Abstract
BackgroundPatient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if such a major investment pays off. We tried to answer the following questions: How do costs and revenues of an intensive care unit develop before and after introduction of a PDMS? Can higher revenues be obtained with improved PDMS documentation? Can we present cost savings attributable to the PDMS?MethodsRetrospective analysis of cost and reimbursement data of a 25 bed Intensive Care Unit at a German University Hospital, three years before (2004–2006) and three years after (2007–2009) PDMS implementation.ResultsCosts and revenues increased continuously over the years. The profit of the investigated ICU was fluctuating over the years and seemingly depending on other factors as well. We found a small increase in profit in the year after the introduction of the PDMS, but not in the following years. Profit per case peaked at 1039 € in 2007, but dropped subsequently to 639 € per case. We found no clear evidence for cost savings after the PDMS introduction. Our cautious calculation did not consider additional labour costs for IT staff needed for system maintenance.ConclusionsThe introduction of a PDMS has probably minimal or no effect on reimbursement. In our case the observed increase in profit was too small to amortize the total investment for PDMS implementation.This may add some counterweight to the literature, where expectations for tools such as the PDMS can be quite unreasonable.
Highlights
Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation
Since our PDMS comes with a direct interface for automated ventilation time documentation, we assume that a reduction of missing or erroneous documentation could lead to visible economic effects, and potentially a return of investment (ROI) that justifies the implementation costs
System details and system in use Beginning in October 2006, a commercial PDMS was introduced stepwise in each intensive care units (ICUs) subarea to replace the former paper based patient chart
Summary
Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. Scientific background Patient Data Management Systems (PDMS) support bedside clinical documentation at intensive care units (ICUs). They comprise components of computerized physician order entry (CPOE) such as daily drug and treatment orders. Missing or erroneous coding information leads to loss of revenues In this context, Fränkel et al detected that errors in the paper– based ventilation time documentation caused 22.7% false patient groupings in six of seven observed ICUs and reported an enormous negative cost effect [3]. We only found direct cost and revenue calculations for RIS/PACS in radiology [4] but none for PDMS in ICU
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