Outcomes Management
Introduction:
The face of medicine in the United States has changed dramatically in the
last 10 years and will continue to change in the future. Much of this is
due to financial pressures created by an insurance industry, which is immune
from anti-trust laws.
Despite this, patients are more involved in their own care and decision
making, and their expectations of what medicine should offer them has dramatically
changed. Patients are hungry for information and want to know that their
decisions regarding their medical care are well advised.
Patient driven Outcomes have the ability to improve medical care, and help
the medical community to validate that interventions are effective in improving
patients using validated Outcomes Instruments. In the past, problems with
data collection, integration with demographics, patient diagnosis and co-morbidities
have been difficult to overcome at best. Despite obvious benefits, which
may derive from widespread Outcomes data collection, Medical Outcomes have
had a rocky course since their inception. Only small amounts of data have
been collected for both monetary and technical reasons. Good data collection
efforts have usually occurred in expensive multicenter studies (randomized-prospective)
that can answer a very limited number of questions. Large, widespread data
collection in contradistinction has the capacity to answer many questions
and even be analyzed retrospectively to answer questions, which are thought
of after data collection using powerful statistical techniques. Early outcomes
efforts resulted in validated instruments, but there have been large difficulties
in data collection and integration with patient demographics and medical
diagnosis and co morbidities. Only when all components are integrated into
a robust database, which can be shared easily with others, will the full
impact of data collection and analysis be realized.
To this end, we have worked to automate nearly every aspect of Outcomes
collection to allow this to become a viable tool, which physicians can integrate,
and use routinely to improve patient care. In addition, it is imperative
that the physicians who use these tools be capable of analyzing their own
data, and sharing it confidentially for collaborative efforts.
E-Med Outcomes Management ©
E-Med Outcomes Management © is a fully functional Windows based program,
which runs on Windows NT, Windows 2000, Windows 98 or 95.
The program was designed by an Orthopaedic Surgeon and a professional programmer
in order to allow direct patient input into a physician's office outcomes
database, in order to nearly eliminate office personnel as a requisite to
collect outcomes data.
The program runs on a web server, which may run on the same computer in
which patients input data, or any machine on a network. Patient data is
stored in SQL7 format and may be accessed by any common database engine.
These include common database programs such as Access, Paradox, DBF, and
SQL7. This allows the program to interface with a myriad of medical billing
systems as well as electronic medical record systems. In this way duplication
of input may be eliminated.
Clearly, demographics are already input into all medical billing systems.
The first important function, which Outcomes Management serves, is to import
demographic data on a set interval. This same demographic data acts as a
security measure ensuring proper patient log-on, and is linked to the outcomes
database also for later statistic analysis.
Patient Input:
The Patient Forms themselves are Web-Based Submission Forms. When filled
out, they are stored as simple tabular data. This allows creation of a database
with Medical Record ID, Patient Demographics, Outcomes Data collected at
appropriate predetermined time intervals, and pertinent physician data (ICD9,
CPT) and operative techniques or complications and prostheses or drugs used.
No name is associated with the final data used for database query. This
protects patient confidentiality. At the same time it allows doctors to
easily pool data without concern for violating confidentiality laws.
Patient use has been simplified by using touch screen entry and no keyboard.
This may be accomplished on a computer Kiosk. In addition, no office
personnel are required to choose which form a patient receives. Patients
easily navigate to it themselves, utilizing simple built-in logic, and a
drawing of the body to point to the affected area. Web forms also improve
the quality of data collection, since incomplete forms will not allow submission
and tell the user what is incomplete.