Healthcare IT Insights

In healthcare, which is where I practice my trade, the classics include Revenue Cycle, Supply Chain and Labor Cost Reduction. Labor cost in most health care providers constitutes 60-70% of the total cost picture, so it is a reasonable place to start. Revenue Cycle and Supply Chain each warrant careful and periodic inspection to ensure that changes in contracts and complexity of products don’t result in increased costs of inventory, accounts receivable or missed opportunities for revenue capture. In the IT space, budgets have been reduced and major projects have been delayed. All great, short term, tactical responses to the current economic crisis.

But hey, have you thought about stepping up and going against the trend? The list of projects is now shorter, so take on a big one… one that seems too expensive to consider, but one for which you know or suspect the benefits are huge for your organization. Take a more “transformational approach” to the initiative and find the ROI you need to justify even the most significant expense. Clinical Transformation is an example, but your transformation could be focused on your web presence, or your revenue cycle.

Read Clinical Transformation from Healthcare Informatics

In contrast to traditional approaches, transformation leads with process change, enabled by people and technology and supported by a business case. Transformational change is not easy – it requires a strong dissatisfaction with status quo, a vision for a desired future state and the means to achieve the change (key among the “means” items is leadership talent). Could this be right for your organization at this time?

The alternative is to take small, safe steps in an incrementalist spiral as user frustration builds and your enterprise bides its time, potentially losing market position to a competitor who chooses a transformational path.

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If it walks like a duck and sounds like a duck, then it is probably a duck…

Federal government programs under ARRA for healthcare have created a lot of energy around extending the reach of electronic medical records through provider incentives via Medicare and Medicaid.  Subject to an affordable budget at the state and federal levels, these seem like solid programs.

The efforts around HIE and the infrastructure to support the sharing of data among providers in the community while sound at first glance are sounding all too familiar.  Remember the Clinton version of Healthcare Reform?  Remember CHINs? Remember RHIOs which were only recently bogging down with such commonality that they changed their names and reopened for business as HIE?  As Yogi Berra would say, this is a déjà vu all over again situation.

As I have shared in other posts, I am an advocate of the HIE solution – but I am more of a capitalist than a communist. There are solid vendors out in the market who can help provider organizations in a number of ways including:

• Patient safety through a more complete collection of CCR components such as active meds, allergies, chronic conditions from disparate sources
• Capture of physician referrals from within the owned and affiliated physician groups
• Reducing the cost of reporting to external entities

Vendors in this space include Medicity, Axilotl, dbMotion, Wellogic, MedSeek, etc. just to name a few.  In my view, a health system focused HIE program can make a lot of sense and have a strong ROI.

What causes my eyes to roll back in their sockets is the “RHIO like” obstacles I hear associated with planning efforts around HIE – in anticipation of ARRA funding.  http://www.emrandhipaa.com/emr-and-hipaa/2009/04/08/simplification-of-health-information-exchanges-and-ehr/

Based on my experience, the following represent some of the most commonly encountered barriers to effective RHIO/HIE:

• Governance/Ownership – who controls the organization?
• Data Sharing/Security – consent for sharing patient information
• Sustainable business model – after the grant funds run out, how do you keep the doors open?

In the absence of government funding, RHIOs were on a slow death march largely due to the absence of a sustainable business model. The most successful models are those who received grant funding from public and private sources – but grant applications are not reliable as a primary source of revenue generation.

The challenge in broad-based RHIO efforts, is the huge disconnect between stakeholders who have the need for shared information and those who have the funds to contribute to RHIO operations. Government funding of HIE/RHIOs only masks this challenge.  How long will it be before government budget problems drive cuts to public HIE funding?

How different is the picture in considering the value propositions of other stakeholders across the healthcare continuum that might have funding to support operations of an HIE such as:

• Large health systems
• Payor organizations
• Pharmaceutical/medical supply companies
• Life science/medical device companies

Clearly, there are potential strings attached in aligning with these stakeholders but are there not also strings attached to government funding?

Quick, this is a quiz.  Without reading the balance of this post, how many call centers do you have in your hospital?

