The Place Where Business Logic Meets Outcomes

   Method goes far to prevent trouble in business: for it makes the task easy, hinders confusion, saves abundance of time, and instructs those that have business pending, both what to do and what to hope. -William Penn

   In response to the implementation of DRGs in the 1980s, I decided to set up a private practice and contract my services to a variety of local healthcare organizations. I learned a valuable lesson during the initial phases of this endeavor. During an appointment with the Vice President of Nursing for a large, corporately owned hospital that was scheduled to negotiate my contract as an outside consultant, the Vice President asked one simple question: "What do you do that my nurses can't do and how much money can you save our organization?" I had no answer except to tell her I was a good and caring ET nurse with several years of experience. She asked me to come back with specific evidence-based data she needed to determine whether her hospital could benefit from my services.

   I spent the next week auditing the medical records of patients for whom I had previously been consulted to provide service in that hospital - tracking clinical events, time, product usage, lengths of stay, and accuracy and consistency of documentation before and after my consultation. By the end of that week, I had prepared a report laden with cold, hard, fact-based data I could take back to the corporate executive. My report clearly demonstrated that I not only had improved the patients' condition, but I also had saved the hospital money. Once she read the report that documented my value and potential cost saving to her organization, she signed my contract. What I did not know at the time was that I was using clinical and financial outcomes to justify my value to that organization.

   Many things have changed in healthcare over the past 20 years, but one thing that has remained constant is the union of business logic and outcomes. When an ill patient is admitted to a site of service for a specific period of time, the expectation is that the patient will be in better condition at discharge than admission. Discharge also generates a bill for the service provided to that patient by the organization while the patient was under its care. This cause-and-effect relationship demonstrates just how closely financial and clinical outcomes are linked, but many clinicians often have difficulty accepting this reality.

  Electronic technologies have revolutionized the way we collect and analyze data. Spending a week or more pouring over patient charts to glean the information we need is no longer necessary. Many healthcare providers are moving toward electronic medical records (EMR). Many emerging tools are available to track clinical outcomes, time, clinical activities, treatments, product usage, education and training, costs, risks, and the like - empowering both clinical and management providers to make wise, data-based clinical decisions. These computer-based tools can have built-in screens that automatically establish HIPAA and other regulatory compliance. Once a provider creates a database, tracking the effectiveness of clinical interventions as well as the fiscal ramifications of the care being provided and the manner (when and by whom) is fairly easy.

  Many tools provide the ability to generate a variety of customizable reports for specific criteria a provider may wish to evaluate. These data can be benchmarked internally, within a corporate chain of providers, nationally, against accepted standards of care, or even globally. Evaluation of the data helps correct weaknesses. For example, if a long-term care facility sees a correlation between nosocomial wounds and Braden Scores, changes in their interventions or additional staff education may be indicated to correct the deficiencies. The method by which the facility recognizes the cause-and-effect relationship comes through an analysis of its database.

   Several types of data collection tools are available¹: desktop software programs specifically designed for wound or ostomy care, hand-held computers that are downloaded daily to a desktop computer, and Web-based intuitive software services. WoundExpert is one of several Web-based services designed specifically for wound management that enable healthcare organizations to measure outcomes, standardize documentation and protocols, and privately benchmark in a secure and HIPAA-compliant manner. Patrick Colletti, President of Pittsburgh-based Net Health Systems, believes such services are where "business logic meets outcomes." Initially developed for long-term care facilities, WoundExpert now serves outpatient wound clinics and inpatient populations as well. Colletti adds, "We now have about 600 users, clients in 29 states who perform about 320,000 wound care visits through WoundExpert every year." Such Web-based services provide a secure password-protected central location for a provider's data collection and analysis with prompts to maintain accurate, regulatory-compliant, consistent documentation. Web-based services are updated automatically, making it unnecessary for a provider to update several computers within an organization or corporate chain.
In order to remain competitive and clinically and financially successful, corporate executives, management, and nurses caring for patients with wounds, ostomies, and incontinence must embrace a system that meets their organization's internal needs for data collection and analysis. Such tools and systems act as the clergy who officiates at the marriage of Business Logic and Outcomes.

1. Peirce B. Streamlining Data Collection: Computer Based Tools and Criteria for Selection. Presentation at the WOCN Society 35th Annual Conference, Cincinnati, Ohio. June 17, 2003.