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Streamlining the Flow of Information - Company Operations

Time-sensitive reports are delivered fast and meet HIPAA security and audit trail requirements.

The Health Insurance Portability and Accountability Act (HIPAA) presents the healthcare industry with a challenge for assuring security, and auditing usage of patient information. Coupled with that is the cost of producing and distributing reports.

Printed reports have a direct cost in materials and time in production and delivery. A large percentage of time is spent handling paper. This is time that could better be spent in other endeavors.

In the fall of 1998, after recognizing the cost savings potential, Wellmont Health System, a newly created healthcare provider in northeast Tennessee formed by a merger between two hospitals--Bristol Regional Medical Center and Holston Valley Medical Center--set out to reduce the paper output in our information systems department. The merger brought the daunting task of establishing a centralized electronic information distribution process.

At a time when most healthcare industry providers were not encouraged to recognize the significant long-term effects of improving their information systems, we were actively searching for ways to continuously improve.

"We formed a project called Omnibus," says Paul Esterle, past corporate director of Information Services at Wellmont. "Our goal was to streamline, control, and monitor the flow of information throughout Wellmont Health System. A major piece of the project was the desire to migrate away from paper copy reports."

Security Concerns

"We realized at an early stage in our report automation project that security was a primary concern," Esterle says.

HIPAA created significant funding for governmental agencies like the Department of Health and Human Services to weed out fraud and abuse in the healthcare industry. This has placed tremendous responsibility upon healthcare IT professionals to ensure that they remain good gatekeepers of the information they control.

"As a Joint Commission on Accreditation of Healthcare Organizations accredited hospital, we wanted to find a more reliable way of tracking the reports that were distributed throughout the organization," Esterle says.

After reviewing Report2Web, a report portal by the company of the same name, we found it to be a valuable part in securing and auditing data, as well as being easy to manage.

"The most compelling piece of the Report2Web software was its ability to track where our reports were being sent, to whom they were going, and when they were viewed," Esterle says.

Furthermore, he says, the Mandated Security Awareness Training that HIPAA requires will complete the report distribution security circle by making it the responsibility of the individual who has access to sensitive material to uphold its confidentiality.

Making it Work

We have two servers in the system. One server captures a print-image of reports from our patient accounting system. The second is the Report2Web server itself.

The routing server is the hub of the Omnibus project. It consists of a low-end Dell server with a small raid array and Linux as the operating system. The second server is a mid-range Dell server with a raid array and NT 4.0 as the operating system.

We use McKessonHBOC Star products for our patient accounting and financial software. These systems produce reports that are subsequently captured by the Omnibus server.

The Omnibus server software consists of open-source products such as Linux, MySQL, NFS, and Samba as well as some in-house written Tool Command Language scripts. Together, these form a sort of interface engine that is used to route data from one location to another, performing data manipulations as needed.

The Report2Web server processes the data received from Omnibus and produces a repository of electronic reports. It also serves as a Web server utilizing Microsoft's IIS services. The security on each report is based on NT security.

The implementation process started in the spring of 1999. We worked with a beta group of users to talk about security and reporting needs. During this time we also wrote and tested the Omnibus routing processes.

In the summer, we began posting some end-of-month reports and some daily reports to Report2Web. The software was used as an alternative to the still-available paper reports.

Reaping the Benefits

We are still in the process of converting all reports and expect to have them available sometime in the first quarter of this year. This could mean a savings of more than $80,000 in direct paper costs. In addition, time spent in IS for bursting/sorting/handling reports has been reduced.

"The finance department saw a marked decrease in its time sorting through a month-end report," said Cathy Johnston from Client Services. "They now can view online and use the search feature to locate individual pieces of information."

Reports are available to the end-user within minutes of the time they are produced, and are readily available in an electronic format for import into any data analysis and trending tools as the end-user might need.

To meet patient needs, time-sensitive reports are delivered faster, reports cannot be lost in delivery, and security and audit trails are available to assure patient confidentiality (a requirement of HIPAA).

Beyond existing infrastructure costs--wiring, NT licenses, etc.--the system cost between $30,000 and $35,000. The cost of this solution was easily justified in the immediate reduction of paper costs and courier expense.

For more information on Report2Web, circle 98

Bryan Phillips is a senior specialist with information systems at Wellmont Health System, Kingsport, TN.