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Concurrent clinical review: using microcomputer-based DRG-software.

D Huertas-Portocarrero, P P Ruiz, J P Marmol

Health Policy (Amsterdam, Netherlands)

|December 11, 1987

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The Prospective Payment System (PPS) and Diagnosis Related Groups (DRGs) have spurred information technology advancements. Concurrent Clinical Review Systems, utilizing microcomputers, enable online monitoring of medical care quality and appropriateness.

Area of Science:

Health Informatics
Medical Information Systems
Healthcare Management

Background:

The implementation of the Prospective Payment System (PPS) based on Diagnosis Related Groups (DRGs) in the U.S.A. has driven the development of critical information technologies.
Professional Review Organizations (PROs) are instrumental in enhancing the control over the appropriateness and quality of medical care provided.

Purpose of the Study:

To discuss the role of information technologies in response to DRG-based PPS.
To highlight the importance of internal hospital capabilities for medical care review.
To introduce Concurrent Clinical Review Systems as a key technology for online monitoring.

Main Methods:

Discussion of information technologies emerging from DRG-based PPS.

Related Experiment Videos

Analysis of the function of Professional Review Organizations (PROs).

Description of Concurrent Clinical Review Systems and their reliance on microcomputers and specific software like 'Clinical Review System'.

Main Results:

Concurrent Clinical Review Systems, operating online during and before hospitalization, facilitate continuous monitoring of medical care.
Microcomputers are crucial in making this technology accessible and widely adopted.
'Clinical Review System' software simplifies the complex task of clinical review.

Conclusions:

Hospitals need to develop internal capabilities to match the review standards set by PROs.
The philosophy behind 'Clinical Review System' and similar software should be adapted for European healthcare systems.
Information technology, particularly microcomputer-based systems, is vital for improving healthcare quality and appropriateness under DRG-based payment models.