow-Up Consultations
Follow-ups are essential for monitoring the disease parameters, and failing to do this could result in future complications. Evidently, the problem of irregular follow-ups has worsened due to the perception of hospitals being high-risk zones during the ongoing pandemic. To ensure the successful follow-up of patients, providers could consider the usage of telemedicine. Telemedicine can allow remote monitoring, and ensure that the patient is able to successfully manage the disease post-discharge with the assistance of his provider.

 

Patient Education
Essentially, post-acute care involves equipping the patients with the ‘skills required for caring for themselves.’ However, in a short amount of time, transferring these skills to the patients could be difficult. For making sure that this information stays with the patients, providers can make use of health information technology tools. This could include a digital record of the necessary information, along with baseline assessments to ensure that the patient understands what has been told to him at his own time.

 

 

In conclusion, it is evident that technology could help us improve post-acute care. However, to ensure widespread adoption, it would be essential that these technologies are both provider-friendly, and patient-centric.

10 Things Your Boss Wishes You Knew About Receivables Management

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Account Receivables (AR) are amounts yet to be received for goods or services ordered. AR is legally enforceable claims for payments generally in the form of invoices raised by a business for the goods or services rendered to the customer. 

 

In a hospital setting, AR could be in the form of Government Schemes and Insurance Claims owed to the hospital by the administering authority, generally the claims processing department of the Government scheme or the Health insurance company. 

 

Here is where things get a little complex. If you are working in the hospital insurance claims department here are some important things you need to know.

 

  1. Each policy or agency has its cycle of payments against the claim raised. For example Insurance Company A may have a processing cycle of 15 days while Insurance Company B may have a cycle of 45 days 
  2. Accounts Receivables management is critical for a hospital to ensure proper reconciliation. Lack of an AR tracking system could lead to bad debts and bad patient experience. 
  3. Limited mode of payments. If your hospital has a limited mechanism of payment receipts, for example, if the hospital accepts only CASH payments, it somewhere reflects on the profit. The solution is to have multiple payment processing options like Credit/Debit Card, Online direct bank deposits, Digital Payments, among others. This gives more flexibility to patients to pay for services. 
  4. Interdepartmental coordination. How often do we experience that the attending doctor has given a discharge note but the Nursing Station, Pharmacy, Diagnostics, Billing Department and Claims department are running from door to door to get the right discharge summary and supporting documents? The solution is to integrate Medical Records, Pharmacy, and Billing systems that streamline the discharge process. 
  5. Hospital Staff training. Many of the medical staff and nursing staff have limited knowledge of the insurance claims process. Regular internal training could help better communication between departments and better coordination 
  6. Using multiple software systems or paper-based systems could increase the time required to gather all necessary documentation. Having one robust system across the organization could ease-out bottlenecks. 
  7. Requests for more information by the claims department of the agency or the insurance company are very common. This simply means not enough documentation was submitted during the initial claim process to justify the claim. Having a centralized information system could reduce the errors and the claims department could have access to all reports, bills, and treatment data before the claim is submitted therefore reducing the overall AR cycle. 
  8. Patients and Their Attending family members the majority of the time are not aware of the insurance coverage. It would be helpful if one dedicated insurance processing expert reviews the policy at the hospital and educates the coverage and limitations of the policy to help the patient understand the policy better and take better decisions. 
  9. Timely and Accurate information when provided to the insurance claims department reduces the overall lifecycle of the AR in question. 
  10. Develop a Plan, SOP, and KPI for your Hospital Claims department, Define roles and responsibilities. It is essential to have a plan in place. High staff attrition is a problem many hospitals face. The Claims Process plan and Process map will assist in hiring the right resource and providing training. KPI measures the performance of the department. 

