February 2001

Facility Profile: Burke Rehabilitation Hospital

By Peter Pesavento

In White Plains, NY, a freestanding rehabilitation institution has taken a bold new step into the future of rehab services and management. Burke Rehabilitation Hospital has recently initiated an effort to use computers and computer-based templates in its day-to-day business in order to streamline and document rehabilitation activities at Burke and its affiliates in a newly formed network. The Burke Rehabilitation Network is made up of hospitals and long-term care facilities in the state of New York. Although still in its nascency, this computerization of rehabilitation management has already shown encouraging results.

Getting Started

The idea of a completely integrated and computerized network for rehab management, education, billing, and patient tracking was born from the precarious health care environment during the 1990s. “Given what was happening with HMOs, managed care, Medicare reimbursement, and the Balanced Budget Act,” says Louis L. Harris, PT, senior hospital administrator and director of network development, “we wanted to focus on organizing rehab services across the entire continuum of care. We thought that if Burke could position itself with operational efficiencies and an overall strategic plan in this environment, we could create a growing organization and maximize revenue.”

Harris adds, “We thought of four key advantages to this network—to deal with the health care market, to provide access to all patients, to develop a consistent, cost-effective delivery system, and to standardize care by looking at best practices.”

Harris explains the two concepts integral to implementation, “The critical piece was collaboration with other hospitals, but an equally important part was information systems. So even in September 1997, when we decided to start collaborative efforts with other institutions, we realized that we were going to have to share information—whether that meant financial, academic, or clinical. And if we were going to look at ways of improving rehab procedures such as best practices, we were going to have to compare outcomes of treatment.”

The first hospital to get on board was New York Presbyterian, an institution 20 miles away from Burke. Burke has always been an affiliate of Cornell Medical School and New York Hospital was its acute care affiliate. In 1998, New York Hospital merged with Columbia Presbyterian Hospital to become New York Presbyterian. When the merger happened, Harris comments, “We realized that Presbyterian had its own rehab unit with 40 beds. This was the perfect opportunity for us to combine our talents and look at creating best practice, triaging patients, and so on.”

Presently, Burke’s newly formed network includes both acute care hospitals and long-term care facilities. Members of the network include: New York Presbyterian, United Hospital in Portchester, and the Beth Abraham Health System, which includes long-term care facilities in New York, Schnurmaker Nursing Home in White Plains, and Andrus Adult Care community in Hastings on Hudson. The new system also integrates the Hebrew Home of Riverdale and the Bethel Home in Croton.

The entire Burke Rehabilitation Network hosts more than 602,000 patient visits per year. For the acute care hospitals, inpatients total 106,194, while inpatient rehab facilities have the largest statistic—treating 310,270 individuals yearly. Outpatients in the system total 115,780 persons, while the nursing homes that offer subacute and long-term care round out with 70,500 visits per annum.

Overall, the Burke network has 300 therapists, 2,000 acute care hospital beds, 1,500 long-term care beds, 260 post-acute care beds, 190 certified rehab beds, and three assisted-living projects.

The computerized network that Burke is using is called Mediserve. October 2000 was the kickoff date but the system’s applications have not yet been accessed by all departments of the rehab network membership. Mediserve’s operating system is Windows 2000, and it runs on two servers, in a cluster configuration. Additionally, the servers each have 768 megabytes of memory. The data is kept in a storage-area network, with approximately 150 gigabytes of available hard-disk space. Harris notes, “All patient information from the other institutions will be here at Burke, and will be protected under the Health Insurance Portability and Accountability Act.”

The mode of operation is application service provider (ASP) for all members of the network, based on the network servers and applications on Burke’s campus. All data transmittal and communications using Mediserve are done via T-1 wide-band-width transmission lines between all participating centers.

The Mediserve system, which is receiving start-up funding over a 3-year period beginning in January 2000, will ultimately cost $5 million when the entire network is up and running in 2002. Burke is picking up the entire tab. Harris comments, “We feel very strongly that the future of rehab is going to be in information systems and outcomes.”

Ultimately, Burke plans to have one computer for every two therapists in the entire rehab network. The computers are placed on movable carts, and use radio-frequency transmission to send the data, which means there are no plug-in receptacles that need to be searched for, or long electrical cords to carry around.

