Benchmarking of hospital information systems: monitoring of discharge letters and scheduling can reveal heterogeneities and time trends

Abstract

Background: Monitoring of hospital information system (HIS) usage can provide insights into best practices within a hospital and help to assess time trends. In terms of effort and cost of benchmarking, figures derived automatically from the routine HIS system are preferable to manual methods like surveys, in particular for repeated analysis.

Methods: Due to relevance for quality management and efficient resource utilization we focused on time-to-completion of discharge letters (assessed by CT-plots) and usage of patient scheduling. We analyzed these parameters monthly during one year at a major university hospital in Germany.

Results: We found several distinct patterns of discharge letter documentation indicating a large heterogeneity of HIS usage between different specialties (completeness 51 - 99%, delays 0 - 90 days). Overall usage of scheduling increased during the observation period by 62%, but again showed a considerable variation between departments.

Conclusion: Regular monitoring of HIS key figures can contribute to a continuous HIS improvement process.

Figure 1

Completeness by timeliness of documentation (CT-plot). This department provides highly complete discharge letters (completeness 98.5%) and no delays – best case. 201 cases from March 2007 were analyzed.

Figure 2

This specialty reaches a relatively high level of HIS discharge letter completeness (96.1%), but there are relevant delays in documentation (median time span from patient discharge to letter 7 days). 76 cases from March 2007 were analyzed.

Figure 3

This department shows low completeness of discharge letters (50.6%), but good results with respect to timeliness. 245 cases from March 2007 were analyzed.

Figure 4

Combination of incomplete and delayed documentation (completeness 52.7%). 91 cases from March 2007 were analyzed.

Figure 5

Overall number of electronic scheduling appointments per day (y-axis) by month (x-axis). During the observation period scheduling was introduced in several departments.

Figure 6

Histogram of number of appointments per day per department (analysis for month 12). Seven departments manage on average between 20 and 40 appointments per day electronically. Usage of electronic scheduling varies between less than 20 and more than 120 appointments per day.