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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