In understanding use of the ARRA by the Office of the National Coordinator and Certification Commission for Health Information Technology to fuel healthcare reform, it’s clear the goal is to build a foundation for future advancements in the tools and knowledge available to providers that will allow for improvements in healthcare and clinical efficiency. What’s not clear is exactly what mechanisms will be used, for future enhancements, to further the reform and what incentives might be used to encourage it. While this is fairly well understood in the medical community, the opportunity to also dramatically improve the business of healthcare is often missed. It’s important to realize that not all these types of changes are required for meaningful use and therefore does not have to be implemented immediately, they should be planned for to prevent re-development at a later time.
Clinical vs Business Outcomes – Currently the focus of incentives is to encourage providers to demonstrate they use their EHR according to requirements commonly known as “Meaningful Use” in clinical outcomes; but what about providers’ business outcomes? Incentives are directly tied to being able to define, track, monitor and report clinical outcomes. The incentives don’t include or recommend certain business requirements necessary for a sustainable business model, without which any number of possible breakdowns could severely hinder the organizations operations. “Operational Integration” is a necessary and critical evil that shouldn’t be avoided. While it was never the mandate of the CCHIT or the ONC to deliver “Best Practices” or business incentives – the main focus has been achieving meaningful use in clinical areas—but should it have been?
Health Care Strategies – In order to deliver the most effective and efficient services, healthcare providers will need to have an integrated business strategy. What does this mean? To be honest, the answers are relative to the type, size and makeup of each provider organization. For example, in local community based hospitals, there is not the skill level and operational capacity for a lot of advanced ‘Best Practices,’ as with Academic organization, so their solutions will need to fit what they are capable of accomplishing. When does it make sense to plan for and incorporate an ERP solution and how does that impact initial development? When is it important to look at the makeup and resources in the organization to determine what system and business processes would be most effective?
Understand who you are – As a healthcare provider, it can be tempting to look at systems implemented by other organizations and model your own based on their successes. However, I’ve found during my 17 years in the healthcare industry that success for an organization is based on the set of uncommon denominators they’re working with. While borrowing good ideas from other organizations can be helpful, it’s important to understand it takes careful planning and a strong understanding of your organization and culture, to successfully implement a healthcare delivery system. Every system is unique and should be treated accordingly.
Paper is paper, electronic is not – Moving to Electronic Health Records (EHR/EMR) is just one aspect of improving healthcare. By incorporating the new standards and being able to achieve outcomes, as defined in “Meaningful Use,” we are providing a foundation to improve the delivery of care. Providers need to look ahead and plan how these newly available tools can impact their diagnostic and remediation therapies, as well as their care plans. Examining the effectiveness of diagnostic practices, comparing outcomes with other organizations and implementing business operation and process changes will all allow you to improve care while staying flexible for future trends and tools in the market.
Security is no longer a wall – In the not too distant past, security was thought of as a wall similar to those surrounding the castles of medieval times. With cloud computing, the concept of a closed environment is gone and as a result, security has become a multi-dimensional issue, as HIPPA requirements, third-party integration concerns, new Healthcare Information Exchanges and affiliated practices all create a range of requirements that must be addressed. Security concerns will be furthered as new functionalities and interoperability of delivery systems come on-line. Security, to be effective, needs to be developed and integrated at the corporate level. The importance of security and privacy need to be recognized at the corporate level, just as the role of information has been acknowledged through the rise of the CIO. While many organizations will lump security into their IT practice, it deserves to be treated as a separate entity with governance over all security concerns, including information systems, medical records and registration. In effect, it should be a stakeholder in any Project Management Office (PMO) initiatives.
Enterprise Change Management – Healthcare providers should be encouraged to become lean in business, in addition to diagnostic and therapeutic services. If you or your organization consider’s EHR’s and system implementations as an IT project, your chance of success is dramatically diminished. Success defined as sustainable business model, as well as, achieving ‘Meaningful Use’ and improving clinical outcomes. Providers need to be certain to tie every service, process and product to the appropriate charge. To manage these resources appropriately, it’s important the right tools are in place. Studies have shown that access to better tools, experience and knowledge help providers become more efficient.
While the stimulus program is encouraging and paving the way for providers to become electronic and to attain minimal (electronically documented) requirements, future incentives may also come from competitive motives. All providers should know the future of healthcare will be different. Competition from growing provider practices and health systems will contract to fewer, larger systems that can disperse efficient and effective diagnostic and therapeutic medical services at lower costs. This precedent is fueled by natural market growth tendencies, as well as declining economic factors, which if anything has changed society to be cost conscience in everything, especially medical care. The days of the ‘local’ doctor are coming to an end, the future will be full of choices, options and hopefully, better informed decisions by everyone.