Outcomes Management
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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.
Scoring:
Scoring of the forms is performed in real-time. The patient sees direct feedback showing where they began and where they are today. Scoring may be examined in various ways by the physician user, and requires no programming experience to examine the data in new ways. Queries are performed using variables including date range, ICD9, CPT, Name, and Outcomes Instrument. In addition, because the forms are electronic reproductions of validated outcomes instruments, they may be combined easily with other physicians in order to pool like data.
Collaboration:
It is the hope that the authors of this Database Management Tool combining a high level database structure and web form processing with security and call-back features, will allow Physicians in diverse settings to realize collaborative efforts to improve patient care and validate results of treatment.
It has been the feeling of many people involved in Outcomes Research that one of the greatest barriers to data collection has been a lack of questions, which a large group of researchers agree upon to investigate collaboratively. Clearly, however, no data can be collected without a simple inexpensive way to obtain collect, combine, and process the data. Only when this is realized can the questions be easily formulated and answered.
Our last programming function will allow all program users to download their data to a national databank, and instantly receive normative data from all other national users. In this way, patients not only see their own progress, but they see it in the context of national normative data in graphical format.
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