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M D Anderson Cancer Center

Look closely at the surgery department of any major hospital and you'll find financial and information management challenges unlike those seen by other departments. At the University of Texas M.D. Anderson Cancer Center, we have found technology to be the answer to these challenges.

At M.D. Anderson, we see more than 12,000 surgical cases a year in our 29 surgical suites, where we service all areas of cancer care and reconstruction. Access and availability of information to make decisions is a top priority. In 1999, we began what was to be a major technology overhaul in surgery when we migrated from a DOS-based solution to a Windowsbased system from Surgical Information Systems (SIS). We implemented several modules of the perioperative information system to help optimize our department's performance.

In addition to typical criteria for purchasing such a system, we had two specific objectives. First, we wanted online revenue charging, in real time at the point of care. Second, we wanted to expand our automated case scheduling and patient tracking, and to make realtime information available to users throughout our entire institution and remotely. We found the solution to the first objective in the Rules Based Charging (RBC) module. The second objective was answered through SISWeb, a module for which we served as the alpha site.

Maximizing Revenue

One of the prime hospital revenue generators is its surgery department, which brings in 68 percent of a hospital's revenue, according to Towers Perrin. This percentage can be positively of negatively influenced by how effectively a hospital generates and optimizes revenues. But, delayed billing, human error and late charges are all contributors to decreased effectiveness. At M.D. Anderson, the RBC module has made real-time billing of surgical cases possible. With it, we have seen decreased data entry and errors, immediate billing of closed cases and enhanced revenue opportunities.

Prior to installing the module, surgical case billing was arduous at best. A nurse would fill out the charge sheet, putting check marks on the paper document to indicate billable items. The following day, the charge sheets were collected and taken to another location at the facility, where the data were reviewed and manually input into the existing system. The data were then batched and sent to the interface engine. Charges were reconciled and posted in three to four days, depending on the current interfacing with the hospital's main charging system. There was no way to know if all charges were going to be billed until after reconciliation was completed.

Now, nurses enter patient data in the SIS system during surgery. Electronic surgical preference cards allow for charting by exception. This gives us consistency in charging and enhances our revenue capture. If we notice during surgery that a chargeable item has not been entered in the system, we can add it on the spot, and it will be in the system for all future cases.

When the nurse closes the record and signs off on the case, the charges are billed. The application automatically pulls appropriate data from the patient record based on pre-defined variables. We can know the charges generated for surgery as soon as the stop time is entered on the case. One of the advantages of the RBC module is the ability to track and generate reports regarding revenue and activities within 24 hours after these charges are processed. With this capability, we were able to reduce the billing turnaround from a typical three-or four-day cycle to a 24-hour cycle.

Measuring Results

How do we know the system works? With the RBC module, surgery charges can be reconciled before posting to the patient's bill, thereby nearly eliminating missed charges. We previously used another system for billing. Weeks before going live with the RBC module, we compared the old system to the new one, running 10 to 15 cases through the entire process on both systems. When our implementation team compared the results, they found an obvious difference within the first few cases: More money was coming across the billing system with our new billing module.

We conducted a random audit (2 percent to 20 percent sample) of the charges before and after implementing the RBC module to see the differences in gross charges. We found that with the module, an end-user should expect gross revenue per case to be higher and more consistent with the cases.

Nurses found the new system to be more userfriendly, and they were more amenable to putting charges in correctly. Three months after we implemented it, we conducted an internal audit to determine if it was accomplishing its goals. No missing charges were found during the audit.

With such a large caseload, one of our biggest challenges is to effectively capture, manage, analyze and disseminate the volumes of patient information that are created each day. To tackle this challenge, we decided to partner with Surgical Information Systems in the creation of its Web technology, called SISWeb.

Taking Information Online

Our goal was to make real-time information available to all users throughout the facility, including our remote users. We also wanted to expand our automated case scheduling and patient tracking. We decided to become the alpha site for the development of this software. Of all the SIS modules implemented, SISWeb has made the greatest impact.

SISWeb replaced a DOS-based online whiteboard. Information now is displayed on an electronic monitor that is constantly refreshed with updated information. Surgeons and anesthesiologists can view their schedules from their home or office through a protected information portal on the Internet or the M.D. Anderson intranet. Built-in security ensures that access is granted only to authorized users, who have the option to personalize the layout and content of their portal to their own tastes, even adding links for favorite Web sites.

Users can schedule directly into SISWeb, on a case-request basis, without multiple phone calls and schedule checks. The application allows us to manipulate the schedule data for our needs, and to view the OR schedule by day/date range or room set, and the surgical schedule by day/date range, surgeon or service.

When a schedule change is made, displays are updated automatically. As a patient moves through surgery and information is entered in the application, SISWeb displays are automatically updated, making it possible for doctors and nurses to know exactly where a patient is in the surgical process. Logistical challenges are minimized, even in cases that involve multiple surgeons.

SISWeb's Family View module gives patients' friends and family an easy, confidential way to follow progress throughout the surgical episode via a waiting room monitor. The case's confirmation number is an identifier assigned to each patient to ensure that privacy regulations are adhered to. As the patient progresses through each phase of surgery, the status indicator on the monitor changes, keeping the family updated.

Because the information is real-time and is easily accessible, it has become a widely used backbone in the operating room (OR). Before using this product, we printed multiple copies of the OR schedule for various departments, knowing the schedule was outdated as soon as a change was made.

Better Relationships

With information widely available, the OR no longer prints schedule documents for manual distribution. After implementing the new system, we were surprised at how many people and departments relied on the OR schedule. Besides the OR clinicians and staff, the application is used throughout M.D. Anderson by surgical staff plus the anesthesia, admissions, coding, lab, radiology and pathology departments.

The implementation process seemed to create better relationships with our surgeons. We had always talked about clinical issues, but now we were talking about technology, too. We tried to make the transition easy, so staff members would adopt the new technologies. Ongoing dialogue and solid preparation for the upcoming changes led to positive attitudes and quick user-adoption throughout M.D. Anderson.

Our experience as an alpha site was so positive that we decided to purchase the SIS technology, called StatCom OR, that combines elements of SISWeb with an intelligent rules engine and messaging system. Not only is the schedule display changed, but automatic messages also are sent to the surgical team to inform them of the change. For example, if a surgery case begins to run late, the system will apply user-defined rules and send messages via PDAs, pagers, beepers, PCs and e-mail to notify the surgical team of the delay. Nurses don't have to spend time trying to reach team members via phone. Everything works seamlessly and automatically, helping our department to run smoothly and our nurses to have more time for patient care.

M.D. Anderson is committed to staying at the forefront of patient care and to having the technology that will help provide that care. Serving as an SIS alpha site gave us the chance to be the testing ground for the latest in perioperative management technology.

For more information about RBC and SISWeb from Surgical Information Systems, www.rsleads.com/401ht-205

Sharon Land, R.N., B.S.N., M.B.A., C.N.O.R., is the director of perioperative services for the University of Texas M.D. Anderson Cancer Center, Houston.

COPYRIGHT 2004 Nelson Publishing
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