Anticlue

Healthcare reporting and XML

I'm not a believer in incumbering a business process with paper reports. I've seen it bring businesses to their knees. However I was playing with XML Maps in Office 2003, and had another one of those ideas that I'll give up to the community in the hope of improving healthcare in America.

XML and healthcare is starting to take off, there is the CCR, HL7 ver 3, the EHR, alot of benefits looking at the large picture. So I'm going to talk about a small portion, the reports of the billing system and finance.

I'm going to propose that an organization with time, looks at generating an xml document instead of a paper report from the respective cobol system. Why you ask? Let me introduce you to MS Excel 2003 XML Maps.

First let's get a sample report into an xml document. I've made up a readmission report here, that is an extract of the medicare and medicaid readmits within 30 days as inpatients. Here is my sample document.

<?xml version="1.0" encoding="iso-8859-1"?>
<ReadmissionReport version="1.56" date="06.27.2004">
   <readmission>
      <PatientName>Elyse Nielsen</PatientName>
      <PatientID>1234567</PatientID>
      <VisitID>200111222</VisitID>
      <AdmitDate>Sat, 26 Jun 2004 09:28:00 -0500</AdmitDate>
      <Payor>Medicare</Payor>
      <NurseStation>Station</NurseStation>
      <RoomBed>Bed</RoomBed>
      <Service>Physiciatry</Service>
      <PreviousDischargeDate>Sat, 5 Jun 2004 17:21:00 -0500</PreviousDischargeDate>
   </readmission>
   <readmission>
      <PatientName>Test Patient</PatientName>
      <PatientID>9234567</PatientID>
      <VisitID>400111333</VisitID>
      <AdmitDate>Fri, 25 Jun 2004 09:28:00 -0500</AdmitDate>
      <Payor>Medicaid</Payor>
      <NurseStation>Station</NurseStation>
      <RoomBed>Bed</RoomBed>
      <Service>Cardiology</Service>
      <PreviousDischargeDate>Sat, 5 Jun 2004 17:21:00 -0500</PreviousDischargeDate>
   </readmission>
</ReadmissionReport>

In a new excel doc, under the Data Menu Item, there is XML, choice xml source. Click on the XML Map button and select your xml file.

Now just select and drag the elements you want to report on. Once this is set up for each individual, with the desired sorting. Import your xml document.

A nice report that you can manipulate. Imagine if this was the daily unbilled report able to be analyzed in a totally different manner.

So how should one go about doing this, well alot of organizations are looking at document management. But let's go this route, first have the printed reports dumped to a folder on the network somewhere. Have the documents from the nightly report well named.

The one truth from reusability is that most programmed cobol reports have the same format for the header. Normally it hasn't change much since the application was built. There is the TITLE-LINE, COLUMN-HEADINGS, and DETAIL-LINE in the working storage of the cobol program. If you are really lucky these have been saved as copy members. (Slight aside: I do not know COBOL, I swear it, no one can make me state any different 8) These structures will have the text layout needed to pull off the field names and report headings.

01 TITLE-LINE
    05  FILLER                              PIC X(20) VALUE SPACE.
    05  FILLER                              PIC X(18) VALUE "Readmission Report".
    05  FILLER                              PIC X(20) VALUE SPACE.
    05  FILLER                              PIC X(5) VALUE "Page:".
    05  PRINT-PAGE-NUMBER        PIC ZZZZ9.

01 COLUMN-LINE

    05  FILLER                              PIC X(15) VALUE "Patient Name".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Mrno".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Serial".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Admit Date".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Payor".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Nurse Station".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Room Bed".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Service".

    05  FILLER                              PIC X(10) VALUE SPACE.

    05  FILLER                              PIC X(15) VALUE "Previous Discharge".

    05  FILLER                              PIC X(10) VALUE SPACE.

What wonderful file data, so here we go have an application that reads the report, determines for this report I need this info from the cobol program, (ascii dumped somewhere), and then coverts the report into an xml file. Wouldn't CF's File Search and <CFXML> tag be great here.

Finally provide training to the "computer experts in the billing department"
on how to import and setup throw in a couple of excel's statistical tweaks. Happy enabled customers with the data in their control not held hostage in an antiquated system.

I'm sure a couple people reading this could improve this idea even farther, so please share.