Healthcare Economy

In my first blog on Meaningful Use (MU), I had identified business process optimization and redesign to facilitate data collection/data quality management for MU as one of the key ingredient for Healthcare Enterprise Performance Management approach towards MU compliance. On delving deeper into the final rule for Meaningful Use, it is emerging that business process redesign will be one of the fundamental requirements for achieving Meaningful Use and more precisely for reporting on Meaningful Use measures.

Getting ready for Meaningful Use will require more than certified EHR and MU reporting solution. Business Process Redesign will be an integral part of it as it is essential for data collection for MU reporting. For example, the MU measure regarding use of CPOE for medication requires that more than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE . For providers who are planning a gradual EMR adoption may not target 100% CPOE usage and may plan for achieving minimum MU compliance threshold. How will they ensure that 30% of the unique patients have at least one medication order made using CPOE? Providers can adopt one of the various possible strategies for achieving compliance. Hospitals can identify departments that together account for a little over 30% of their patients and mandate CPOE usage in these departments. Another strategy could be to identify the set of medications that gets prescribed to over 30% of the patients and it can be mandated to order these medications electronically. Both these approaches here require a change in the process followed by certain departments or for certain medications.  Most of the MU compliance measures that have a compliance threshold defined will require some kind of policy or process changes by providers who are taking minimalistic approach to MU compliance.

Clinical Quality MU measures do not have a threshold level for compliance but the complexity lies in identifying inclusions and exclusions for reporting on these measures. CSC Report on Hidden Requirements for Meaningful Use  illustrates with an example that the data elements required to identify inclusions, exclusions and measure outcomes for Meaningful Use are significantly more than one may think initially. Even for providers that are not new to use of EMRs, a lot of these data elements are not getting captured in EMR. The data elements required are spread over several systems like Registration, CPOE, ER system, Laboratory Information System, Pharmacy Information System etc and some data is available in paper format only.  To ensure that all the data elements required for MU reporting are captured electronically, some process changes may be required. For collecting all the data elements required for reporting, optimal data flow path needs to be identified which may lead to further change in processes. Not all the old ways of doing things can align with what MU reporting necessitates and providers have to be flexible and agile in optimizing their processes for MU. Business process redesign can only be successful if physicians and staff transition to different way of doing things seamlessly. This brings us to the whole aspect of change management which I will discuss in my next blog.

Posted by Seema Pandey at 10:48 AM | Permalink | Comments (0) | TrackBacks (0)

I've heard it all about Meaningful Use; well, almost.  So many attitudes.  We're a level 6/7 HIMSS hospital, so we're covered and don't have to do much; We don't really care much about Meaningful Use - we'll just figure out how to minimize the penalties; We need the incentive money badly so we're going to do whatever it takes, but we don't know what that is yet exactly; and more.  Single platform hospitals probably have it the easiest job of reporting if the vendors deliver, which they probably will.  But what about the best-of-breed hospital system?  A whole new reporting infrastructure might be required. 

But what I have yet to hear is an attitude that expresses excitement about using the Meaningful Use framework to finally implement a modern performance management paradigm that proactively manages day-to-day activites to achieve a new level of enterprise performance?  Why?  Most large industries are expert at this.  Meaningful Use provides the carrot, or the stick, for hospital execs to take the plunge and start the journey towards meaningful performance management. 

Some hospitals are trying, typically the larger, more advanced systems, but there is no reason for everyone in our industry to use Meaningful Use as the catalyst for a wholesale shift forwards from transaction management to performance management.  The analyst community, particularly Gartner, is actively promoting the concept as well as some think-tanks, like the Center for Healthcare Informatics and Decision Support (CHIDS).  Gartner calls it Integrated Clinical/Financial Advanced Analytics.  Infosys calls it Enterprise Performance management.  Whatever you want to call it, now is the time to start.  If you have any involvement with the Meaningful Use initiative in your hospital, I encourage you to lead from the front and use Meaningful Use to champion the cause for proactive performance management.  There never has been a better time.  Look forward to continue this discussion.

Posted by Mark Brownlee at 10:45 AM | Permalink | Comments (0) | TrackBacks (0)

I am deviating a bit here from my previous blogs. Having read through vaious articles on meaningful use, it appears to me that the context of healthcare reform has shifted from implementing  EHR technology to Implementing "Meaningful Use" , as definition it is a fact.

