HTRAK, A Computerized Health Maintenance Tracking System for Primary Care* Paul S. Frame MD Tri-County Family Medicine Program Dansville, NY Departments of Family Medicine and Community and Preventive Medicine The University of Rochester School of Medicine and Dentistry Rochester, NY
Paula L. Werth MPS Tri-County Family Medicine Program Dansville, NY *Supported by AHCPR grant # HS06283 duplicate data entry. Existing systems allow only a yes/no answer to the question of whether health maintenance procedures have been done and do not inform the provider of other important options.[6]
ABSTRACT This presentation describes a computerized health maintenance tracking system for primary care designed to be linked to the practice billing system. Providers enter health maintenance data along with billing data on an encounter form. Physician and patient reminders are generated once a year for all patients regardless of appointment status. Multiple entry options are available and the frequency ofprocedures can be variedfor individual patients. Summary reports are generated to assist compliance and quality assurance.
HTRAK HTRAK 0 [7] was developed to overcome the deficiencies of existing systems. It is intended to be linked to the practice billing system or other Several important demographic data system. concepts were included in the design: 1) Patient demographic data must be obtainable from the same files used for billing and administrative purposes. Duplicate demographic and health maintenance data entry is unacceptably costly. 2) Data entry for all health maintenance procedures done on a given visit must be quick, preferably entered on a single screen. 3) Multiple entry options for each procedure must be available to encompass the range of provider and patient behaviors. Necessary options include the following codes or their equivalent: A: Test normal on a certain date (D-date). B: Test abnormal on a certain date (X-date). C: Test abnormal but inactive (I-date). D: Test refused on a certain date (R-date). E: Test done elsewhere on certain date (E-date). F: Test not indicated on a certain date (N-date). 4) Reminders should be generated for all patients regardless of appointment status. 5) Providers must be able to specify the month reminders are sent or cancel patient reminders. 6) A status report must be created for the chart at specified intervals. 7) The
INTRODUCTION Most computerized health maintenance tracking systems currently in operation [1,2,3] are part of a computerized medical record system and are not economically feasible for the average primary care practice. The most common health maintenance reminder method in these systems is the creation of a status report which is available to the provider at each patient visit. This report may include a problem list, medication list and other clinical information for the provider; in addition to health maintenance data. It is usually generated for every visit regardless of the frequency of visits. Few of the current systems generate reminders to all patients at a specified interval or generate reminders to patients who do not have a scheduled appointment. Stand alone health maintenance tracking systems have also been developed [4,5] but these systems require costly
0195-4210/92/$5.00 X)1993 AMIA, Inc.
833
References
frequency and description of indicated procedures must be modifiable without programmer assistance. Providers record health maintenance data on an encounter form along with billing and demographic data at the time of a patient visit. Health maintenance and billing data is then entered into the computer by clerical personnel. If HTRAK is linked to a billing system, a download is done monthly of the health maintenance data files. HTRAK then prints provider and patient reminders for all downloaded patients regardless of their appointment status. Provider reminders are placed on the front of the patient's chart while patient reminders are mailed to the patient. In addition to reminders, HTRAK generates summary and detail reports of patients overdue for a particular procedure. An alternate frequency feature allows providers to do procedures only on selected patients or to change the frequency for selected patients. HTRAK is written in FOXPRO e a relational database manager which runs on IBM compatible hardware. Up to 20 health maintenance criteria can be specified each based on one or two gender and age determined intervals.
RESULTS AND COSTS Preliminary results from the ongoing prospective trial of HTRAK are encouraging. In the population receiving computerized reminders compliance with the health maintenance protocol increased from 44 % of indicated procedures done to 67%, a 52% increase. Cost analysis has shown the costs of running and maintaining the system are reasonable. Provider time which involves recording data on the encounter form takes an average of 22 seconds per adult who requires health maintenance. Incremental data entry cost for 100 patients seen is $17.35. The cost of maintaining the system, generating reminders, and mailing patient reminders per 100 patients overdue for health maintenance is $78.50. The final data analysis will determine whether this system generates incremental revenue for the practice. Costs of linking HTRAK to the practice billing system will vary widely depending on the compatibility of the systems. Programming costs for this linkage are estimated to range from $1,000-$5,000.
834
1
Ornstein SM, Gaff DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders; tools to improve population adherence to selected preventive services. J Fam Pract 1991; 32:82-90
2
Harris RP, O'Malley M, Fletcher SW, Knight BP. Prompting physicians for preventive procedures: a five-year study of manual and computer reminders. Am J Prev Med 1990; 6:145-52
3
McDonald CJ, Hui SL, Smith DM, Tierney WM, et al. Reminders to physicians from an introspective computer medical record. Ann Intern Med 1984; 100:130-138
4
McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH. Promoting cancer prevention activities by primary care physicians: results of a randomized controlled trial. JAMA 1991; 266:538-544
5
PREVENT sold by Williams and Wilkins Inc. Baltimore Md.
