IDENTIFICATION OF THE SIGNIFICANCE OF THE PROBLEM OR OPPORTUNITY

This proposal addresses the need to develop products which help all participants in health care to assess and monitor the quality and level of care furnished to patients. Pressures to limit costs and improve quality by standardization and managed care are coming from insurers, government agencies, health management organizations and payors of all types. Protocols, practice guidelines and/or standards of care are increasingly being discussed and implemented to control costs and improve care quality. Computer software designed to monitor health care data can provide vital assistance to this end. The computer can search for situations that do not meet quality standards and, where appropriate, suggest specific guidelines to be followed. Clinical protocols, critical paths, practice guidelines, standard orders are other terms used to describe approaches to standardizing and monitoring care. In this proposal the term protocols is used in its more general sense to describe all of these sets of conditions, actions and rules that set standards and guidelines for the delivery of health care and health management services. In most small and medium-sized health care agencies, protocols exist on paper and are referenced well after the situations they apply to have occurred. Consequently, they also are refined only sporadically and with minimal analytical material available on which to base the changes. However, when set up and enforced in concert with an organization's primary software management system, protocols have the potential to greatly improve the quality, efficiency and cost effectiveness of health care. If designed and developed correctly, protocol software will:

allow for triggering events, rules and enforcement of protocols to be defined.
monitor health care data as it is entered.
prompt for or require that specific procedural guidelines be followed.
assure that providers and case managers are alerted immediately with the patient specific information (including chart notes) necessary to effect timely and careful follow-up with patients, guarantors and others involved in particular cases.
help staff members analyze and review care outcomes to determine how protocols should be refined to improve patterns of service.
be location and machine independent to allow case managers and guarantors anywhere in the country to be notified instantly.

Properly designed protocol software will provide primary assistance to an organization as it continually assesses patterns of service and refines protocols with an aim toward the improvement of the quality and cost effectiveness of care. When protocols are maintained and enforced on an organization's primary or "live" data management system, users receive prompts regarding quality care standards and cost effective health care management when the care is provided or planned -- not after the fact. Currently, few small- to medium-sized physician offices and clinics have computerized protocol systems. Of those that do, most have systems which run independently of the facility's primary data gathering system and commonly cannot share it's data. This combination greatly reduces the effectiveness of protocols. Protocol management software closely integrated with the "live" data entry system ensures that medical staff get vital information when they need it most. Thus, the opportunity to reduce health care costs while improving the delivery of services by employing automatic quality management techniques is clearly significant. If protocol software is available to clinicians and staff members in a user friendly and familiar context while they are working with the patient it will reduce human error and paperwork by automatically monitoring rules and standards and printing documents such as routing slips and standard orders with detailed instructions already filled in. Any additional data entry that is required to confirm activities that have been completed or to track variances can be minimized with predefined lists.

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