 

Join the webinar to know more :

Solving Hospital AR problems

stronghospitals

 

 

Cyber Security in Hospitals and Healthcare Facilities

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“Early last summer, Chinese and Indian armies clashed in a surprise border battle in the remote Galwan Valley…Four months later and more than 1,500 miles away in Mumbai….Hospitals had to switch to emergency generators to keep ventilators running amid a coronavirus outbreak that was among India’s worst…those two events may have been connected — as part of a broad Chinese cyber campaign…”

In the ongoing tensions between India and China, cybersecurity has become a hot button issue. Recent reports suggest evidence of foreign malware targeting critical operations in India. Among other operations, Indian healthcare facilities are being perceived as key objects of cyber attacks. With the recent digitisation of operations, hospitals are particularly vulnerable to these attacks. In this background, this blog explores the sensitive nature of healthcare data, and suggests ways for hospitals to protect against cyber attacks.

PII and PHI

Healthcare data is sensitive as it deals with both Personally Identifiable information, and Protected health information. Personally identifiable information refers to data that could ‘possibly identify a specific person’. Examples include address and credit card details. Protected health information refers to ‘any information in a medical record created in the healthcare process’. This could refer to health information such as blood type and allergies. Arguably, PHI is even more sensitive to handle since it cannot be changed.

Incidents of Data Breach

The extent of damages done to hospitals can be reflected in incidents of data breaches. In July, 2015, UCLA health reported a data breach of the records of 4.5 million patients. Investigation revealed that basic encryption of medical data had not been carried out, which made the data vulnerable. As a consequence, ​​names, dates of birth, Social Security numbers, Medicare and health plan identification numbers as well as some medical information were exposed to hackers.

Measures for Protection

For effectively protecting the healthcare facilities from cyber attacks, we outline the following 1​

measures​ :

● Robust IT platforms: It is important for hospitals to have robust IT platforms with a strong application base. These applications should not constantly break down. If they do, they should be restored quickly.

  • ●  Responsible Planning: Hospital staff should carry out regular planning to review the risks posed to the systems. Anti-malware software needs to be installed and regularly updated. And if possible, data needs to be encrypted.
  • ●  Training and Awareness: Humans can make mistakes, and can err in judgement. For reducing the risks in decision making, regular training and awareness is a useful tool. Learn.MetahOS.com has a course on cybersecurity, which can be useful for hospital staff.In conclusion, increasing digitisation will expose hospitals and healthcare facilities to new risks. Healthcare facilities face extra responsibilities due to the sensitive nature of the information. For securing all grounds, strong technology partners can be critical.References:https://economictimes.indiatimes.com/news/defence/china-appears-to-warn-india-push-too-hard-and-the-lights-could- go-out/articleshow/81266286.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

    https://www.latimes.com/business/la-fi-ucla-medical-data-20150717-story.html

    Argaw, S.T., Troncoso-Pastoriza, J.R., Lacey, D. e​ t al.​ Cybersecurity of Hospitals: discussing the challenges and working towards mitigating the risks. ​BMC Med Inform Decis Mak​ 20, 146 (2020). https://doi.org/10.1186/s12911-020-01161-7

Optimising Communication in Healthcare

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In today’s world, several individuals are involved in a patient’s care journey. And all of these individuals constantly share information with the patient. Often, these micro-level interactions determine patient satisfaction.

Poor interactions could lead to dissatisfied patients. Pleasant interactions could result in satisfied patients. Consequently, for improving the patient experience, streamlining communications is essential. In this post, we present the advantages and disadvantages of different communication channels.

Type of Communication
Based on the nature of the interaction, communication can be classified as synchronous or asynchronous. Synchronous communication includes two way interactions such as telephony.
Asynchronous communication involves one way interaction such as text messages.

Synchronous Communication
In healthcare, telephones are commonly used for synchronous communication. They involve simultaneous interactions. However, telephonic interactions are known for regular interruptions. Due to these interruptions, individuals with a heavy workload could face problems in recollection. For example, a busy clinician could forget to take notes if he is interrupted often.

