Justifying your Occupational Health Clinic budget

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Facing increasing budgetary pressures means that more than ever occupational health clinics are under pressure to justify their existence. Here is a preview of our forthcoming webinar with Dr Mary Anne Alexander which addresses the concerns of nurses, doctors and managers and shows how better use of data can help to provide the answers.

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  • Welcome to this installment of the Medgate Webinar series and thank you for joining us. Today’s webinar will be Justifying the existence of your Occupational Health Clinic
  • Thanks Mike--Good morning first of all I would like to introduce myselfI’m Mary Anne AlexanderIn my career, I have accumulated experience in implementing of electronic medical records, establishing clinical protocols for the collection of required data elements, creating software configurations within medical information systems and contributing to the development of information technology within the healthcare sector.My credentials include …For 10 years, I was the Deputy Medical Director of the Fairfax County Public Safety Occupational Health Center in Fairfax, Virginia providing occupational and primary care medical services to public safety personnel in addition to being the functional lead on the integration and implementation of information technology initiatives. We used Medgate’s EHS software at that facility and I had a good relationship with the company and the product, so I joined the medical product team and have been contributing to the development of the applicationI am now the President of MD Prime Analytics, a company providing consultative services related to information technology in the medical profession including business development, product development and enterprise business intelligence strategies for healthcare delivery systems.My passion is…providing the best health care to patients with a focus on preventative, occupational and primary care services while using technology to the best of our ability to facilitate that cause.
  • So, let’s get started.Why justify the cost of an occupational health program? Well, its necessary to identify the cost-benefit analysis of any business venture but in occupational medicine there are many stakeholders besides the organization that financially supports the cost of the health program.++++++++++++and whether the occupational health program costs are worth the benefits.This is a multi-faceted question that has ramifications to many interested parties involved in providing occupational and health services.
  • An occupational health clinic is at the heart of an ecosystem: There are many interested parties in providing occupational health services to certain patient population. There are Internal and external stakeholders. The Internal stakeholders are primarily within the clinic or closely associated with providing services directly to patient. This includes the patients, providers (physicians, allied health professionals), admin staff, clinic managers and organizational managers that oversee the clinic.The External stakeholder include the larger Organization’s management team, investors in the organization, third-party vendors, government agencies (federal or state with oversight responsibilities), regulatory agencies (OSHA, NIOSH), government health agencies (local, state and federal health departments – CDC,). All involve parties have an obligation to ensure appropriate medical services are provided but at the same time there is a critical need to justify the existence of the occupational health center – to show that not only is it providing excellent and appropirate care to the employee population but also that it is a viable business model as well.
  • Why have an occupational health center? How is an employee’s health related to productivity?Consider how the cycle of health & productivity of an employee affects the ROI for occupational health centers. Start with health and lifestyle behavior of an employee affects that employee’s ability to work or in the case of not being healthy – to be absent from work. Hopefully the employee is present most of the time and when they are at work, their health status allows them to perform their duties as productively as possible. If the employee is productive, that will lead to profitability (or efficiency in the government sector) for the organization. There is a need to show positive workforce productivity/efficiency trends in budget-driven organizations. It is very important to support ROI data in the occupational health sector and promote healthy, resilient, productive work forces.
  • While it is important to document ROI for occupational health centers, at the same time there a trend for ever shrinking budgets for occupational health services both in the private and government sectors.For example, an article in the New York Time in 2013 quoted ‘the federal budget for protecting workers is less than half of that set aside for protecting fish and wildlife”. **NOTE – is the chart the number of MILLIONS that were cut from these agencies??? While the number of inspectors (** For what) has grown under the Obama administration, OSHA still has just 2,400 responsible for overseeing roughly eight million work sites — roughly one inspector per 60,000 workers, a ratio that has not changed since 1970. The federal budget for protecting workers is less than half of that set aside for protecting fish and wildlife. The New York Times – “As OSHA Emphasizes Safety, Long-Term Health Risks Fester” – March 2013
  • The ROI model is a great way to provide financial justification for the investment in health and wellness programs. Occupational health clinics are not protected from an organization’s financial pressure to justify their services. Simply saying that we are taking care of our employees is not an adequate justification of services provided. Like every other department in an organization, calculating ROI is very important. ** Need to know more about the study – where, how many people>** - print outFor example, showing that obesity in the workforce is related to a cost or that by addressing obesity in a worksite health promotion program can reduce health risk factors and create over $300,00 in projected savings – 59% of the savings from reduction of health care costs and 41% resulting from improved productivity. Being able to project or document a program’s savings or impact is a crucial. This also ties back to the graph of employee health is related to productivity and profitability of the organization. is related to savings. By implementing a worksite health promotion program targeting obesity, the data showed to the practical way to provide financial justification for investment in worksite health promotion when risk reduction data are available. Link to source: http://www.acoem.org/uploadedFiles/Career_Development/Tools_for_Occ_Health_Professional/Health_and_Productivity/Using%20a%20Return%20on%20Investment%20Estimation%20Model%20to%20Evaluate%20Outcomes.pdfExample: Obesity - Certain modifiable risk factors lead to higher health care costs and reduced worker productivity. A predictive ROI model was applied to an obesity management intervention to demonstrate the use of econometric modeling in establishing financial justification for worksite health promotion.Hospital management implementing wellness programs not because they cared about their employees but b/c it was costing money – health care expenditures were rising.
