TrakCare White Paper

Realising Early Benefits From a Modular HIS Implementation

a case study

Introduction

The benefits of implementing a fully integrated hospital information system (HIS) – better patient care, increased efficiency, lower costs, etc. – can be enormous. But the price tag can also be large, and the time-to-payback long. Choosing a modular HIS allows healthcare organisations to start reaping real benefits from the departments that have been automated, even as they continue to integrate other areas. Being able to show quantifiable benefits early in the implementation process can help hospital IT administrators make a compelling case for instituting an HIS.

This paper presents a case study of the San Giovanni Battista Hospital (a.k.a.: Molinette Hospital) in Turin, Italy. Starting in the year 2000, Molinette Hospital rolled out a modular HIS, implementing it first in the emergency ward. This early stage of the HIS rollout was the subject of a rigorous “total value of ownership” study¹ by the Research Centre for Studies in Healthcare Management at the Università Cattolica in Milan. The results clearly show that Molinette Hospital derived considerable early benefits from automating IT functions within the emergency room, even as they were implementing the HIS in other areas of the hospital. The study also serves as a useful blueprint for how some of the benefits of a hospital information system can be quantified.

Molinette Hospital Today

With 1,400 beds and treating approximately 60,000 inpatients a year, Molinette is one of Italy’s largest hospitals. About 300 organ transplants and the same number of bone marrow transplants are performed there annually. In addition, approximately 10,000 ambulatory patients are treated at Molinette each day.

Obviously, such a large and busy organisation requires efficient use of all its resources. Molinette uses the TrakCare hospital information system ² to automate virtually all major hospital areas including, inpatient, outpatient, emergency, radiology, day hospital and day services, resource booking, oncological pharmacy, and order entry. Patient data is stored in a single, secure electronic patient record (ePR), which is easily accessible to care providers throughout the hospital.

By implementing TrakCare, Molinette Hospital has substantially increased revenues and decreased costs. For example: In the public Italian healthcare system, reimbursements from the regional government are tied to a complex process through which the hospital must supply data about patient registrations. Since deploying TrakCare, Molinette has greatly improved the accuracy of patient data, and cut their revenue losses due to “lost” information by 90% - from 10M to 1M Euros. TrakCare has also made it possible to speed up revenue realisation, because submitting patient data for reimbursement now happens nearly in real time, whereas before it typically took two days. Even more important than the measurable financial benefits are the improvements in patient care. Precious physician and nurse time formerly dedicated to paperwork has been freed up so clinicians can better focus on activities of direct value to patients.

The CERISMAS Study

As they rolled out their new HIS, Molinette agreed to participate in a study done by the Research Centre for Studies in Healthcare Management (in Italian: Centro di Ricerche e Studi in Management Sanitario, or CERISMAS). The study was intended to demonstrate the usefulness of a “total value of ownership” methodology developed at CERISMAS. Due to the size of Molinette Hospital and the complexity of its operation, detailed analysis was limited to the functions of the emergency ward, which was the first department to implement the new HIS.

As they conducted the study, CERISMAS measured the time it took to perform specific administrative tasks within the emergency ward, both before the implementation of the HIS, and after it had been deployed for six months. They also analysed billing data from comparable time periods before and after the HIS implementation.

The Results

The “total value of ownership” methodology used by CERISMAS in the study provided a quantitative measurement of both the increased revenue and the decreased costs due to implementation of an HIS. It also examined the human dimension, qualitatively measuring how well doctors and nurses accepted and used the new system.

Increased revenue

As already mentioned, reimbursements for healthcare from the regional government to Molinette are strongly dependent on the hospital’s ability to provide complete and accurate patient registration data. Comparing January-July billings for the years before and after implementing TrakCare shows that while there was a small increase (5%) in the number of patients treated, the number of invoices to the regional government went up by 77%. This translated directly into a 51% increase in the revenue generated by the emergency department.

Decreased Costs

The amount of money saved was determined by looking at the various processes within the emergency ward, the specific tasks involved, who performed them, and measuring the time saving resulting from using the new HIS. Two examples are given below.

Table #1 shows the time and cost savings in the registration process:

Activity	Who performs it	Average time of execution (in minutes)		Average cost of execution (in Euros)
		Before Adopting the HIS	After Adopting the HIS	Before Adopting the HIS	After Adopting the HIS
First Level Triage	Adminstrative/Nursing Staff	2	1	.68	.34
Second Level Triage	Nursing Staff	3	3	1.08	1.08
Personal Data Registration	Administrative/Nursing Staff	3	1	1.03	.34
Identification of the Emergency Ward’s Competence Area	Nursing Staff	1	1	.36	.36
TOTALS		9	6	3.15	2.10

 

After the implementation of the HIS, both the time and cost of registering patients were decreased by 33%.

Table #2 shows how some of the tasks involved with treating a patient
are affected by the HIS:

Activity	Who performs it	Average time of execution (in Minutes)		Average cost of execution (in Euros)
		Before Adopting the HIS	After Adopting the HIS	Before Adopting the HIS	After Adopting the HIS
Take in charge of the patient	Physician	1	0	.94	0
Double check priority code	Nurse	1	1	.36	.36
Acquisition of triage data	Physician	2	0	1.88	0
Patient’s examination	Physician	15	15	14.11	14.11
Request of exams and tests	Physician	5	1	4.70	.94
Diagnosis and outcome	Physician	5	5	4.70	4.70
Patient’s discharge	Physician	3	1	2.82	.94
TOTALS		32	23	29.51	21.05

 

On average, the time and cost to treat and discharge a patient were reduced by close to 30%.

CERISMAS performed analyses like the above for all the processes and activities within the emergency ward. They weighted these results by the number of patients that went through each process. (For example, some patients are discharged to the care of their general physician, some receive additional care within the emergency ward, and some are admitted into the hospital as inpatients.) They determined that the cost of running the emergency department for six months went from 1,352,028 Euros before implementing the HIS to 988,390 Euros afterwards, an improvement of 26%. Based on those numbers, CERISMAS estimated that, even without considering revenue increases, the payback time for implementing TrakCare in the emergency ward would be 154 days.

The Human Dimension
CERISMAS noted in their report that most of the time savings measured as a result of using an HIS were found in “clerical” tasks that are of little or no direct value to patients. By eliminating or significantly reducing the time spent on these tasks, nurses and doctors have more time to spend with patients.

The study also found a high level of acceptance for TrakCare among the hospital staff, with 96% of the nurses saying it met or exceeded their expectations for an HIS.

Conclusion

Implementing the TrakCare hospital information system with its fully integrated electronic patient record has saved Molinette Hospital millions of Euros while improving the quality of patient care. But equally important is how quickly Molinette was able to realise those benefits. The study performed by CERISMAS clearly shows that from the moment they deployed the first module, automating IT functions within their emergency ward, Molinette started reaping substantial, quantifiable benefits in terms of increased revenue and decreased costs.