Asynchronous Communication
Asynchronous communication does not involve simultaneous exchange of information. This form of communication could involve SMS messages and whatsapp texts. Although asynchronous communication excludes the possibility of interruptions, it is ineffective in getting urgent messages communicated.

Conclusion
Given their advantages and disadvantages, healthcare facilities need to utilize both synchronous and asynchronous forms of communication. The communication channel can be determined depending on the type of message that needs to be communicated. Consequently, metahOS allows for both forms of communication to take place in a seamless and secure way. This helps in increasing patient satisfaction.

References:
Coiera E. Communication systems in healthcare. Clin Biochem Rev. 2006;27(2):89-98.

7 Little Changes That’ll Make a Big Difference With Your Hospital Contact Center

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The majority of the patients prefer to connect and talk to a hospital representative over the phone in spite of the advancements and introduction of chatbots and AI engines. In the time of distress, it is natural to have human interaction and reassurance, which dissolves most of the anxiety and ambiguity. 

In most of modern hospitals there exists a telephone EPABX and intercom framework for structured internal communication. The external communication through inbound telephone calls needs a streamlined workflow and systematic log mechanism to keep track on the number of missed calls, type of calls, proper tracking for quality and training among the front office. In many cases, these records come in handy in case of medical-legal matters.

 

The majority of the small, mid-size and large hospitals have an in-house front office team. However, all the hospital administrators or hospital owner-doctors indicate a high amount of attrition in front office staff leading to high costs in training and drop-in communication chain against the set internal policy. In many cases, it is being observed that some hospitals and health service providers choose to delegate contact center work process, staffing, and training to a third party service provider which has its own set of advantages and disadvantages.

While most of the hospitals have an in-house front office team, the traditional intercom system is not able to keep pace with the smartphone revolution. Doctors, nurses Hospital staff start communicating using several private chats and messaging systems outside of the legacy EMR or HIS systems, complicating the communication channels, inability to track details of message exchanges for accountability purposes. This may also be against the communication and patient privacy policy regional laws, opening up a new channel for the medico-legal lapse. 

 

With this background, it is recommended by a team of policy and hospital administration experts that modern 21st-century hospitals should adopt the following :

  1. Transition from paper / emr/ traditional his systems to a contemporary hospital operating system.
  2. Introduce administrative policies preventing hospital staff from exchanging patient-related data on private chat / messaging systems.
  3. Adapt a seamless unified digital platform which is a streamlined single window for all internal and external communications.
  4. Track inbound patient communication missed calls, outbound calls using an advanced contact center system, get more professional. 
  5. To solve the staff attrition problem, choose a system that does not require intense training. Any new staff with basic telephone and computer skills should be able to adapt to the new system. 
  6. Smartphones are a new normal, Millenials / gen x / gen y are going to be the major workforce in the coming decades. Instead of forcing them to adapt to a 4-decade old system, the hospitals need to transform their software to work across devices while maintaining the required security. 
  7. The front office and billing department and the clinical services teams should be able to communicate seamlessly to ensure the patient experience is enhanced. Modern day hospitals need to look at adopting a patient centric platform which has the ability to provide single window tool to manage the patient journey 

Budget 2021 and Digital Health

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Digital Health

In the 2021 budget, healthcare has been the key focus area. With an increase of 137%, the amount earmarked for healthcare for 2021 is Rs 2,23,846 crore. Specifically, the government wants to strengthen its focus on ‘preventive health, curative health and overall wellbeing’ for all the citizens of this country. 

 

The 2021 budget has given an enormous boost to the initiatives of m16 Labs. From our inception, we have worked on making healthcare more accessible in Tier II and Tier III cities. And in the process, we have worked to reduce healthcare costs and improve quality in care provision.

 

Since our technology integrates all aspects of care provision, it enables reduction in healthcare costs through avoiding the duplication of efforts in care facilities. On the other hand, it improves care quality for patient through enabling coordination among providers, and by making information accessible to patients across the care continuum. The use case of a PHC in Karnataka is a testimony to how our solutions can make care accessible to the last mile, while improving quality and reducing costs. 