Although the ARRA MU mandates have taken care of all the pertinent provisions for the security, privacy  and certification of the EHR technology products,the mandates  stresses more on the compliance part of the measures and not on the implementation of EHR technology across various care settings.

This may impact a large part of the provider and various care settings with operational and clinical productivity loss.Also it appears that EHR shall be deployed only because the providers have to implement it to achieve the MU mandates for the incentives, but not actually using the same for the patient and operational benefits.
The very fact of bearing the penalties in case of non-compliance will push the providers (IPA, individual physicians and Hospitals) to use the EHR, first to the measures of stage 1 incentives and then to  stage 2 and stage 3. Thus the bigger implication of improving clinical outcomes and reducing healthcare costs is mostly forgotton.

The vendors seem to design, realign the product to the certification needs (which will have the core requirements to the clinical delivery),but might miss out on aspects that actually will benefit the providers and the patients. The vendors may emulate the product in accordance with the MU stage 1 mandates without considering the clinical workflows, or changes to ICD-10 and other future reglatory changes.The EHRs should not be a mere reporting engine but an instrument to manage clinical delivery of a provider system.If not implemented appropriately, the MU mandates, pushing to reduce healthcare cost and improve clinical outcomes, might actually end up burdening the entire provider delivery system.

Providers will need to look "beyond compliance" and not just aligning to the MU mandates for reporting core CMS measures. It is not about questioning the MU initiative, which is the most suitable way of deploying EHR technology across the care settings, but putting a perspective on appropriate EHR technology implementation!

Posted by Shishir Kumar at 10:28 AM | Permalink | Comments (0) | TrackBacks (0)

Last week I was talking to someone in the business operations of a healthcare payer organization about healthcare reform and its implications on technology investments and strategy. He said that - the bill will force all the healthcare organizations to expedite their efforts in becoming nimble and agile. Rise of consumerism and increasing cost of healthcare has forced the healthcare organizations to become more agile for last few years; this bill (PPACA) has just put a time cap around it.

I have spent almost 11 years doing business technology consulting for various clients in the healthcare payer industry. The Technology architecture of most of these organizations has mirrored the traditional Groups oriented business model. The model started changing a couple of years ago with the rise of consumerism through products like CDHP and value based products. The traditional business model (except individual or small group business) for most of the payers was based on a large captive membership through Groups or employers. The entire business process or value chain from customer acquisition, sales, product, underwriting, plan, membership, claims, re-imbursement, and EOB/COB/ERA was designed to support these large employer groups. The underlying premise or principal for the IT architecture was to view GROUPS at the center of all processes and enable business processes to enable the services and support for the Groups. A typical Large Group varies anywhere from 50 to 3000(or more for large national accounts).  This predominantly Groups oriented IT architecture led to an IT architecture that is designed to address a group of people rather than individual members. The pressure to implement date driven mandates resulted into product and benefits information permeating into all the downstream systems like member, claims, providers etc.   

The term - Product or Plan in Healthcare payer context is used interchangeably. When a product is sold to a Group, a number of variants of the product are created within the systems of the payer organizations. These variants are based on the factors like geography of the members, benefits chosen by the members, state and federal level mandates etc. These variants are eventually used to process the claims filed by the providers for the services rendered to the members. Over the years changing mandates and closed coupling of products and benefits domain with the core claims systems has created a highly monolithic set of system.

As Healthcare reform gets implemented and the health care exchanges force the fundamental shift from Groups to Individual consumers, there will be a greater need for product standardization and externalization. There will be an increased effort to de-couple the product systems with the other systems especially claims adjudication systems in the payer ecosystem.  I do not foresee a reduction in the number of products offered by the payer organization rather there would be greater need for highly customized products based on Value based design and the need to provide benefits customization flexibility directly to consumers.  The need for analytics at product level will also drive a unified single view of products across the complete value chain.

The payer organizations have to clearly de-couple and externalize the way product information is stored and used by its claims and other downstream systems.  The HC industry can take some ideas from other retail or P&C insurance companies who have been dealing with individual consumers for lot longer and have developed more agile technologies in product domain.  As product implementations become more standardized, BPM technologies may also take a prominent role in giving the control of managing the products in the hands of business folks.

Posted by Amit Shukla at 1:37 PM | Permalink | Comments (0) | TrackBacks (0)

It's now time for the hospitals and physicians to chalk out the roadmap for embracing the meaningful use and set the ball rolling for transforming the way IT is leveraged in healthcare.  I would like to highlight 3 key points in this blog -  Need for a long term strategic approach, Effective change management and leveraging HPM.