  • **NEED transition.So I talked about the importance of documenting and capturing data to justify an occupational health center’s services as it relates to services provided to the employees and how those services can impact employee health and justify a clinic’s existence. That is not always an easy task. There are many challenges in being able to accurately and efficiently put into place those programs and capture the data efficiently.Alternative:But another area of data capture that is very important to justify a clinic’s existence is accurately capturing the services that the clinic provides.
  • Two common challenges are the are you able to capture and measure what you want to? (Are you able to answer the questions that you want to ask about patient populations or clinic workflows because you have the data? – maybe put in other slide)1. Roadblocks to capturing the dataCapturing the data while providing clinical servicesCapturing the data that will support improved program managementAre you able to capture or measure what you need? Priorities of practitioners2. What to measure XXXXXXXIf so, are you What are you measuring and how are you measuring it.- Are you measuring what you need to facilitate better management?
  • As a health care provider, I don’t want to be unduly burdened with extraneous tasks such as documenting how many blood pressures I took or how many lab results I reviewed. I want to focus on what I was trained to do which was take care of patients. I want to focus on doing my job to the best of my ability and not have to worry too much about the documentation/record keeping aspect of the job. Documenting activities is a part of any medical practice, so that isn’t unreasonable – What becomes burdensome is when I have to keep track or services in different places, different files, locations (even within an electronic medical record). I want to spend as little time as possible documenting my services and focus on care giving. However, I must acknowledge that proper documentation of services (no matter how cumbersome it may be) is a necessary part of any medical practice and must be done. In fact, documenting the service provided by an occupational health clinic is critical to all the stakeholders and patients of the clinic. In the end, the patients will benefit greatly from accurately documenting all the services that the occupational clinic provides because better documentation will easily justify the clinic’s existence and When an occupational health clinic implements a specific occupational health program, the vast majority of OH professionals do not want to concern themselves with justifying the cost to internal and external stakeholders.That said, there are a number of employees to which this matters a great deal – with budgets being reduced across all types of industry, being able to accurately justify the existence of your clinic can have a real effect on the amount of staff that an occupational health department can carry, and what programs it can carry out. The challenge, then, in occupational health is being able to provide this justification without it becoming a cumbersome addition to the daily workflow of nurses and practitioners.
  • So we know how important it is to capture accurate data related to clinic services that are provided but let’s look at what tasks occupational health providers spend their time doing…The results of an occupational health nursing practice analysis showed the top 10 tasks and lowest ranked tasks performed in the occupational health setting. The top 10 ranked tasks are mostly related to providing medical services, assuring confidentiality of services, managing worker comp cases, performing tests such as audiometric tests, health surveillance items, and interpret test results – only 1 item is directly related to use and a maintaining an employee health recordkeeping system – this gets back to providers are focused on providing medical services – not documenting those services.An analysis of occupational health nursing Based on Occupational Health practice analysis, the items that we spend the most time on are primarily related to patient services. Providing treatment of injuries/illnesses, addressing confidentiality issues/paperwork, interpreting results of tests, hearing exams, assessing employee’s work status – only 1 item listed relates to maintaining employee health record keeping
  • Now let’s take a look at the lowest ranked tasks within in the occupational setting – *Need to have same color for all So, #1 is providing care for families of employees – health care service related but the rest of these tasks But the rest of these tasks almost all relate to data.#2 is design and conduct research – need to capture data, analyze data and report on the date#3 – evaluate benefits programs for healthcare delivery – how do you evaluate? You need data#4 – apply knowledge of business cycles, trends and forecasts to market programs – related to datae - how do you know what your business cycles and trends are?#5 – participate in research on practice issues/problems – need data#10 – design data collection instruments, questionnaires and other forms – data is requiredMost of these lowest ranked tasks are related to capturing information/data and performing analytics to improve or modify the services provided. I’d argue that these lowest ranked tasks are just as important as the top 10 tasks because by performing these data related tasks, you will be better informed about your clinic practices, more efficient in providing those services and better able to continue to cycle of improvement and justifying the existing clinic services. most of providers’ activities are related to providing care/services and less time is spent on data/research/analysis  - but it is necessary to have the analysis in order to evaluate/improve/justify clinic’s existenceMuch less time is spent on capturing data of the services are provided, analyzing that data, applying that knowledge to business/practice trends. Conduct and design research
  • Healthcare providers need to be given the time, tools and training to facilitate the best data capture. Need for a system that facilitates capturing of data while the practitioners are performing their regular duties – real-time charting and documentation will greatly support the ability to justify your existence by providing more accurate data/numbers without burdening the staff with increased admin responsibilitiesNeed a systemt
  • Two common challenges are the are you able to capture and measure what you want to? (Are you able to answer the questions that you want to ask about patient populations or clinic workflows because you have the data? – maybe put in other slide)1. Roadblocks to capturing the dataCapturing the data while providing clinical servicesCapturing the data that will support improved program managementAre you able to capture or measure what you need? Priorities of practitioners2. What to measure XXXXXXXIf so, are you What are you measuring and how are you measuring it.- Are you measuring what you need to facilitate better management?
