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Written by: Bob Habasevich, PT on Friday, May 6, 2011 Posted in: Inpatient Rehab

With today’s economic stresses and productivity demands, hospitals and healthcare facilities need to continuously pay attention to getting things done right the first time – without mistakes and with maximum efficiency. Anything that slows down workflow and negatively impacts productivity is viewed as an excessive cost in care delivery systems.

Technology and automation have promised to ease that burden and give providers more capacity to get the work of healing people done faster, more effectively and in less time. So why isn’t the work day getting any shorter?

Payers are demanding more and more documentation of what was done and ask the question “Was it effective?” to justify the payment. Providers now complain that “it takes long” to record and document care, often longer than it does to deliver it. Is this the new accountability?

In settings where there are no clear best practices, accountability is based primarily on efficient and effective management of agreed on innovative interventions (or programs or processes), including the placing of a higher premium on evaluation and modification (learning) as new information becomes available.
We all want to learn and apply best practice to care but getting to that knowledge requires the analysis of data and documentation of what was performed. Without it, no learning occurs and we practice the habits of the past.

We are at a point where we’re being asked to do something we have not done before and it takes time to do it. This seems excessive given the past requirement of getting the task done. For example, it was quick and easy to evaluate a patient’s functional ability, look at the FIM™ scale of 1-7 and put a number into the IRFPAI box to rate the patient’s impairment. When someone is watching, it takes longer to go through the assessment steps to conduct the required FIM™ sequence of evaluation steps to arrive at the appropriate rating. The same may be true when a computer prompts you for answers to the same qualifying questions. The difference in time requirement is whether the accountability is based on recoding a score or classifying patient function by the rules of FIM™ scoring.

The whole concept of accountability is the sharing of accurate and reliable clinical information, the access to all clinical information on a patient so that you’re not duplicating what’s already been done and using the data that’s available to make informed clinical decisions. Data must be in electronic format, not paper, or the cost of managing in both dollars and missing information will be excessive. Disparate systems need to share that data with each other. The hospital needs access to the doctor and clinician data. Doctors need access to the clinician data and the lab data. The technology teams need to find a way to make these freestanding systems share information in a relatively seamless fashion. In the meantime, tradeoffs of doing things that take longer to complete will seem excessive when compared to doing something the old way from which minimal learning occurred and best practice remained a concept.

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