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“ACHIEVING EFFICIENCIES BY IMPLEMENTING EFFECTIVE ELECTRONIC PATIENT MANAGEMENT SYSTEMS”

Jeffrey M. Sneddon, Information Technology Director, and Ronald M. Ferguson, M.D. Ph.D., Executive Director, Comprehensive Transplant Center, The Ohio State University Medical Center, Columbus ,Ohio

Purpose: When a patient has end stage organ failure, the only effective therapy is to receive a new organ. Such patients are sent to Transplant Centers and a process is begun. The process involves the collection of a great deal of detailed information, for these are complex patients usually with multiple chronic problems and comorbidities in addition to the failure of the organ. A patient from the time of referral to the transplant and throughout their entire post-transplant course is closely followed by that center. Transplantation represents an accrual market. The size of the patient load and volume being followed are dependent upon the number of new patients transplanted each year entering the system and the success rates of the program itself. If success rates are high and it is a high volume program, a rapidly accruing number of patients are the result. In order to properly evaluate transplants and properly care for these patients, it is essential to have the efficient and organized management and flow of information concerning each of the patients and information about the program itself. This requires a rather sophisticated information system. If such an information system is in place in a transplant program, the quality of patient care (measured by the end results of grafts survival, incidence of acute rejection and patient survival) can be improved. In addition the financial delivery of the care can become more efficient and productive and predictably manageable.

Method: The information system utilizes functions on three levels of activity simultaneously. The first level of function is the day to day patient management of individual patients from the time of their referral until the time of graft loss, death, or leaving the program. This level of activity of the information system function is used on a daily basis by the nurse coordinators, the transplant physicians and the referring physicians via a fully functional browser interface. A second level of function is reports concerning the program. These are useful tools for managing patient flow and organizational management of workflow within the program. It is this level of activity and reporting from which the productivity reports can be generated. There is a third level of functional activity of the information system that is a sophisticated life table analysis of outcomes and a variety of statistical maneuvers that can be performed on the data contained within the database. Such statistical population studies are important for retrospective analysis of patient populations as well as prospective clinical trials.

Results: With yearly increases in referrals, evaluations, transplants, and workload, we have accomplished improved patient access and outcomes by decreasing the time of referral to evaluation and increasing productivity as measured by a work productivity index. Interfaces to medical center systems and outside agencies have significantly improved accuracy and management of large amounts of data that were previously done on paper. Rapid analysis of clinical data using in-built tools provides clinicians with detailed aggregate information about patients and protocols to allow informed decisions to be conducted. It is the considered and strongly held opinion that the efficiency gains in work productivity demonstrated for our program are directly due to the better management of information and the use of our information system. The nurse coordinators, both in the pre-transplant evaluation and listing process as well as the post-transplant follow-up all consider the information system to be an indispensable tool for carrying out their jobs.

Conclusion: Effective use of transplant information systems can lead to efficiencies in productivity, improve patient access and outcomes, and streamline program reporting processes.

Jeffrey M. Sneddon