  • Can’t improve it if you are not measuring it. Need to be very clear on what do you want to improve and what needs to be measured to that can be documented. Another roadblock – is that you can’t manage what you aren’t measuring You need to identify what needs to be improved and what need to be measure to document any improvement. So how do you determine if a health promotion program is cost effective or having the desired or predicted impact?First, You can’t manage what you aren’t measuring. You need to determine WHAT needs to be improved and WHAT needs to be measured. Identifying which medical conditions or lifestyle factors that you want to improve and what metrics will be used to measured to track those changes. How do you reduce your health care expenditures on high risk employees (such as smokers) if you don’t know who they are? How do you document a reduction in tobacco use if you don’t know who is using tobacco?What 2 parts – what to improve and what needs to be measures. How – which programs to monitor and to implement a change if needed to make an impact.What
  • After you determine the WHAT you want to improve and what needs to be measured, then you can determine how to affect a change – What program change will be implements so that you can determine if there to measure, then you must determine the HOW. I want to reduce the number of tobacco users in our company. First need to measure how many employees are using tobacco (what to measure – need the data). Then determine how we will reduce that number by providing nicotine replacement therapy and counseling, You can’t manage or improve any program without the proper measurements and data capture related to those desired programs and results. How will a change be implemented and measured. How will the program or initiative be implemented and monitored in order to capture the metrics that will be measured. For instance, for health promotion programs will a nutritionist be provided for each shift for 1 month and then measure the weight changes or follow responses from surveys, etc.**May need more talk..
  • Two common challenges are the are you able to capture and measure what you want to? (Are you able to answer the questions that you want to ask about patient populations or clinic workflows because you have the data? – maybe put in other slide)1. Roadblocks to capturing the dataCapturing the data while providing clinical servicesCapturing the data that will support improved program managementAre you able to capture or measure what you need? Priorities of practitioners2. What to measure XXXXXXXIf so, are you What are you measuring and how are you measuring it.- Are you measuring what you need to facilitate better management?
  • This is a typical billing slip associated with medical services. The visit is quantified by the amount of time that a practitioner spends with the patients. The more time spent with the patient relates to a higher level of care and level of billing/cost. However, this time based assessment of clinic services greatly underrepresents the amount of actual activities/medical services provided. For instance, in the brief visit which is usually around 10-15 minutes, an ECG, a blood draw, and a blood pressure reading check could have been completed or the practitioner spend the 15 minutes talking to the patient. The cost associated with how that 15 minutes was used is very different – the consultation costs are very different than obtaining an ECG, blood draw and blood pressure reading which has the cost of equipment usage, supplies used, personnel and recording keeping time associated with them.If those tasks are not appropriately captured, it is much harder to report on the costs, services provided or effectiveness of new processes that have been adopted.
  • I would propose that most occupational health centers are not doing what they think they are doing – and what I mean by that is, in my opinion, most occupational health centers probably sorely underestimate the amount of work that is being provided by the clinic. Occupational health is a unique section of medicine where it is typical for many activities to be performed during one encounter. Unlike the majority of the medical practices where patients usually report to a medical facility for 1 primary reason, in occupational health, patients have many items that need to be attended to during a clinic encounter. IN addition, there are the case management and worker;s comp issues that must be addressed as well. An encounter is any contact with a patient either in person or via other form of communication. Commonly missed encounters are ------ external consultation, triage consults (do I send the employee over after on-site injury, etc)..These missed encounters add up and lead to an underestimation of services provided.