I have been amazed at the number of call centers I find in some very well run healthcare organizations.  I am talking about providers … community hospitals with 18, 25 over 100 distinct call centers.  Clearly, most of these are small clusters or “call groups” that have evolved independently across the enterprise.  While many of these groups require “line of sight” proximity to the area they support, there is tremendous opportunity to co-locate significant portions of this capacity.  Benefits of co-location include the potential to cross train and reduce overtime as one area covers for another in times of peak demand.  In addition, management and supervisory functions may be reduced, creating capacity for additional, customer service oriented functions. 

One of those “incoming” sources of demand is the extended web presence being developed by many of my clients.  As the industry standard moves from online brochures to virtual tours and consumer centric transaction processing, more and more support will need to be provided to non-employees.  If I take the time to register as a member of the health system community, and then need help resetting my password to check my lab results, what am I going to do? Who am I going to call?  I can tell you from my personal experience with the airlines that I cannot complete an online transaction without that little head popping up and asking me if I need assistance. 

Healthcare provider organizations have an opportunity to upgrade their capabilities in this area and run the table on improved customer experience.

http://www.infosci-journals.com/downloadPDF/pdf/ITJ3637_U0FCYR8XUf.pdf

From co-locating call centers, to extending web support through agents to “closing the sale” by making sure that the inquiring patient ends up booking the appointment – the opportunities to positively affect growth and efficiency are significant.

I am interested to hear from those of you who have explored this area and considered the enabling technologies including IVR, CTI, CRM, VOIP, and Campaign Management.

On a recent Sunday at church, I was feeling this burden when the light bulb went on – keep it virtual stupid! I have more than 500 contacts on LinkedIn (that and $2 can get me a cup of coffee). I know people in my network who are also members of my parish. Many of them are also busy – but also with lots of contacts – in different professions and industries. Now we are talking… What if we set up a Group on LinkedIn for volunteers who would virtually assist and coach other members of the parish going through job search? 

So the power of Social Media is alive and well in my personal life. I have been amazed at the initial response of individuals to whom I reached out as initial volunteers – no one has declined to participate.  The key is that this group is designed to be virtual. Through email and cell phone conversations and an occasional face to face meeting over a cup of coffee on a Saturday morning, each coach is expecting to be able to manage two concurrent relationships. Based on projected demand, we think we will need 100 coaches. THIS IS COOL. We are working through the logistical details and expect to launch the program in a few weeks. Stay tuned. 

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One of the hot drivers of Web 2.0 in Healthcare is the concept of Social Media. User-generated content and interconnected and interactive web applications have changed where we find information and how we interact with other people. Health Social Media (Health 2.0) uses these new technologies to promote collaboration between patients, caregivers, medical professionals and other stakeholders in health. The following provides examples of various categories of Health Social Media.

Health Social Media

PatientsLikeMe (www.patientslikeme.com)

Daily Strength (www.dailystregth.com)

Sermo (www.sermo.com)

MySpace – CURE DIABETES Group

Health Wickis

FluWiki (www.newfluwiki2.com)

Wikipedia (www.wikipedia.com)

Blogs

DiabetesMine (www.diabetesmine.com)

Prostate-Health (www.prostate-help.org)

WebMD (http://webmd.com/community/blogs)

Health Podcasts

Johns Hopkins (www.hopkinsmedicine.org/mediaII/Podcasts.html)

Podcast Health on HIV/AIDS (www.podcasthealth.com)

Health Video Sharing

icYou (www.icyou.com)

YouTube (http://youtube.com)

As it relates to consumers of health services and patients as a subset of that stakeholder group, expectations for social media interaction with healthcare organizations are being driven up by their experience with other common tools such as Facebook, LinkedIn, YouTube and MySpace. While much of this is a generational trend, we are at or beyond the tipping-point where people of all ages and socio-economic levels are engaging in on-line communities. The time is past where forward-thinking healthcare organizations can write this off as a fad or by concluding that “older people” (traditionally heavy consumers of all types of health services) don’t like to use the computer. While we may not be at the point where we can assume all consumers and patients will opt into electronic communities, we must certainly consider how the notion of community can contribute to marketing plans for strategic service lines.

I look forward to your comments and additional input on various social websites that relate to health and wellness.

This year we’re participating in the Midwest HIMSS Fall Technology Conference where the official theme will be centered around Virtual Healthcare as the show title indicates “Virtual Healthcare: Keeping IT Real.“

HIMSS holds particular value for participants looking to gain insight on healthcare information and management systems from reputable experts. I always value the educated attendees HIMSS offers, from both a networking and thought leadership perspective. That alone typically makes it worth my while. 