There are two challenges facing Burke’s staffing in relation to the newly installed computer network. The first is making sure everyone is computer literate. According to Janet Herbold, PT, who is in charge of the clinical aspects of the project, “This is probably our biggest challenge. We produced a survey for our staff to find out their level of computer literacy. Then we needed to bring them up to speed in that aspect first, before they could even go online. The second challenge is ensuring that the receivers have access to computer technology, so they can get our information when it is sent electronically.”

Functions, Strengths, and Advantages

The functioning of the Mediserve system has two elements: the scheduling and registration component, and the documentation aspects of the computer project. “Both of them interact together,” says Herbold.

The system employs templates that are universally used by the entire group of therapists in their specialties. Herbold talks about the strengths of the usage of these templates: “There is consistency in what we are documenting. For every diagnostic group, we always ask the same questions of the same patients, so we make sure we have a consistent data tool. From that, we get consistent outcomes.”

Herbold additionally notes, “We actually can tag something in the middle of the template to be viewed later on, demonstrating that a patient has progressed, or that a cluster of patients with the same diagnosis has this potential outcome.”

Another benefit of the computerized system is that the notes are searchable, and accessible by other therapists and physicians. Herbold elaborates, “For example, if a physician wants to find out how a patient is doing in terms of planning for her discharge date, he can just pull up the patient’s status on the computer. It can also help to plan transfers of a patient from one institution to the next. If the patient is on the system, we can help maintain continuity of care.”

Harris echoes Herbold, adding,“If a therapist is seeing a stroke patient at NY Presbyterian in the acute care unit, and he decides that this person may be a rehab candidate, we can go on the system right here at Burke. We will be able to look up the data, know exactly what the therapist did, and continue the care without any interruption, or having to redo unnecessary evaluations.”

Since putting the system into effect, there have already been tangible results. Herbold points out, “There is also a definite reduction in the time it takes to put in a note, to complete a note. We are able to write the notes while the patient is right in front of us, instead of having to take notes and later rewrite them on proper forms in longhand.” She also mentions that the time savings can be a half hour or more, “In general, therapists were able to complete their notes in about 45 minutes; in the past they would spend 45 minutes with the patient, and then at least an additional half hour writing the notes [in longhand].”

Another streamlining aspect relates to billing. Herbold mentions, “An added benefit is the ability to drop a bill at the same time you are documenting. Billing is a basic component of the template, as opposed to a separate entity. Doing billing can take a few minutes in itself.”

Going For Full Integration

According to Harris, the short-term goal is to connect the services of the network with good information. “Our number one goal is to develop a collaboration interconnecting institutions, and then connect those services. When we do that, we have system management, and now we have the information systems to hook that up.” As for a long-term objective, improving quality of care is foremost. “We aim to improve quality by decreasing variation in care, and looking at best practices, which refers to the collaborative effort of all the therapists involved, determining what the outcomes are, and then collecting that data with this information system. Subsequently, we feed the results back to them so they can see exactly how they compare to other people in the network,” declares Harris.

As for the Mediserve system, Herbold points to several goals that Burke plans to accomplish this year. “In terms of our computer system, we will go completely live in 2001,” she says. “During the first quarter of this year, NY Presbyterian will go live, and here at Burke we will have our inpatient databases up as well. In the second quarter, NY Presbyterian’s rehab department will be up. And over a longer period of time, we will bring the acute care hospitals up to speed in our network.”

Responding to a question on seeing trends in Mediserve’s impact on costs, Harris declares, “Although we do not have any cumulative data for that now, we do have such information anecdotally. I think we can say that there have been two areas in which we are having cost savings. One, we get the bill out a lot faster, and it is more accurate [because data on procedures performed come from the therapist’s own note report], and two, we eliminate a hand-off to another group or individual for recording. That ultimately should translate into increased productivity and cost savings.”

Ultimately, Harris sees the Burke Rehab Network evolving into a learning organization. “This means that a grouping takes this data, learns from it, and improves itself in three main areas—level of care, productivity, and management.”

Peter Pesavento is associate editor of Rehab Management.

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