  • So within an occupational encounter, it is typical for multiple activities to be completed. An activity is anything that is completed on behalf of the patient/employee. Because much of occupational health is preventative in nature and has a large component of surveillance activities, there usually are many distinct activities that are completed during a visit.
  • Must capture all clinic encounters and all clinic activities.The more granular the data the better reporting capabilities you will have. If you don’t have an accurate picture of what specific services you are providing, how can capture the impact of your work?First of all, you should get credit for what you are doing – this helps demonstrate to the organization the exact services that are being provided and everyone wants to know that.Second, The external stakeholders need to know exactly what you are doing (possibly underestimating what the clinic is doing) so that support of the business processes will continueMost importantly – how can you provide accurate analysis of the services being offered and make appropriate adjustments in those services if you don’t have accurate data. The adjustments could be directed toward employee groups by improving work-related injuries, chronic medical conditions, etc. but the adjustment can also be directed toward the internal processes of the clinic and how to be more effective in delivering those services to the patients.- how those services impact employee health, productivity, reduction so restricted duty time…
  • So the key to justifying a clinic’s existence is data, data, data. The first step is capturing the data – you much get an accurate picture of what specific activities and services are being provided.Second, you must be able to get the data out - you need a system that is capable of exporting the data for both internal and external purposes. This means getting medical information out of the system for the patients, easily compiling data for external providers (for referrals/consultation, case managers) and also trend analysis for the organizational stakeholders for business analysis.And lastly, you need to analyze the data and use the results to continue to improve the workflow processes, the impact on employee health and to justify the clinic’s existence.Capturing data related to employee’s/patients so you can justify services based on the measurable impact on employees and/or employee health programs Capture data related to services provided – a simple but accurate reflection of each and every activity completed will greatly enhance a clinic’s ability to justify it’s existence.But just because you capture the data you need to be able to get the data out. Just as it is important to have a medical record system that isn’t cumbersome for the practitioners to use so that the data into the system, the same is true for getting the data out of the system. The exporting of data is necessary for all stakeholders - interal and external.Once the data is queried and analyzed, that is when the real impact can take place. This is where organizational/clinic adjustments can take place, impact of programs can be documented/tracked and solid justification of clinic services will be highlighted.
  • Concerning the capturing of data – most of the data from a clinic will be related to the services that the clinic employees spend the most time doing. Most clinic practitioners spend the majority of time providing health and wellness services or case management services. So there is a wealth of data available that can be used to address patient facing programs as well as internal clinic workflow processes.Amount of time they spend in each OHN activity areas where you get the most information to justify… and make improvements
  • Needs toUser friendly/intuitive – no matter what system, you won’t get the data if users don’t use the systemIntegrate with medical workflows to not burden users – whether paper or electronic – the point at which that data is captured must fit into the normal workflow of the clinic – otherwise you are losing data and subsequently opportunityThe data that is captured must Capture the granularity needed to provide robust data – that will give you the ability to identify and address the issue - for instance – collect weight -
  • If you don’t have an HER, use any existing tools – very important that you track the informationData needs to be in electronic formatFor reporting purposes – use whatever tools you have. The importance of analyzing the data cannot be emphasized enough.Go through each point. Re: point 3, you could even say “I know we have some Medgate customers on the line so I just want to emphasize for those of you using software that it’s really easy to just expand that tool to monitor occupational health programs”
  • The data can be captured in many forms but the most efficient would be a EHR – having said that – the system mustData capture can be taxing but if appropriate EHR is chosen the benefits will be evidentMany health care providers have found that electronic health records (EHRs) help improve medical practice management by increasing practice efficiencies and cost savings.A national survey of doctors1 who are ready for meaningful use offers important evidence:79% of providers report that with an EHR, their practice functions more efficiently82% report that sending prescriptions electronically (e-prescribing) saves time68% of providers see their EHR as an asset with recruiting physicians75% receive lab results faster70% report enhances in data confidentiality
  • Most occupational health clinics will have large amounts of data – even in paper charts – there is a great amount of longitudinal data that is collected over the years. But if you can’t get the data out, it is useless except for residing in that patient’s chart to be reviewed at each clinic visit/encounter. Example, from personal experience, I have seen clinics with 30 years worth of employee health data that included surveillance exams prior to implementation of PPE being used, prior to blood borne pathogen training requirements – the ability to analyze that data is huge – but the opportunity is lost because no one can get the data out easily. The only way was to hand review each chart, page by page – what a loss of data resources. If data is not available for analysis, opportunities lostIn order to get the data out, you must closely consider how the data is being captured. The reporting requirements and data exporting ability will greatly drive how and what needs to be captured. Asking yourself, what data needs to come out of the system will define what data needs to be captured.The power of the data that is being collected – no matter in what the format – paper based charts, excel spreadsheets, lists of activities, or an electronic healthcare system – the data is not being capitalized on if it is not being exported and analyzed. It is very important to get the data out to identify trends or areas in need of improvement or to identify areas of success.Paper-based or databaseCollaborate with other members of staff to get the information togetherPaper-based system: Administrative staff who collate the data from multiple sourcesDatabase system: IT staff who are able to run queries to output the required data. Preferably, the primary user (you!) should be able to construct reports easily without the assistance of a third party.
