Roger Crook, Yardley Management Solutions, Inc.

As hospitals and health systems make their information technology investment plans, they should be considering the move up to HPM from TRENDSTAR.  Hundreds of organizations are squeezing every last dime from their TRENDSTAR investment, but they need to be careful not to miss opportunities presented by the overall IT investment strategy to make this move.  The TRENDSTAR customer base is gradually migrating to HPM for many excellent reasons, but the real impetus for upgrade decisions comes from the overall information technology context.

For every organization there is an optimal point at which to make this investment and to begin reaping the benefits of HPM's analytic power.  So what are the factors that come into play in this decision?  We will discuss these below:

1) New clinical or patient accounting systems. 

The drive to automate patient care processes presents opportunities for the move with several facets:

a) New interfaces.  Patient data interfaces for systems like TRENDSTAR and HPM are challenging and costly.  If an interface from a new source system is needed, does it make any sense to expend resources on the interface to TRENDSTAR, when you may be making the migration to HPM within a year or two anyway?  The TRENDSTAR and HPM data models and thus interface formats are completely different, so the TRENDSTAR interface will be a throw-away when the move to HPM is made.

b) New data.  The new systems contain new data, data that will add value for analysis.  In fact, a big part of the reason for the new systems is to allow more detailed and accurate data capture.  Can you put this new data into TRENDSTAR, and should you?  HPM has robust data extension features that TRENDSTAR cannot match.  Efforts to capture this extended data in TRENDSTAR will largely be wasted when the move to HPM follows.  It’s a lot easier to showcase your new data in HPM with its integrated extensions and worksheet reporting tools.  A vital part of new system strategy should be to use its data to analyze progress made in adoption and patient care and service improvements.

c) Changing tables and structures.  In addition to new data and data formats, new source systems often mean changes to the general ledger accounts, department numbers, and service item numbers or charge description master items.  The level of effort required to make these changes in an existing TRENDSTAR system is comparable to re-implementing the system.  These efforts will also be repeated when HPM is brought up a year or two later.  HPM also offers better capabilities to handle the data from before and after the source system goes into operation.

Arrival of a major new source system is a major trigger event for the decision to upgrade.  Usually the investment to upgrade in HPM is dwarfed by the cost of the new source system, and can be bundled with it.

2) New Personnel

New people in the hospital organization create demand for information, and demand for people capable of delivering the information.

a)       Management.  Hospitals and health systems are increasingly data driven organizations, in large part to new generations of managers who are comfortable working with office automation tools.  New managers often look for more information than their predecessors, information like cost and margin by service line.  While TRENDSTAR has these capabilities, they are significantly better in HPM.  If it is time to tune up cost accounting or revenue modeling to support management, does it make sense to embark on new processes in TRENDSTAR?  Part of the data such as standards and statistics can be converted, but allocation structures cannot, so part of the effort to bring it up in TRENDSTAR will be wasted when a later move to HPM is made.

b)       Staff.  As the users of TRENDSTAR are promoted or retire, new users must be trained.  Many more hospital departments are now also interested in the data and uses of TRENDSTAR.  Both these factors create demand for training.  Unfortunately,  TRENDSTAR’s user interface was designed before Windows.  The character based screens and lack of mouse functions are a barrier to learning and retention.  Many users, once trained actually try to avoid using TRENDSTAR because they find it difficult to understand and navigate.  HPM’s user interface is familiar to new generations of users, and as a result HPM has much wider acceptance and use.  Does it make sense to expend more training resources on TRENDSTAR when we know many of the new users we train will never be proficient with the system, or do we invest in HPM where you know you will have acceptance and wide-spread use?

Though usually not the main trigger event, the difficulty in staffing to use TRENDSTAR is significant.  The new generation of system users is often afraid they will be pigeon-holed as TRENDSTAR users forever.  Lack of capable users means TRENDSTAR can’t keep up with management demands.

3) Health Care Reform and Management initiatives

The economic downturn has already increased demand for hospital management information significantly, and this trend will continue no matter which direction reform takes.  Scorecards that depend on measures like cost and profitability by service line, as well and more detailed clinical measures are placing increasing pressure on decision support departments today.  TRENDSTAR and HPM are the engines that drive these measures.  Productivity in the production of this information is vital, but TRENDSTAR users are more often forced to cobble solutions together that HPM already provides, such as clinical analytics for readmissions and adverse events.  Cost accounting is often used along with other measures to assess economic value of possible or actual improvements, and again, HPM offers a significantly better approach, offering better detail and ease of use.  By comparison, some TRENDSTAR users update cost only once or twice a year, undermining the value of the information.

The bottom line is that we all expect hospital bottom lines to get more difficult, no matter what.  The information from TRENDSTAR and HPM is vital to measure where performance can be improved, and the success of management and process improvements.  HPM lets more users get more and better information, more easily.  The time to make the investment to upgrade to HPM is probably now, before it is absolutely necessary, and while the organization can still fund the project.  If hospital management is increasingly like a hike in the desert, make sure you bring your GPS (HPM), not your compass (TRENDSTAR).