Medicare Critical Access Hospitals (CAHs) are rural community hospitals that meet specific government requirements and standards, receive cost-based reimbursement, and guarantee availability in the event of critical situations.
Indiana University (IU) Health Tipton Hospital is a CAH located in Tipton, Indiana. In their own words, “Indiana University Health Tipton Hospital offers patients exceptional technology, outstanding physicians, and dedicated support personnel in a setting close to home. Our 50 board-certified physicians in more than 20 specialties use state-of-the-art diagnostic equipment to improve individual outcomes.”
Ryan Hulce is an IT Specialist at Tipton. Before he joined the hospital, he worked in IT for more than ten years, mostly in manufacturing. As Ryan explains, “This is my first endeavor in healthcare and I had no experience with IBM or IBM i—I couldn’t even spell AS/400. Today, our main software application is HMS—it does just about everything. For hardware, we have two Power 7 IBM i servers. And, we use MIMIX to replicate them for our Disaster Recover y (DR) solution.
“We use Sequel Data Access [the IBM i data access and analysis software] on a regular basis to write reports and queries. Typically, we don’t give people access to write views (queries). Instead, we give them access to run queries and display the results. Basically, my job is to write queries using Sequel, the Sequel Web Interface, and dashboards.”
According to Ryan, “Recently, our report requirements have increased dramatically. We need to send quality data to a lot of different organizations that use the data to see how the hospital is doing. That’s a major push because a lot of the reimbursement from Medicare, Medicaid, and Blue Cross is tied to the results of our quality scores. We really have a business need to extract and manage our data, so we chose Sequel. We use it to collect the data we need and distribute it to other systems. Sequel helps us keep our government reimbursements where they need to be.”
Meeting Meaningful Use
As Ryan describes it, “We plan to use Sequel to meet the government’s Meaningful Use electronic documentation standards. For instance, the nurses must document each case at the bedside using a device—an iPad, a Tele PC, or a Medcart. Plus, all physician and pharmacy orders have to be electronic, with lots of safeguards. The government has given us specific criteria, so we use Sequel to get the data we need to meet Meaningful Use.
“We wanted to make sure we were capturing charges, accurately. With healthcare, it’s critical that we capture everything and make sure it’s accurate. Our Charge Capture Team relies on Sequel for reports to track how accurately things are being charged. We found cases where we charged too much or not enough. With Sequel, we’ve been able to clean that up. We pulled the data, looked at it, fixed it, and made sure everything was accurate.”
Fast, Controlled Data Access
Two of Ryan’s favorite Sequel features are scripting and dashboards. “We use Sequel scripting a lot. When I access the HMS database, I may write a half-dozen queries to local IBM i files and another one to tie them together. With Sequel, I can supply timely information. We use a lot of prompting. Each department can view a report and see what they’re spending at their cost centers. And, it’s more secure. Before Sequel, a department manager could see every department on a report. With Sequel we control what they can see.
“We also create our own dashboards. For example, I have dashboards that show an over view of the hospital. They display information about how many patients we’ve seen today and where. Then, I can drill down and display details. And, viewing the surgery schedule in HMS used to be cumbersome because you needed different security and you had to use a weird screen. I simplified the process by creating a query. Now, people double-click an icon on their desktop, enter a username and password, and the surgery schedule is right there. The CEO sees the entire surgical schedule; each doctor sees only his or her par t of the schedule. When I get some free time, I want to build more dashboards—they’re a big hit.”
An Easy ROI
IU Health Tipton Hospital found that the Return On Investment (ROI) for Sequel was fast. “We’ve really cut down on printing—we cut our report volume in half and that means a nice savings. Sequel has saved us a lot of money. It’s also nice that it’s so easy to put the data into Excel.
“Another way Sequel saves money is that we used to contract our reporting needs. Insurance companies often audit us, and when that happens, I get called to write reports. Before, we might spend thousands of dollars for a report that I can now create in 8 hours or less. We do everything in-house, so Sequel has really paid for itself.”
Compliance and Reporting Requirements
The hospital has a requirement to provide a big report to the United Health- care Consortium (UHC). As Ryan explains, “Basically, UHC ranks you by comparing your data against other hospitals. They compare things like length of stay, readmission rates, post-surgery infection rates, and so forth. This report was a massive under taking—we had to write a huge query containing 20 sub queries and 10 scripts. Plus, we’ll need to supply more as time goes on. Right now, we only submit inpatient data to UHC; soon we’ll expand that to include outpatient data.”
The Health Insurance Portability and Accountability Act (HIPAA) is very important to all hospitals and IU Health Tipton Hospital is no exception. As Ryan describes it, “With Sequel, the people who don’t need to see personal information don’t see it—they don’t know the details about a patient, they just know that they have a patient. Other people may only need to know what insurance a patient has, or whether they have insurance. And, the CEO wants demographics—he wants to know whether people coming in for surgery are from the town of Tipton or elsewhere. I can write queries to handle all of these situations.”
Support and Training
Ryan likes the Sequel support and training. “I don’t call phone support a lot—I use Live Chat mainly. The support people are always terrific. For training, HMS brought in a Sequel trainer and gave us a 3-day class. I had some database background—I’m familiar with databases. I did some queries before using SQL and Access. Since Sequel uses SQL language, it was easy to understand and use.
“Coming from a manufacturing background, I was surprised how difficult some medical vendors are to work with. Fortra is a great vendor to work with. We haven’t had any issues—they always go ‘above and beyond.’ Sequel is a great product and I love its flexibility.”