 

Use Case: A PHC in Karnataka   

Dr. Sathish Pai, Consultant Dermatologist at a super speciality hospital and, Mr. Harish, Chief Pharmacist at a Primary Health Care Centre decided to provide free teleconsultations using WhatsApp for the villagers in a remote region of Shimoga District in Karnataka. 

 

Due to the lack of hospitals in the area, the villagers would have to travel a long way to consult a specialist doctor in the city. Initially, Mr. Harish collected the patient data, such as the patient name, previous history, symptoms, and pictures of the affected area. Then, he sent them to Dr. Sathish via WhatsApp. After a thorough analysis of the pictures and symptoms of the patient, he established a diagnosis and sends across the prescription, only if the ailment is treatable through teleconsultation or else the patient is asked to either consult him in-person or is suggested to see a doctor nearby in their area. 

 

The process was strenuous and required to keep multiple documents on a day-to-day basis like patient details, diagnosis, and physical consent forms which the Government has made mandatory for the patient to sign to show they are willing to receive teleconsultation.

 

With Primary Health Care Centres now providing easy accessibility to super speciality services, patients suffering from diseases need not travel to hospitals in the city to seek treatment instead can stop by the PHC and obtain quality treatment free of cost and once cured can resume their day-to-day work without causing a hindrance to their survival. Given the current situation, it won’t be wrong to say that telemedicine has indeed augmented health care delivery in India especially in such trying times.

 

Supporting Patients across Continuum of Care

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MetahOS Continuum of Care EMPI

As every healthcare provider knows, each time you conduct a patient encounter, it is important that you gather information about your patient in order to treat them properly. The Enterprise Master Patient Index (EMPI) is the industry’s leading methodology for recording and treating patients with multiple medical needs. EMPI improves outcomes and patient care through seamless treatment of patients across the continuum of medical care while improving efficiency in processes, promoting practice strategy alignment, and improving compliance with individual regulatory agency requirements. EMPI leverages all critical information gathered in the clinical setting including demographics, diagnosis, problem list, medications, procedures performed and more. Using EMPI you can bring all potentially relevant patient records for a given encounter into one place-helping to facilitate delivery of seamless care.

Enterprise Master Patient Index

 

An enterprise master patient index or enterprise-wide master patient index is a database that is used across a healthcare organization to maintain consistent, accurate and current demographic and essential medical data on the patients seen and managed within its various departments. The patient is assigned a unique identifier that is used to refer to this patient across the enterprise. The objective is to ensure that each patient is represented only once across all the software systems used within the organization.

 The essential patient data includes name, gender, date of birth, race and ethnicity, Aadhar number, current address and contact information, insurance information, current diagnoses, most recent date of hospital admission and discharge (if applicable), etc.

EMPIs are intended to solve the common problem where multiple systems across the organization gradually become inconsistent with respect to the patient’s most current data when the patient’s information changes, and only one system is updated, i.e., the changes are not propagated to others.

 

Key Identifiers

Last Name, First Name

Date of Birth

Administrative Sex

Address

Types of patient identification problems that compromise the integrity of the EMPI typically fall into one of the following categories:

  • Duplicates: Two or more medical record numbers for one single patient.
  • Overlays: Two or more patients are assigned one record number.
  • Overlaps: Patients seen at multiple facilities have overlapping medical record numbers at each facility within an enterprise or integrated delivery network.

The EMPI is adaptable to a variety of healthcare architectures, including Health Information Exchanges the others. 

EMPI services should include:

    • Data Cleansing
  • Data Normalization
  • Data Standardization
  • Recognize at all points of service
  • Improve quality of care by accurately locating and linking demographic information
  • Improve clinician satisfaction by providing more trusted and accurate patient identification at the point of service
  • Quickly create applications powered by patient data that can be used to solve standalone problems or can be embedded into existing applications

Build a foundation for growth with a highly scalable solution that can be extended to include a single view of providers, healthcare organizations, etc.