6
Frame PS. Can computerized reminder systems have an impact on preventive services in practice? J Gen Intern Med 1990; 5(suppl):S1 12-S 115
7
Frame PS, Zimmer JG, Werth PL, Martens WB. Description of a computerized health maintenance tracking system for primary care practice. Am J Prev Med 1991; 7:311-8
Paula L. Werth MPS Tri-County Family Medicine Program Dansville, NY *Supported by AHCPR grant # HS06283 duplicate data entry. Existing systems allow only a yes/no answer to the question of whether health maintenance procedures have been done and do not inform the provider of other important options.[6]
ABSTRACT This presentation describes a computerized health maintenance tracking system for primary care designed to be linked to the practice billing system. Providers enter health maintenance data along with billing data on an encounter form. Physician and patient reminders are generated once a year for all patients regardless of appointment status. Multiple entry options are available and the frequency ofprocedures can be variedfor individual patients. Summary reports are generated to assist compliance and quality assurance.
HTRAK HTRAK 0 [7] was developed to overcome the deficiencies of existing systems. It is intended to be linked to the practice billing system or other Several important demographic data system. concepts were included in the design: 1) Patient demographic data must be obtainable from the same files used for billing and administrative purposes. Duplicate demographic and health maintenance data entry is unacceptably costly. 2) Data entry for all health maintenance procedures done on a given visit must be quick, preferably entered on a single screen. 3) Multiple entry options for each procedure must be available to encompass the range of provider and patient behaviors. Necessary options include the following codes or their equivalent: A: Test normal on a certain date (D-date). B: Test abnormal on a certain date (X-date). C: Test abnormal but inactive (I-date). D: Test refused on a certain date (R-date). E: Test done elsewhere on certain date (E-date). F: Test not indicated on a certain date (N-date). 4) Reminders should be generated for all patients regardless of appointment status. 5) Providers must be able to specify the month reminders are sent or cancel patient reminders. 6) A status report must be created for the chart at specified intervals. 7) The
INTRODUCTION Most computerized health maintenance tracking systems currently in operation [1,2,3] are part of a computerized medical record system and are not economically feasible for the average primary care practice. The most common health maintenance reminder method in these systems is the creation of a status report which is available to the provider at each patient visit. This report may include a problem list, medication list and other clinical information for the provider; in addition to health maintenance data. It is usually generated for every visit regardless of the frequency of visits. Few of the current systems generate reminders to all patients at a specified interval or generate reminders to patients who do not have a scheduled appointment. Stand alone health maintenance tracking systems have also been developed [4,5] but these systems require costly
0195-4210/92/$5.00 X)1993 AMIA, Inc.
833
References
frequency and description of indicated procedures must be modifiable without programmer assistance. Providers record health maintenance data on an encounter form along with billing and demographic data at the time of a patient visit. Health maintenance and billing data is then entered into the computer by clerical personnel. If HTRAK is linked to a billing system, a download is done monthly of the health maintenance data files. HTRAK then prints provider and patient reminders for all downloaded patients regardless of their appointment status. Provider reminders are placed on the front of the patient's chart while patient reminders are mailed to the patient. In addition to reminders, HTRAK generates summary and detail reports of patients overdue for a particular procedure. An alternate frequency feature allows providers to do procedures only on selected patients or to change the frequency for selected patients. HTRAK is written in FOXPRO e a relational database manager which runs on IBM compatible hardware. Up to 20 health maintenance criteria can be specified each based on one or two gender and age determined intervals.
RESULTS AND COSTS Preliminary results from the ongoing prospective trial of HTRAK are encouraging. In the population receiving computerized reminders compliance with the health maintenance protocol increased from 44 % of indicated procedures done to 67%, a 52% increase. Cost analysis has shown the costs of running and maintaining the system are reasonable. Provider time which involves recording data on the encounter form takes an average of 22 seconds per adult who requires health maintenance. Incremental data entry cost for 100 patients seen is $17.35. The cost of maintaining the system, generating reminders, and mailing patient reminders per 100 patients overdue for health maintenance is $78.50. The final data analysis will determine whether this system generates incremental revenue for the practice. Costs of linking HTRAK to the practice billing system will vary widely depending on the compatibility of the systems. Programming costs for this linkage are estimated to range from $1,000-$5,000.
834
1
Ornstein SM, Gaff DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders; tools to improve population adherence to selected preventive services. J Fam Pract 1991; 32:82-90
2
Harris RP, O'Malley M, Fletcher SW, Knight BP. Prompting physicians for preventive procedures: a five-year study of manual and computer reminders. Am J Prev Med 1990; 6:145-52
3
McDonald CJ, Hui SL, Smith DM, Tierney WM, et al. Reminders to physicians from an introspective computer medical record. Ann Intern Med 1984; 100:130-138
4
McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH. Promoting cancer prevention activities by primary care physicians: results of a randomized controlled trial. JAMA 1991; 266:538-544
5
PREVENT sold by Williams and Wilkins Inc. Baltimore Md.
6
Frame PS. Can computerized reminder systems have an impact on preventive services in practice? J Gen Intern Med 1990; 5(suppl):S1 12-S 115
7
Frame PS, Zimmer JG, Werth PL, Martens WB. Description of a computerized health maintenance tracking system for primary care practice. Am J Prev Med 1991; 7:311-8