  • Obviously the most efficient and streamlined system is a appropriate electronic healthcare system that can easily capture data without disrupting the daily workflows of a clinic wMore sophisticated and compelling make it easier to:Show the impact that your programs are having on your employeesJustify your budget hile allowing for the data to be exported in a reasonable fashion.
  • Allows for identification of issues/progress/change at all levels - examplesAllows for specific interventions – at all levelsAllows for more responsive course adjustmentsAnalyzing the data is the where the power and ability to significantly impact an organization lies. By analyzing the data, you are able to;-identify the issues or concerns, any progress or lack there of, and/or any changes (negative or positive)By analyzing the data, you are able to identify specific interventions that need to take placeAnd lastly, it allows for more responsive course adjustments or corrective actions for programs or workflows.More sophisticated and compelling make it easier to:Show the impact that your programs are having on your employeesJustify your budget A simple example of this is the flu vaccine programBy using an electronic medical records – we were better able to capture the number of vaccines being completed (an increase of 30% from previous years), which lead to better budgetary planning for the next year and by taking it a step further we were able to identify departments/agencies that were not participating in the flu program – which lead to us identifying that the departments with low participation rates were the ones on night shift schedules – so we could make an adjustment in the administration program in a timely fashion.Relate data to illness times and dates…. Example: Flu vaccination programBetter metrics leads to better program
  • By collecting the data, the ability to analyze the internal workflows of the clinic will be enhanced. Rather that waiting on feedback from external sources, you will be able to identify trends faster and respond quicker. so rather than reacting to issues or complaints, the data will afford you the ability in a lot of instances to recognize and to address areas of need faster. Being more proactive rather than reactive is the goal.
  • Analyzing the data and communicating those results to external stakeholders is critical. I would love to say that the only agenda for occupational health clinics is to provide excellent medical care to employees but the reality is that there is a real cost associated with those services and justifying those services to external stakeholders is necessary. By capturing data – such as blood pressures, STD calculations or data related to employee perception of employee health programs – it is all data that empowers the administration. May need some more comments….
  • So the key to any reports is analytics – how powerful are the reporting capabilities, how flexible are the reporting capabilities, how user friendly are the reporting capabilities and how granular.When is comes to reporting, the key questions to ask are:How powerful are the reportsHow flexible are the reportsHow user friendly are the reports andHow granular are the reports.
  • The benefit of using an electronic software system that captures occupational health services is that you hopefully will be able to-capture accurate data that truly reflects the unique needs of occupational medicine - such as multiple activities per encounter, case management, worker’s comp, etcEasily retrieve the data by having automated reportsConfigure the data by creating custom reports that meet the needs of your specific clinic – without Easily export the data to be analyzed
  • Can improve patient care at the same time acquire better tracking of service provided by different providers/practitionersProvides for more granularity of services providedCapture multiple activities per encounterSurveillance groups – Capture multiple activities per encounterSurveillance recalls function – Helps eliminate inadvertently omitting services while patient at clinic
  • This screenshot shows the Medical chart view that allows you to view the employee’s SEGs and the related exam activities in one place
  • Go through animation to tell the story
  • The ability to run reports from any software system is key. In my experience, the analytics that most software applications/platforms offer are woefully inadequate for meeting the needs of reporting requirements – whether it is a learning management system, content management system or electronic medical record system. I will say, though, that Medgate has an extensive list of pre-existing (or canned) reports that cover many clinic processes. And they are easy to use. For whatever system you are using, it is crucial to identify what reporting capabilities exist within the system.
  • If possible, I highly recommend that the end-user be able to create and modify existing reports as much as possible. Inevitably each client/user/clinic will have specific reporting requirements that will not be covered by the basic application. No application can meet the needs of every client 100%. Therefore it is ideal that the end-user be able to create queries specific to their needs that won’t require a external resources (IT department, customization). Having a friendly user interface that lays the data at each user’s fingertips is optimal.
