PDA Application Development Helps Hospitalist Groups Improve Billing and Quality of Care

By Frank Yacano, Director of Business Development, SYWARE, Inc.

PDA application development creates and end-to-end solution that improves the business and clinical performance of the practice.

Effective management of a medical practice begins with a complete and accurate record of services performed. But too often, physicians record the details of patient encounters in the time-honored way - scribbled notes, which then must be deciphered by office staff before being entered into a billing system and submitted to payers.

Ambiguous or incomplete information at the point of care means problems downstream - processing delays, rejected claims, services provided but never accounted for. As payer organizations evaluate claims with ever-closer scrutiny, physicians need tools that allow them to easily capture all services performed, in terms that payers will accept.

Physicians have been using PDAs since the mid-nineties to keep personal records about their patients. But in a large group practice, there's a need to take these capabilities a step further. How can information captured at the patient's bedside be put to work most effectively to improve business performance as well as the quality of care?

Using PDAs, physicians can record information about patient encounters in a way that balances physician convenience, the needs of the medical group, and stringent payer requirements. This information is then wirelessly delivered to the practice's central management system where it provides input for billing and tracking patient outcomes.

Midwest Hospital Specialists, an acute care practice of about 25 physicians serving hospitals in the greater Kansas City area, recently rolled out a new mobile healthcare information system based on Window Mobile Pocket PCs and AIMS Mobility, a software application developed by Biologix-IT (http://www.biologix-it.com), a Kansas City-based firm specializing in creating healthcare applications and information management solutions for private medical groups. The system runs input forms and an underlying patient database created using Visual CE from SYWARE (http://www.syware.com/prodlib/win_ce/vce/vce.htm).

Initial patient admission information is communicated to a central system electronically from payer organizations that have contracted with the practice, as well as from hospitals directly. The initial record provides basic details about the admission, such as patient identification, payer information, and where, when, and why the patient was admitted. Subsequent records are added as doctors submit information from each patient encounter, ultimately providing a complete history of the medical group's encounters with the patient until discharge.

Tapping through the patient encounter
At the start of their workday, doctors tap the Sync button on their handheld screen to wirelessly download the day's patient census information from the practice's central database to their handheld (a Hitachi T1000 with Sprint wireless card). Within seconds, the Pocket PC is loaded with all admissions records of patients that need to be seen on that particular day by the physician's call group. A doctor can then filter the master census to obtain a subset of patients for a specific facility.

One of the most convenient features created by the PDA application development project is Room Sort: by tapping a button, the handheld displays the patients by room number, so the doctor can visit patients by the most direct path, rather then walking back and forth all over the hospital.

The PDA database application guides physicians through the patient encounter to ensure that information collected is complete, accurate, and conforms to standards required for reimbursement. An intuitive forms design, with features such as pick lists and check boxes, allows doctors to quickly tap through the fields while recording all relevant details associated with the encounter. The forms are structured to reflect the flow of activities during the patient encounter, including symptoms, history, exam findings, diagnosis, services performed, time spent, tests ordered, and follow-up. As information is entered, new windows, cascading as needed to capture all relevant details associated with symptoms, a diagnosis, or treatment plan.

This approach allows doctors to save time while recording the encounter compared to writing notes on paper. Transcription errors are also eliminated, with their associated delays and costs.

Putting the data to work
At the end of the day, physicians again tap the Sync button to upload the day's patient encounter records to the central system used by physician groups for managing admission records of patients in acute care facilities. A master database tracks patient progress, generates bills, and analyzes overall outcomes and demographics.

In addition to physician convenience, the mobile device becomes part of an end-to-end solution that improves the business and clinical performance of the practice. For example, information captured at the point of care helps solve two extremely common billing problems: services that are never billed, as well as encounters that are under-billed (where wary doctors worried about being challenged aren't charging their legitimate rate). Analysts at headquarters review information collected by physicians and assign accepted billing codes to each task performed. The analysts are trained to understand how to correlate physician records to get the appropriate rate for that particular service.

Data extracted from patient records can be used to create metrics to measure performance and identify factors that help physicians deliver the best possible care. Length-of-stay studies are one example: the system can compare a care team's average length of stay for a particular medical condition against the length of stay for the same condition for other care teams - as well as against published guidelines and the performance of competing providers. In addition, the ability to analyze patient demographic information can carry a great deal of weight in contract negotiations. For example, if a medical group is negotiating a contract to care for thousands of patients, the ability to show the payer organization that patients were sicker or at higher risk than average can be crucial in extending the approved length of stay.

Building a customized solution
"Visual CE provided rapid and stable PDA application development that was 10 times faster than traditional development products such as Visual Basic or Visual C++," said Chuck Colley, President of Biologix-IT. Drop-down lists, note boxes, search windows, and many other controls can be sized and positioned as needed using an intuitive WYSIWYG environment. This drag & drop flexibility means that a handheld application can be easily tailored to meet the requirements of different medical practices and physician specialties.

Colley also cites Visual CE's extensive pre-built and pre-tested functionality in accelerating PDA application development. For example, he created a button labeled Sync that performs all the communication activities to wirelessly synchronize between the handheld and the central database. "I can choose from a list of command sequences for functions like sorting, filtering, or communications. I don't have to write all the code behind the command buttons. All that stuff is already done."

A second SYWARE product called mEnable is used to enable wireless access between the PDA application and server database. The mEnable architecture allows any Visual CE application to wirelessly read from or write to any ODBC-enabled database, including Microsoft SQL Server, Microsoft Access, Oracle, or Sybase.

Improvements - leading from the front end
The ability to efficiently capture patient information at the point of care while complying with payer and regulatory rules can lead to better outcomes, improved financial performance, and more satisfying relationships with payer organizations. By ensuring that appropriate information is collected at the front end, the Pocket PC is the starting point for improved business processes. Results include reduced payer denials, delays, and underpayments. As part of an integrated database management solution, it provides the source for critical performance indicators to help physicians deliver superior care - and that's all good news for any busy medical practice.