This year six Midwest area HIMSS chapters are co-hosting the Fall Technology Conference. The conference has expanded with pre-conference events including the 3rd Annual Midwest Nursing Informatics Symposium, CPHIMS Workshop, and CIO Executive Dinner. Also this year, our own Marc Danziger will be co-presenting with our client, Florida Hospital’s David Oakley on the topic of Social Media in healthcare. The presentation title is “Setting Healthcare Strategy in a Web 2.0 World”.

I know, given the current economic conditions, a potentially crucial 2009 is on the minds of all of us in the healthcare industry. Leveraging proven web 2.0 technologies in healthcare “Healthcare 2.0” to cut waste (we know at least 1/3 of all healthcare costs are waste) has never been more crucial, and will no doubt be a thoroughly discussed issue at this year’s Midwest HIMSS event. There will be many healthcare organizations at the conference not only looking to refine their current business practices, but also because they want to figure out how they can leverage these new processes to immediately cut costs. If you are planning on attending you can register for the Midwest HIMSS conference here. Hope to see you there!

Health Information Exchange (HIE) is a term used to rebrand the collaborative efforts in communities and regions across the country, formerly known as Regional Health Information Organizations (RHIO).   1,2,3… 4 - yes RHIO is a 4 letter word. HIMSS states that there are more than 600 Regional Health Information Organizations (RHIOs) or “RHIO type” projects underway across the country; however, according to a recent eHealth survey, only seven are truly operational.

Why has it taken so long for RHIOs to take off? Think about the challenge of integrating clinical information across your own health system—from owned and affiliated entities with various vendor platforms to the boards of directors and physician practices involved. Now include competitors, payors, pharmacies, commercial labs and individuals. Multiply that challenge by infinity and remove the cogent business case that links the capital investment to realized benefits.

While interoperability is still a future state vision, Health Information Exchange (HIE) is happening now. HIE is easy to understand and apply to your organization because it takes the massive organizational dimension (regional, read multi-entity, inclusive) out of the picture in the near term. Today, proven platforms and vendors exist to assist you in achieving integration of clinical information within your own health system. An HIE solution can make sense for your organization even if you have adopted and implemented a common vendor platform, since HIE solutions serve support clinical information hand offs among independent practices, payors, pharmacies, lab companies and patients.

Technology advances are rapidly affecting the healthcare industry. Mobile technologies are enabling processes with power not long ago reserved for large computers. Better, faster, cheaper and definitely smaller is evident in the amazing technologies being deployed in the medical devices – from smart pumps to implantable defibrillators. Diagnostic equipment too has advanced in capability due to “computer on board”. The technologies of medical devices and information systems are converging.

Convergence in this context creates challenges for those tasked with the maintenance and operations of the technologies. In most organizations, medical devices are maintained by biomedical engineering whereas the computer systems are supported by the information systems department. Who maintains the “computer on board” the new million dollar whatchamacallit? Biomedical professionals are not historically trained to be concerned about interfaces, file back ups and system reliability. Conversely, IT folks don’t like to get too close to things that could harm a patient. I have heard from CIO’s who have been asked to confirm the supportability of a gamma knife (non-invasive surgical instrument used on brain tumors). If the CIO is not the authority, then who is? We’ve come a long way from making sure that payroll got out on Friday.

I’m hearing this issue more and more over the last year: many healthcare organizations spent tens of millions of dollars since Y2K on ERP solutions addressing the needs of “back office” functions such as General Accounting and Finance, H/R, Payroll, and Materials Management. Too often those investments were made in haste to meet the ominous deadline of the new millennium and did not allow time for thoughtful consideration of related process and organizational changes that might have increased the benefits realized from those major investments. Did you consider the advanced capabilities of your system such as Position Control or did you simply celebrate the ability to meet Payroll deadlines in the year 2000? Is your I/T or Finance Department still in the business of generating reports or have you considered what is required to make good information available in a secured environment for self-service?

So now it is 2008 and many organizations are looking at a major upgrade. Staff is spread thin. The end users have not been thrilled with the usability of the system. A system that has now become part of the routine operations. I’m curious, where is the tipping point that causes an organization to consider a renovation in parallel to the next vendor driven upgrade cycle? Any thoughts?