Riding the Information Wave ...
Published in:
Advance for Health Information Management - Technology in Medical Records
- 9/30/94
Health care and hospitals are subject to hundreds of regulations and changes every year. The quantity of general medical practice information is exploding. Reimbursement for health care is completely dependent upon accurate data collection and adherence to these regulations and practices. The Health and Human Services department alone publishes thousands of pages of regulation each year. Every area in a hospital is affected, from the medical staff and nursing to finance and Health Information Management.
In the course of a busy day, how can you possibly even know about all these changes, let alone keep altering your operations to meet them? And you have to respond to them in order to continue delivering health care services.
In the information age of the 1990's, access to information is becoming the great equalizer. Previously, only large hospitals could afford access to these massive amounts of information because they were only available in paper form, or through expensive time-sharing computer services. The time has come when the solo medical practitioner and the smallest rural hospital can have access to that same information.
And the technology to do this is not complicated or expensive. It's been with us for several years. We're all familiar with it in the form of music/audio compact disks (CD's). The audio CD has completely replaced the phonograph record in the past five years because it is a clearly superior technology from the point of view of both the audiophile and the publisher. Because it is a digitally-recorded media it has much higher fidelity, can hold more content, and is less expensive to reproduce.
That same technology is now being applied to virtually every aspect of information publishing. For the first time, massive amounts of information can be published, distributed and kept updated inexpensively. It's called Compact Disk - Read Only Memory (CD-ROM) because it is recorded by the publisher once, and can't be written over or changed afterwards. Used in a PC with search and display programs, you can find any desired piece of information on the disk in less than a minute.
And the amount of information on a CD-ROM is astounding. For example, one year of the Federal Register on paper contains about 70,000 pages, weighs about 240 pounds and makes a pile 10 feet high. The same information easily fits on a single CD-ROM disk that weighs a half ounce. One CD can hold about 300,000 pages of text - or the equivalent of over 1,000 pounds of paper copy!
Optical recording - the technology that makes CDs work - is also being used to implement the Computerized Medical Record (CMR) because of its immense storage capability. But you shouldn't confuse a CMR project with using CD-ROM's for information access. A CMR project is a complex, expensive undertaking because it involves changing the way all the data in your hospital is handled.
Using a published CD can be simply a matter of plugging a $350 player into any PC, loading a small software program, inserting the CD, and you're up and running in about 30 minutes.
Now, what's really available and what can you do with all this information? If you're like me, you barely have enough time to skim the local newspaper, let alone thousands of pages of regulations. Just because you can get it doesn't mean you can read it all.
The number of CD titles is literally exploding. In 1991 there were fewer than 100 titles, by 1993 there were over 3,000, and in 1994 almost 10,000 titles are available. And don't forget that a single CD title can be the equivalent of 100-300 paper books. It includes everything from Federal regulations, medical research, article abstracts, and legal cases through encyclopedias, classical literature, anthologies, and, of course, the ever-present computer games. Consumer CD's, such as encyclopedias and literature, have fallen in price to the $19-$79 range due to the high sales volumes. The prices of business-oriented CD's are in the $250-$2,000 range because they are really subscription services with periodic updates. Either way, it's a much less expensive to get the information on a CD than in any other form.
What can you do with a CD-ROM? It's not like a book that you are going to read. It's more like having a complete reference library on each subject sitting at your fingertips. With a few CD's you can probably have more reference works on your desk than most public libraries have on their shelves. You use it to look up specific information.
For example, suppose your PRO questioned the wording on your attestation statement? You could use one of the CD's I describe later on to search for the words "attestation" and "statement" occurring anywhere in the textual information on the CD. That could include a search of over 100,000 pages of regulations. In a minute or two, you'd find out that HCFA modified the attestation requirements in March 1994, see the approved attestation statement, and properly re-submit the claim, saving your hospital any lost reimbursement.
A physician can use a CD-ROM to find in seconds the latest information on one of over 50,000 drugs and side effects, review current cancer treatment protocols for a particular patient case, or search a world-wide literature database on CD for recent medical articles on any subject.
That's just impossible to do with paper sources, even if you had them on-site.
Software companies will soon be distributing their software on CD's because it's cheaper and more reliable. Companies are experimenting with "sampler" CD's where you can get 50-100 different application programs on a trial basis on a single disk. Try an application out - if you like it, just call in with a credit card number and they'll give you a password that will make the application full function.
What do you need to get started? If you already have a PC, the easiest way is to get an external CD-ROM drive that plugs into the printer connection on your PC. This comes with software that lets you use both the printer and the CD-ROM at the same time. It has the advantages of simple installation and portability - you can use it on any PC including a laptop. And you can move it around as needed - so another department such as the Business Office could borrow it together with the CD. It's very reasonably priced at around $300-$350. The only drawback is that it's slow. But it's a great alternative if you need the portability or only use it occasionally.