  • In order for upper management to act upon solid data, they must first receive it. If the system facilitates this transfer of knowledge, in the form of data, then the occupational health programs will benefit.And, Upper management is more likely to receive pertinent data when it is easy to retrieve.By allowing end-users (provider, clinic manager) to easily access and create data reports it gives the clinic the power to share the data so that the stakeholders – internal and external can act up the data. This data sharing fosters the continued growth of the occupational heatlh programs.
  • Health care has to move into the hi-tech ageI would extend this statement to include getting the right information/data to the right person outside of the clinic as well (stakeholder/executives) so that the data is available for analytics
  • Finish reading slide. That’s the end of my presentation for today. I hope that you got some valuable insights into how you can the existence of your Occupational Health Clinic which will only results in benefit for everyone. Please don’t hesitate to contact me with any questions and thank you for your attention. In order to promote health and workplace productivity which will reduce workplace costs, it is critical to get the data to support that effort.
  • Welcome to this installment of the Medgate Webinar series and thank you for joining us. Today’s webinar will be Justifying the existence of your Occupational Health Clinic
  • Justifying your Occupational Health Clinic budget

    1. 1. Enterprise EHS Software Solutions JUSTIFYING THE EXISTENCE OF YOUR OCCUPATIONAL HEALTH CLINIC
    2. 2. Enterprise EHS Software Solutions MARY ANNE INTRODUCTION • Many years managing occupational health services and integrating technology into the practice of medicine • Deputy Medical Director of the Fairfax County Public Safety Occupational Health Center for 10 years • President of MD Prime Analytics • Medical consultant for Medgate OH&S software
    3. 3. Enterprise EHS Software Solutions NEED TO JUSTIFY EXISTENCE OF OCCUPATIONAL HEALTH PROGRAM
    4. 4. Enterprise EHS Software Solutions WEBINAR DETAILS • These slides were written as supporting materials for a webinar given in April 2014. View the on-demand webinar now: “Justifying your Occupational Health Clinic”
    5. 5. Enterprise EHS Software Solutions Occupational Health Clinic Patients Providers (physicians, allied health professionals) Investors Government health agencies (CDC) Government agencies (federal or state) Third-party vendors Regulatory agencies (OSHA, NIOSH) Organization management Admin Staff Clinic managers INTERNAL & EXTERNAL STAKEHOLDERS Internal External
    6. 6. Enterprise EHS Software Solutions CYCLE OF HEALTH & PRODUCTIVITY Health status, risks Chronic disease Health & Lifestyle behavior Ability to work AbsenteeismPerformance Profitability Productivity Presenteeism
    7. 7. Enterprise EHS Software Solutions EVER SHRINKING BUDGETS “The federal budget for protecting workers is less than half of that set aside for protecting fish and wildlife.” Source: Center for Effective Government – “Austerity Budgets Threaten Worker Health and Safety” FY 2008 FY 2012 FY 2013 FY 2013 (With sequester’s5.1 % Cut) FY 2014 (With House 22.2% Cut to FY 2013 levels) FY 2014 (With sequester’s7.2 % Cut) Overall 1,306 1,286 1,274 1,209 991 1,190 OSHA 529 576 569 540 443 531 MSHA 361 379 378 359 294 353 NIOSH 416 331 327 310 254 305 Source: The New York Times – “As OSHA Emphasizes Safety, Long-Term Health Risks Fester” – March 2013 Worker Safety and Health Agency Budgets Cuts in Millions of FY 2013 Dollars
    8. 8. Enterprise EHS Software Solutions • ROI = practical way to provide financial justification for investment in health programs • Example: Obesity costs money Objective: Worksite health promotion program Results over 1 year: 7 of 10 health risks decreased. Total projected savings: $311,755 59% attributed to reduced health care expenditures 41% resulted from productivity improvements A $1.17 to $1.00 ROI. ROI ESTIMATION MODEL Source: JOEM • Volume 50, Number 9, September 2008
    9. 9. Enterprise EHS Software Solutions CHALLENGES THAT CLINICS FACE
    10. 10. Enterprise EHS Software Solutions CHALLENGES TO THE OCCUPATIONAL CLINIC #1 - Healthcare providers are capturing data #2 - Are you capturing what you need to? #3 - Accurate Data Capture
    11. 11. Enterprise EHS Software Solutions The vast majority of OH professionals: • wants to focus on doing their job properly • do not want to worry about keeping count of: what they did how you did it how often CHALLENGE – HEALTHCARE PROVIDERS CAPTURING DATA
