Factors Considered by HMA When We Develop an Integrated Health Evaluation Data Management System (IHDMS) David Chenoweth, Ph.D., FAWHP President, Chenoweth & Associates, Inc. 128 St. Andrew’s Circle New Bern, North Carolina (252) Copyright, Chenoweth & Associates, inc.

Integrated Health and Evaluation Data Management System What is an IHDMS? “Group of health-related databases linked by software that can identify specific types of data from individual databases to determine relationships between and among the data.” Typical Databases Found in Business & Industry Personnel records Inpatient health care claims Safety/accidents records Health promotion participation Chemical exposure Disability (workers’ comp) Employee Assistance Program Occupational exams Health risk appraisal data Employee medical records Demographic profiles Outpatient health care claims Productivity

Major Categories of Factors Health Mgmt Goals Personnel Types of Data Vendors Financial Legal & Ethical Policies Administrative & Logistical

Developing & Implementing an Integrated Health Da t a Management System IHDMS A. Conceptualization Visualize what an IHDMS can do for the organization; establish a simple definition of IHDMS that can be conveyed to key decision-makers. Identify a list of people who can benefit from IHDMS, benefits manager, human resources, nurse, safety, rehab/case mgmt., health promotion, etc. Determine what an IHDMS can do for the organization that isnt’ being done now. Review the corporate mission statement, short-term, and long-term business plan. Identify strengths and how an IHDMS would enhance them; identify weaknesses and show how an IHDMS would minimize or eliminate them. B. Assessment Assess the business environment and geographic location(s) to determine the feasibility and specificity of an IHDMS; for example, shift to managed care, aging workforce, benefits restructuring, etc. Assess organization’s ability to develop an IHDMS: Identify existing in-house databases and networks Identify databases maintained by outside firms Identify inhouse personnel interested in an IHDMS

Developing & Implementing a IHDMS C. Prioritization Consider all in-house databases and solicit input from all users; identify each user’s needs and formulate a list of common denominators. Prioritize needs and subject them to specific feasibility criteria, i.e., cost, number of beneficiaries, developmental time, corporate-wide application, etc. Prepare a preliminary proposal for a recommended IHDMS structure; submit to inhouse staff only for feedback. Check proposed structure against corporate mission statement, short-term, and long-term cost- management plans for next 3-5 years. D. Organizational Structure Assess outside* database functions, data value, and vendor’s ability to collaborate with organiz. *Third party administrators, insurers, MCOs, etc. Based on preceding findings, revise initial proposal accordingly and develop a structure that meets all designated criteria.

Developing & Implementing an Integrated Health Data Management System IHDMS E. Data Strategy Involve key personnel to decide : IHDMS Goal IHDMS Objectives & timeframe Specialists needed How IHDMS will be used by current database users and potential users if new programs are planned or downsizing leads to greater workloads. Estimate implementation costs and additional database maintenance costs. Hardware Software Consultants Staff time Management Time Compare costs to expected benefits using: * benefit- cost analysis * Costs as % of client’s current benefits budget Consider the feasibility, practicality, and comparative cost of developing an inhouse centralized IHDMS vs. small modifications in the current arrangement.

Developing & Implementing an IHDMS F. Outcome Planning Determine evaluation protocols: What variables(outcomes) will be measured? What timeframe will be used? Who will perform evaluation? What measures will reflect progress? How will outcomes be quantified, i.e., time savings, earlier diagnostic findings, interdepartmental efficiencies. less dependence on outside vendors, etc.? G. Pre-Operational Testing Establish protocols: Report formats Specific report requests Personnel access Technology implications Do a Beta trial: subject a common health problem to different hypotheses and check for inter-database capabilities.

Integrated Health Data Management Electronic Data Interchange* In-House Microcomputer at Headquarters Third Party Administrator Site-Specific Data BenefitsSafety Medica l WellnessH.R.Personnel * Permits multiple functions between various databases to occur, i.e., what percentage of year olds have recently filed a workers’ compensation claim. Company Locations Group Data

Identify External Health Claims Data Administrators & Internal Data Recipients Third Party [claims] Administrator (TPA) Company Employees use health care services from various providers M.D./P.T., Chiropractor, etc. HMO Hospital CPTs (procedures ) Insurer Human Resources Benefits Personnel Group Reports (semi-annual/ annual) Diagnostic Related Groups Major Diagnostic Categories ICDs DRGs