You can add a CD-ROM drive into an existing PC, but it can be complicated. When you look at all the costs and trouble, you're usually better off getting a new PC already equipped with a CD-ROM drive and donating your existing PC to another department.
If you're getting a new PC, it should have a 486 CPU, 8MB of RAM, a 300-400 MB hard drive, a CD-ROM drive, a color monitor, and a 3 1/2" diskette drive. A sound-enhancement card is optional for business purposes, but it does makes CD-ROM games much more realistic. Total price for these systems is $1,700 - $2,000 at large computer warehouse stores. That's a fabulous value when you consider that a stripped-down entry-level 486 system starts at $1,200 (with a color monitor). Many new CD-ROM applications that use Microsoft WINDOWS now require 4-8MB of RAM memory, so definitely get a system with 8MB installed initially. If you try to upgrade from 4MB to 8MB later on, the first 4MB will usually have to be replaced to install the additional 4MB - doubling your memory costs - since different memory "chips" are used for 8MB sets. New systems also usually come with a set of 5-10 consumer oriented CD's, such as an encyclopedia, last year's TIME magazines, and a few games.
The CD's are easy to use. Most of the information sources come with software already built-in to read, search, and print the CD-ROM information. While each of these navigation software systems is slightly different, they all perform essentially the same functions, so it's not difficult to learn a new one after you've used a couple of them.
Here are few sample sources for health care information on CD's:
The Federal Register and Code of Federal Regulations (CFR) contain the source for most of the Federal laws and regulations that affect hospitals and health care. These include Medicare coding and reimbursement, clinical laboratory regulations and OSHA regulations, to name a few. While the Department of Health and Human Services (HHS) issues most of the regulations governing hospitals, often more than one agency impacts hospitals - it's important to be able to find all the relevant regulations.
Typically, a user of the Federal Register and CFR will scan each new CD issue for relevant citations since the last issue. Using an automated search facility makes this a painless process. The new items can be quickly reviewed, and then excerpts printed for affected departments (such as Medical Records, Labs, Business Office, Finance).
We used to get the paper copy of the Federal Register and did the same thing manually. It was very time-consuming. Since the Federal Register became available on CD-ROM in 1991, we've been able to keep up-to-date with only a few minutes a week.
This is an invaluable source for the entire hospital, and it's very inexpensive, especially if you only need quarterly updates. Contact John Byrnes at Counterpoint Publishing 1-800-998-4515 for more information.
The Medicare/Medicaid Library on CD-ROM is another excellent source for hospitals. It contains relevant regulations, Federal Register items, CFR items plus the complete Carriers Manual - over 130,000 pages in all. The Carriers Manual covers all aspects of data collection, federal program coverage, and detailed billing information for Federally-sponsored programs such as Medicare, Medicaid and CHAMPUS. Combined with the latest Blue Cross/Blue Shield Administrative Bulletins, it is the ultimate authority on hospital and medical billing. Medical Records needs access to these regulations because many of them concern coding issues that impact reimbursement.
The Hospital Manual is just one of the volumes in the Carriers Manual. While every hospital should have a paper copy, hardly any one can keep it updated with all the changes properly interfiled. Receiving a completely updated version on CD-ROM every month with the changes interfiled eliminates this time-consuming step.
We use this invaluable source in-house. Our client hospitals often call with questions that relate to intermediaries rejecting what appear to be properly coded Medicare claims. We can go right to our CD-ROM version and, in minutes, give the hospital the exact rule that controls the situation. Contact Larry Sanek at IHS 1-800-525-5539 for more information.
Both of the above CD's can run on almost any PC equipped with a CD-ROM drive. They don't require Microsoft WINDOWS or a 486
There are massive data bases available that are of interest to hospitals. Some of the more popular research databases are MEDLINE and CANCERLIT. These contain literally hundreds of thousands of abstracts of articles in the medical field. Also available are drug interaction, cancer treatment protocol, nursing literature, bioethics and health delivery system databases. While these may fall more into the scope of a Medical Library than the Health Information Management function, they can be invaluable resources for health care professionals in your hospital. These and over 100 other databases are available from SilverPlatter Information, Inc. at 1-800-343-0064.
There's even a CD of CD's: CD-ROMs In Print 1995 by Meckler Corporation (1-800-632-5537). This is a bibliography of over 6,000 available CD titles.
In the next 2-3 years CD-ROM drives on computers will become as common as FAX machines in the office and home. CD technology will be the bridge to the "information superhighway" of the future - but it's inexpensive and available today. Keeping up with the information explosion is critical, so justifying a CD-ROM application is easy. Don't spend a lot of time analyzing it. Just do it.