    12. 12. Enterprise EHS Software Solutions COHN 10 Highest Ranked Task Statements 1. Assure confidentiality of personal health information and comply with established codes of ethics and legal or regulatory requirements 2. Provide treatment of work-related injuries or illnesses 3. Maintain OSHA-required logs and documents 4. Use and maintain an employee health recordkeeping system 5. Manage workers' compensation cases 6. Assess employees with work restrictions or limitations and make appropriate job placement recommendations (i.e., fitness for duty) 7. Perform audiometry 8. Implement policies and procedures for maintenance of confidentiality 9. Conduct health surveillance of individuals/groups for specific hazards 10.Interpret results of screening tests and refer as indicated Source: Occupational Health Nursing 2011 Practice Analysis© CHALLENGE – HEALTHCARE PROVIDERS CAPTURING DATA
    13. 13. Enterprise EHS Software Solutions COHN 10 Lowest Ranked Task Statements 1. Provide direct care for families of employees 2. Design and conduct research 3. Evaluate benefit programs for health care delivery to employees and dependents 4. Apply knowledge of business cycles, trends, and forecasts to market programs 5. Participate in research on practice issues/problems 6. Collaborate in the development of a business continuity plan 7. Provide resources for community education 8. Develop and monitor performance criteria for vendors and suppliers 9. Collaborate to develop nuclear, biological, and chemical response plans 10.Design data collection instruments, questionnaires, and other forms Source: Occupational Health Nursing 2011 Practice Analysis© CHALLENGE – HEALTHCARE PROVIDERS CAPTURING DATA
    14. 14. Enterprise EHS Software Solutions • Healthcare providers need to be given the time, tools and training to facilitate the best data capture. • Challenge: Capture the data while providing medical services CHALLENGE – HEALTHCARE PROVIDERS CAPTURING DATA
    15. 15. Enterprise EHS Software Solutions CHALLENGES TO THE OCCUPATIONAL CLINIC #1 - Healthcare providers are capturing data #2 - Are you capturing what you need to? #3 - Accurate Data Capture
    16. 16. Enterprise EHS Software Solutions CHALLENGE - YOU CAN’T MANAGE WHAT YOU AREN’T MEASURING 1. What needs to be measured so you can improve?  Example – What measures of productivity need to be improved?  Chronic medical conditions  Lifestyle or behavioral factors: cigarette smoking, use of alcohol, seat belt use  Health or biological factors: blood pressure, total cholesterol, height, weight
    17. 17. Enterprise EHS Software Solutions 2. How: Which programs should you monitor and which changes should you implement to make an impact?  Specialists on site: Nutritionist, Exercise Physiologist, Tobacco Cessation Counselor…  Discounted programs: Weight Watchers, gym memberships, Integrative Medicine  More medical monitoring /surveillance CHALLENGE - YOU CAN’T MANAGE WHAT YOU AREN’T MEASURING
    18. 18. Enterprise EHS Software Solutions CHALLENGES TO THE OCCUPATIONAL CLINIC #1 - Healthcare providers are capturing data #2 - Are you capturing what you need to? #3 - Accurate Data Capture
    19. 19. Enterprise EHS Software Solutions CHALLENGE - ACCURATE DATA CAPTURE YOU’RE NOT DOING WHAT YOU THINK YOU ARE! • Inadequate qualification of clinic services: How much time a provider spends with the patient?
    20. 20. Enterprise EHS Software Solutions Encounter: any contact with the patient either in person or via other form of communication. Clinic visits Commonly missed encounters: emails exchanges/phone calls completed forms that patient drops off fitness for duty evaluations/consultations external consultation triage consults CHALLENGE - ACCURATE DATA CAPTURE YOU’RE NOT DOING WHAT YOU THINK YOU ARE!
    21. 21. Enterprise EHS Software Solutions Activity: anything that you carry out on behalf of a patient (or employee). blood tests, hearing test, physical Must capture multiple activities per encounter patient reports to the clinic for a flu shot + hearing test + STD form completed CHALLENGE - ACCURATE DATA CAPTURE YOU’RE NOT DOING WHAT YOU THINK YOU ARE!
    22. 22. Enterprise EHS Software Solutions • Measure more! • Identify gaps between services provided and failure to document those services • Be as specific as possible concerning the activities provided CHALLENGE - ACCURATE DATA CAPTURE YOU’RE NOT DOING WHAT YOU THINK YOU ARE!
