Between Invoice and Stethoscope

“Integrated healthcare” is the buzz phrase upon which a hospital’s competitive edge will rise or fall in the future. The term refers to cooperation between the hospital and outpatient physicians’ practices or to the establishment of healthcare centers, such as those for the treatment of breast cancer. In particular, the buzz phrase “integrated healthcare” shifts nursing documentation into the foreground. Nursing documentation is the central treasure trove of information at a hospital; it serves as an instrument for communications and control, not to mention the business aspects of presenting the benefits provider with verification of the work performed. These two characteristics make comprehensive integration of nursing documentation into a hospital’s information system nearly unavoidable — both in terms of the quality of care and for economic reasons. In addition to service entry (realized with SAP systems in many hospitals), an individual patient’s history and data on all patients must become part of the design of an integral hospital information system.

Optimal Flow of Information Among Nursing Personnel

The factors to be considered in electronic and digital nursing documentation include: data security, encryption-based protection against unauthorized access, protection against information loss, and transmission errors. The first two issues must be handled with great care in IT risk management — a task to be performed at the international level. In Germany, for example, one must consider of the Law on Corporate Control and Transparency (KonTraG) and of criteria for the forthcoming rating of credit risks as mandated by Basle II. In the U.S., a recent study by the Computer Security Institute of the Federal Bureau of Investigation has found serious deficiencies in IT security for the seventh time in a row. The need for protection against information loss and transmission errors arises because of the integration of nursing documentation into the hospital information system and the manner in which the documentation is handled. For example, it makes little sense to establish a stationary documentation workstation in the nurses’ station and have the nursing staff go back and forth between patients’ rooms and the workstation. Errors and omitted transmissions would certainly occur.
Only seamless integration can ensure the optimal flow of information between nursing staff, physicians, and other groups of professionals that participate in a patient’s care in the hospital. At intake, nursing personnel must have precise information about an individual’s status and care requirements. For example, the electronic documentation should detail which actions the staff should perform with patients and which actions patients can perform on their own. Forms that are already being used in traditional, paper-based nursing documentation should have electronic counterparts. The forms include detailed reports on the nursing case history. They document the patient’s condition upon intake and include a chart that offers a weekly overview of all measurable data on the patient.

Nursing Documentation Should Guide Employees

It’s important that the integrated solution also fulfills ergonomic requirements and not overwhelm users with its complexity. The volume of data demanded grows continually. Moreover, the information is required for medical controlling; for personnel, resource, process and quality management; and for billing. Past practices included time-consuming double-entries, which tended to produce errors. It’s easy to see why transferring the data required by external parties from paper-based nursing documentation into a separate system didn’t score high with employees. In contrast, digital nursing documentation must guide the nursing specialist (with a self-explanatory interface for example) and thus create indispensable added value for employees.
With the clarity of an effective and easy-to-understand instrument, the application provides information about a patient’s current status and nursing history at all times. In this manner, it lays the foundation for smoothly-run nursing care. In the end, nursing data enables more precise determination of cost object controlling, the preliminary and final costing of procedures surcharges, or flat rates per case. The documentation can be improved over the long term only by implementing holistic and integrative nursing and medical information systems. Individual nursing activities are transparent for all participants, resulting in a reduced workload for the individuals involved in the treatment and nursing process.

Satisfied Patients, Lowered Costs…

The benefit is multiplied when data is transmitted from mobile data-entry systems at the patient’s bedside directly to the nursing documentation. Conversely, this method also makes the relevant data available during doctors’ rounds. Moreover, at the patient’s bedside, the attending physician can directly generate requests to various service facilities. And, last but not least, this system enables healthcare providers to satisfy patients’ justified interest in a quick reply to their questions. But even apart from the mobile component, electronic nursing documentation brings increased patient satisfaction: avoiding unnecessary X-ray lowers examination costs.
With the transparency achieved through digital nursing documentation, daily procedures and work processes can be scrutinized. Recent studies assume a time savings of approximately sixteen percent simply from the ability to find patient data and examination results more quickly. Eighteen percent of costs can be avoided when redundant data storage is no longer required. In individual cases, a cost savings of 25 percent per patient can be realized. However, the positive influence on the work organization is just one consideration. Along with a lasting streamlining of processes, improved communication, and optimization of treatment quality, this transparency can also lead to more autonomy for caregivers – thus reducing dissatisfaction.

…Only With Complete Integration

Questions about quality assurance and certification for hospital services are being discussed at the international level. Numerous organizations are concerned with questioning the quality of services provided, including the following:

  • Germany: Cooperation for Transparency and Quality in Hospitals (KTQ)
  • U.S.: Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • France: National Agency for Accreditation and Evaluation in Heath (ANAES)

Moreover, for hospitals in Germany, billing by flat rate per case (diagnosis related groups: DRG) will be introduced in 2004. Beginning in 2005, the law requires hospitals to publish a quality report. The upcoming certification procedures are a significant incentive for introducing digital nursing documentation internationally.
From patient intake to transfer or release, the treatment and nursing process can be successfully mapped in electronic nursing documentation only if it is seamlessly integrated into the central information system. Mobile data entry must also be synchronized with the corresponding ERP system, such as an SAP solution. In addition, a findings workflow must be created to ensure the comprehensively structured and formalized documentation of treatment. What’s required is digital nursing documentation that can map all service facilities in a hospital’s service centers. Billing-related data can be generated from the back end only when the documentation is completely tied into it — as a guarantee to secure hospitals’ income and as a relevant factor in competition among benefits providers.

Diplom-Volkswirt Christian Stoffers
Diplom-Volkswirt Christian Stoffers