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F E A T U R E

Poland's Kielce ZOZ sets a broken health care network straight with Progress application partner Textus Virtualis' applications.
By Bill Manning

Wizards of ZOZ

Doctor, it hurts when I do this," says the patient flexing an injured limb, in an ancient but venerable vaudeville routine. "So don't do it," replies the doctor - instant symptomatic relief that avoids the more difficult job of curing the underlying problem.

Many patients in Poland today may also be uttering similar expressions of pain. This, not only because of their various afflictions but also because of that country's rapidly privatizing - and often inefficient and underfunded - healthcare system.

In many cases, at least part of the inefficiency inherent in the system manifests itself in the form of duplicate doctor appointments, poorly documented insurance claims, and outdated or outright inaccurate clinical information attributable to antiquated computer systems. Systems desperately in need of a 21st century technology intervention.

Such was the case at Kielce ZOZ (Zespol Opieki Zdrowotnej - Healthcare Center), a network of 22 healthcare clinics serving over 400,000 patients in the city of Kielce, (pronounced "kyail- say").

The center knew it was behind the healthcare curve when it looked at its collection of older standalone PCs that could neither share information easily within a facility nor transmit clinical and financial data that could be integrated with the headquarters' central database. Add in a technologically under-trained staff, and the prognosis for better service and streamlined patient data management wasn't good.

That's why two years ago, Kielce ZOZ implemented Argus, a healthcare management solution based on the Progress® RDBMS and developed by Warsaw-based Progress application partner Textus Virtualis. It proved to be, as they say, just what the doctor ordered.

G I V I N G T H E B O O T T O S N E A K E R N E T

Poland's healthcare system is experiencing a wrenching metamorphosis that is hitting patients, government, and the bottom line simultaneously, according to Tomasz Judycki, founder of Textus Virtualis, and a longtime Progress user .

In recent years, responsibility for managing healthcare delivery to the nation's 39 million people has been transferred from the Polish national government to local governments, an intermediate step before the country makes the transition to a fully privatized system within the next few years. As a result, Kielce faces the same management challenges and budget constraints that every healthcare provider around the world seems to face these days. Nowhere were those constraints more in evidence than in Kielce's IT infrastructure.

"This was a chain of clinics still using 386-based PCs that weren't networked, which was bad enough, but they didn't even have such basic applications as a computerized patient registration system," remembers Judycki. "Each PC had installed on it a copy of CA-Clipper, a collection of database applications from Computer Associates based on dBase and used to track patients' clinical and financial information.

The problem was that each month Kielce ZOZ had to gather all that information from its clinics and input the data into its central database for insurer claims submissions and other purposes. "To do that, however , the information had to be copied to a diskette at the clinic level and physically delivered to headquarters where the information would be consolidated for settlement," Judycki explains. "It was a process that could take days to complete. Not only did that slow the reimbursement process, but an under-trained staff, as well as the limitations of the applications themselves, added to the lag in payments. The insurance company would find mistakes - double-billing or missing data - and refuse to pay because of errors."

A presentation on the Argus solution given in late 1999 to a group of healthcare providers by Textus V irtualis quickly caught the attention of Kielce ZOZ's IT staff, which immediately recognized the software's potential for a cash-strapped operation.

"Clipper was good for a small firm, but with our rapidly expanding patient base we needed a much more powerful and centralized database that was also economical and easy to use by both IT staff and by our clinic workers," says Kielce ZOZ IT manager Waldemar Kopys. "We also were looking for a solution that didn't require us to upgrade to the latest PC platforms or invest in expensive networking infrastructure in order to run newer applications and share information between our clinics and headquarters operations. Tomasz' confidence in his Progress application's stability and robustness convinced us that was the way to go."

S P E E D, A N D S A V I N G S, F R O M W E B - E N A B L E D A P P L I C A T I O N

Beginning in M arch of 2000, Textus V irtualis mapped out a client/server solution for Kielce ZOZ that featured the centralized database applications it required without the client upgrades that would have made the project prohibitively expensive. By the summer, the system was largely in place and operational, with Textus Virtualis training a small team of Kielce ZOZ employees to configure the desktop systems and train its clinic workers to use the new system.

The Argus 5.0 Web-enabled applications, created with the help of WebSpeed®, uses a Progress database to support the core patient registry application that tracks patient appointments and doctors' schedules, and stores and retrieves medical records and treatment histories. In addition, Argus features a laboratory management module, for authorizing diagnostic tests and archiving results; a local pharmacy module that inventories drugs and registers patient prescriptions; general reporting modules for insurance companies and health care clinic supervisors; and cost analysis capabilities.

Argus itself runs on a recently upgraded 1.6 GHz Pentium dual processor Windows NT 4.0 server. The server, located at headquarters, transfers patient claims information to the healthcare fund responsible for reimbursements. Headquarters is, in turn, connected to each of its 22 clinics via a multiport Cyclades card handling 22 Zyxel Elite modems. Clinic PCs are connected to the server via an Intranet using phone lines leased from a local telecom provider.

Best of all, Kielce ZOZ was able to protect the investment in its older desktop systems because the Textus Virtualis solution only required the addition of Internet Explorer as a modern, easy-to-use GUI for entering and retrieving data from Argus applications. Among Argus' many conveniences, notes Kopys, is its ability to verify patient eligibility for coverage of medical services by the Swietokrzyska Regional Healthcare Fund. The Fund covers approximately 98% of the patients received in Kielce's local healthcare units.

"The system has been designed to provide services even with incomplete data," explains Kopys. "For example, a required field while registering a patient is his or her PESEL (civil ID number). But the new system is flexible enough that it is possible to override that field requirement and still register patients who don't remember their numbers by retrieving the information from the central database if there's been a previous visit. That's a big advance over what we were able to do with our old system."

The system has also improved patient service and operational efficiency through its ability to process 8,000 to 10,000 transactions a day with greater speed and accuracy than was previously available. Kopys reports that the Argus solution, in fact, has reduced the time needed to process patients by 45%. It has also lowered data entry errors by an even more impressive 90%, a statistic that translates into employees making fewer mistakes, so they can concentrate on doing their jobs better, and results in faster insurance reimbursements to improve clinic cash flow.

"The Argus system revolutionized the processing of patient records at Kielce ZOZ… and the IT department has earned a new respect and importance it didn't have before," says Kopys. "Kielce ZOZ has become well known in the region and in all of Poland for what we accomplished. Other healthcare clinics throughout Poland, in fact, are now interested in Argus because of its low cost, high functionality, ease of use, and minimal staff needed to manage and maintain it."

And still greater functionality and national interest are sure to follow, adds Judycki. "Healthcare regulations, as well as patient and doctor needs, change quickly in Poland as I'm sure they do elsewhere," he observes. "That means we'll be continually updating and refining our applications so that clients such as Kielce ZOZ can change with them."