1.Hospitals should take a long term strategic approach while implementing the EHR and look beyond the MU incentive/penalty avoidance. Meeting requirements of each stages of meaningful requirement will provide short term tactical returns in the form of incentive dollars and penalty avoidance. However, this is also the time to look at the long term goals the hospitals have in terms of improving operational efficiency, quality of care and patient safety, and identify opportunities to move forward to some of those goals using MU journey as a catalyst for change. For example, there is a mandatory MU requirement to develop capability to exchange key clinical information among providers of care and patient authorized entities. A hospital may already have a roadmap to implement seamless exchange of data among different departments. This could be an opportunity for the hospital to develop and implement a solution to interchange clinical data internally as well as with external entities. By reevaluating the ROI of some transformational IT initiatives in the hospitals, in the context of MU and the overarching HIT direction, opportunities can be identified to realize greater value by combining some of the transformational programs with MU related programs. 

2.A focused change management effort is required to accelerate adoption of EMR. It should also address the key concerns of the physician community around learning, productivity and ease of use. Even the most successful technical implementation of EMR may fail at achieving the program goal, in absence of a clear change management and adoption strategy. Given the magnitude of the change and the number of users affected, engaging external vendors having learning and adoption solution may be a good idea to stay ahead of the curve.

3.To manage and improve the clinical, operational and financial performance of the hospital on a continuous basis, hospitals should take an enterprise approach to Hospital performance management (HPM). HPM systems need to be in place for tracking and reporting on MU requirements because the data for reports will not be available in a single system. Apart from the EHR, data needs to be pulled in from different sources. HPM will provide a single system to track all the metrics, irrespective the source of the underlying measures.   Therefore it is imperative that, apart from investing in EHR and other transactional systems to capture data, hospitals start building a foundation for HPM. Initially it can address the MU reporting requirements, with further releases to address other key financial, operational and clinical quality metrics. While blueprinting and selecting the HPM solution, due considerations should be given to the capabilities for interoperability, data analytics and customizable dashboards, workflow and real time alerting, mobility, configurability and user and security management. This will ensure that investment made on meaningful use provides return which goes beyond the incentive and penalty and spurs further IT driven initiatives for sustained improvements in all aspects of hospital performance, patient safety and quality of care.

Posted by Jayanta Ghosh at 10:44 AM | Permalink | Comments (0) | TrackBacks (0)

With recent finalization of the ARRA, I see the providers have geared up to tap the promised $27 billion. No-wonder the focus for them today is only and only "Meaningful Usage". Trust me; if one does a simple googling for "Meaningful Use," over million hits shows that the race has already begun for the giant leap. These are encouraging signs....US healthcare has started thinking BIG. But, yes I mean -there is a but. When the existing challenges of patient safety, clinical quality assurance and escalating cost are still the stumbling blocks in the wheel of care services; can providers really become this shortsighted to just achieve the meaningful usage benchmarks and run the show? I guess, the answer should be No. Achieving meaningful use can only be an initiation of their reform journey, not the destination. This however doesn't mean that Providers should overlook their immediate milestone and start looking at the horizon. After all, one won't be able to make the big, if he doesn't start in small.

When the reform guarantees the change in role of the government, moving from being a passive to a more active purchaser and providers are ensured to earn increased reimbursement based on outcomes, quality and patient satisfaction- I honestly see, Dr. Blumenthal's directives promising the foundation stone for the reform. An active initiative which can surely break the silos through semantic interoperability, detailed clinical communication; standardize the clinical practices; aids efficient decision making can really actualize the dream US healthcare delivery model- an efficient, quality rich care services at affordable cost with integrity of privacy & security. Precisely, "Meaningful Usage" is a real start of this US healthcare reform marathon, a catalyst to extend the reform momentum much farther to achieve an exceptional level of healthcare performance much beyond the set "meaningful use" goals.

So as I stop today: Let's ensure that the vision for reforming a healthcare system already paralyzed with myriads of challenges cannot simply happen with one bill. There must be persistent aim for excellence and not complacence through just one "Meaningful usage" compliance. US healthcare has miles to go....

Posted by Dr Suman De at 10:37 AM | Permalink | Comments (0) | TrackBacks (0)