Approach:

  1. Business Process Understand the business processes and existing infrastructure
  2. Training  Train the users / developers on how to use or build an EMPI system
  3. Technology Work with existing technology or provide a framework to establish query response with the EMPI engine

Algorithms and Identifiers:

EMPI needs to use various algorithms to establish a single patient index, the most frequently used and the one that we recommend is levenshtein, also along with the algorithm there needs to be a an identifiers setup which will determine and index the patient.

Jaro Winkler: https://en.wikipedia.org/wiki/Jaro%E2%80%93Winkler_distance

Levenshtein: https://en.wikipedia.org/wiki/Levenshtein_distance

Referral Management Systems: Will they ever Rule the World?

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MetahOS Referral Management System

 

Background 

In most countries, the two main types of care facilities include clinics and hospitals. As gatekeepers, clinics are expected to provide services for uncomplicated cases. From the clinics, the more serious cases are referred to the hospitals. This pyramid of care facilities results in reducing costs for the payer and improving quality of care within the health system. Apart from the transition from primary to specialist care, referrals occur from specialist to specialist care or from an inpatient setting to emergency care. This post looks at the challenges and enablers to electronic referral management systems. 

Referral Management System 

The WHO defines a referral ‘as a process in which a health worker at one level of the health system […] seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of, the client’s case’. Broadly, the usage of referral management systems is carried out to improve health outcomes by monitoring the patient’s journey across the care pathway. 

 

Since the need for referrals occurs due to the escalation in need or change in diagnosis, referral management systems play a critical role in effective care provision. 

 

Challenges to Referral Management Systems 

The key challenges to referral management include: 

 

  • Care provision in clinics is considered to be of a lower quality. This results in people seeking care directly at the tertiary facility.
  • Impersonalized system of record keeping, which results in patients feeling lost. 
  • Paper records result in difficulties in data collection and storage. Because of these problems, there is a lack of accurate information. 
  • The presence of different languages and standards in healthcare creates difficulties in making use of stored information to improve health outcomes.
  • The presence of different record keeping mechanisms results in the fragmentation of information.
  • Difficulties in managing care systems.

 

Enablers of Referral Management Systems:

To a large extent, problems in referral management systems can be overcome with the usage of electronic patient records. 

 

  • Electronic record keeping mechanisms result in increased transparency in care systems.  This increases patient trust.  
  • Information is streamlined through different languages, standards, and record keeping mechanisms in order to improve health outcomes. 
  • Maintaining both provider directories and patient records is easier digitally. 
  • Communication between care providers is streamlined through the use of a single platform. 

 

In conclusion, referral management systems are effective tools for improving quality of care provision, and reducing costs. Despite its effectiveness, several challenges hinder the effectiveness of referral management systems. However, these problems can be overcome with the usage of technologies, which streamline information to improve outcomes. 

 

Sources:

Bossyns P and Van Lerberghe W, 2004, The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger, in Human Resources for Health 2004, 2-1, available on line at: http://www.human-resources-health.com/content/pdf/1478-4491-2-1.pdf

Cervantes K, Salgado R, Choi M and Kalter H. 2003 Rapid Assessment of Referral Care Systems: A Guide for Program Managers, published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development, Arlington, Virginia, available on line at: http://www.jsi.com/Managed/Docs/Publications/WomensHealth/PNACW615.pdf

Department of Health, Republic of South Africa, 2003, The Clinic Supervisor’s Manual, Version 3, see Section 6: Referral System Guidelines, available on line at: http://www.doh.gov.za/docs/factsheets/guidelines/clinical/index.html 

Barnett M, Sirui S, Landon B. Trends in Physician Referrals in the United States. Arch Intern Med. 2012; 172(2): 163-170. doi:10.1001/archinternmed.2011.722. 

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