    23. 23. Enterprise EHS Software Solutions KEY STEPS IN JUSTIFYING YOUR CLINIC’S EXISTENCE
    24. 24. Enterprise EHS Software Solutions #1 - Capturing data: Get an accurate picture of what activities are being carried out in your clinic #2 - Getting the data out:  Must be relatively easy to extract data #3 - Analyzing/Reporting data: Useful for both internal and external stakeholders Identify points for interventions and measurement of effectiveness
    25. 25. Enterprise EHS Software Solutions CAPTURING DATA Source: Occupational Health Nursing 2011 Practice Analysis©
    26. 26. Enterprise EHS Software Solutions • Methods to capture data need to: Be user friendly and intuitive Integrate with medical workflows 79% of providers report that an EHR allows their practice to function more efficiently Source: HealthIT.gov article: Medical Practice Efficiencies & Cost Savings CAPTURING DATA
    27. 27. Enterprise EHS Software Solutions • Leverage existing tools Use existing tools – if you have spreadsheets, use spreadsheets • Important that you track • Capture the granularity needed to provide robust data reporting CAPTURING DATA
    28. 28. Enterprise EHS Software Solutions • The data can be captured in many forms but the most efficient would be a EHR • Without appropriate data capture the ability to effectively manage occupational health programs is greatly diminished. CAPTURING DATA
    29. 29. Enterprise EHS Software Solutions • No matter what format, data must be easily retrieved For individual patients For external providers (referrals, case managers) For admin staff/clinic managers For organizational managers • Data export should be available to end user – not just admin/IT staff GETTING THE DATA OUT
    30. 30. Enterprise EHS Software Solutions • Electronic software system – Can reliably capture more data, get more data out and more easily analyze the data! • If you’re already using software, leverage it to examine the data to monitor occupational health programs! GETTING THE DATA OUT
    31. 31. Enterprise EHS Software Solutions ANALYZING/COMMUNICATING DATA • Analyzing the data at all organizational levels (patient, department and enterprise level) Allows for identification of issues/progress/change Allows for specific interventions Allows for more responsive course adjustments
    32. 32. Enterprise EHS Software Solutions COMMUNICATING DATA - INTERNALLY • By collecting data, your team will be able to: Look at the program objectively and learn lessons to improve the program Identify internal trends faster than is required for external reporting purposes Implement fixes quicker “During the flu vaccine program we identified a deficiency in providing enough flu vaccines to a particular employee group so we adjusted the program to meet that need”
    33. 33. Enterprise EHS Software Solutions COMMUNICATING DATA - EXTERNALLY • Demonstrate that the money invested in the program has had some effect: Analyze the impact on budgets Integrate the points of justification that external stakeholders are asking in your internal reporting cycle “We reduced flu-related sick leave by 15% this year”
    34. 34. Enterprise EHS Software Solutions JUSTIFYING YOUR EXISTENCE: USING EHR AND ELECTRONIC REPORTING
    35. 35. Enterprise EHS Software Solutions HOW SOFTWARE SUPPORTS BETTER ANALYTICS #1 - Capture accurate data  Including multiple activities per encounter #2 - Get the data out  Run automated reports #3 - Configure the data  Create custom reports #4 - Share data  Export the data
    36. 36. Enterprise EHS Software Solutions • Capture multiple activities per encounter • Surveillance groups – Capture multiple activities per encounter • Surveillance recalls function – Helps eliminate inadvertently omitting services while patient at clinic CAPTURE ACCURATE DATA
    37. 37. Enterprise EHS Software Solutions
    38. 38. Enterprise EHS Software Solutions
    39. 39. Enterprise EHS Software Solutions RUN REPORTS & GET THE DATA OUT • Use pre-existing reports to cover basic clinic processes • Should be easy to use and generated by a user – don’t need IT support
    40. 40. Enterprise EHS Software Solutions Existing Reports
    41. 41. Enterprise EHS Software Solutions CONFIGURE THE DATA: CUSTOM REPORTS • Medgate Report Writer: Ability to create custom reports without need of IT or vendor customization – provides flexibility of retrieving data
    42. 42. Enterprise EHS Software Solutions CU
    43. 43. Enterprise EHS Software Solutions EXPORT & SHARE DATA • Involving upper management in the progress of the occupational health programs • Share indicators • Ways to share: Customized reports that can be shared with & given to management Employee portal
    44. 44. Enterprise EHS Software Solutions Accelerate the use of information technology in the health world, in order to provide secure electronic health record systems that get the right information, at the right time, to the right health care professional. Source: World Health Organization Article: Health care has to move into the hi-tech age
    45. 45. Enterprise EHS Software Solutions When the effectiveness is known, it is possible to plan how the desired impact on the work environment and the employees’ health and well-being could be attained with as little cost as possible. THE FUNDAMENTAL GOAL IS NOT TO PRODUCE OUTPUT, BUT TO PRODUCE HEALTH
    46. 46. Enterprise EHS Software Solutions JUSTIFYING THE EXISTENCE OF YOUR OCCUPATIONAL HEALTH CLINIC Data with analytics is the solution For more information, visit the Medgate website.

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