On March 22nd and 23rd, the Institute for Health Technology Transformation (iHT2) Summit in San Francisco held their seventh annual conference, bringing together local health system executives, health IT vendors and policy pundits.
After two days of panels and workshops addressing a broad range of HIT topics, the final panel, “New Models and Practical Approaches: Developing an IT Strategy for the next stages of Meaningful Use” attempted to tie these disparate topics together from a health system perspective.
Represented on the panel were the San Francisco Department of Public Health, California Pacific Medical Center, Anthem and NorthBay Healthcare, yielding substantial organizational diversity across providers and payers from the private and public sectors.
Despite the panel’s title, the conversation focused less on Meaningful Use and EMR Incentives, instead addressing the perennial challenges of vendor selection, interoperability, resource allocation, return on investment and innovation.
The group was refreshingly candid about the challenges faced by organizations large and small, and seemed committed to progress towards outcomes-focused delivery. Yet as the panel observed, after decades of the healthcare industry systematically eluding technology adoption and innovation, the expectation to build a fully interoperable health IT information system in a handful of years is aggressive to say the least.
Naturally, cost was a major focus for all the stakeholders, given the shift from IT as a perfunctory billing platform to the keystone for clinical decision-making and quality reporting. The panel estimated that health system IT investment would need to increase from its current ~2-3% of annual spend to ~4-5% of expenses, as it is in financial services. The challenge, of course, is that health system margins are somewhat thinner than those of investment banks. Combine that with the fact that efficiencies created from expensive health IT implementations and EHR adoption include a reduction in unnecessary reimbursable procedures, and it’s unsurprising that hospital CFOs have questioned the business case for all this progress.
And yet, the “perfect storm” of the HITECH and PPACA acts has created an environment in which it seems as if every health system initiative depends on the IT department. Panel anecdotes suggested that whether implementing a single end-to-end application (like Kaiser Permanente with Epic) or employing a best of breed approach (like the SF Department of Public Health with bolt-on apps for inpatient, ambulatory and behavioral health), close vendor partnerships can enable the flexibility and functionality that health systems need to meet their planning objectives. As such, the panel observed that vendor transparency about the length of their development cycle and the extent of interoperability within their consolidated product portfolios is critical to maintain good relationships with health systems.
The panelists also predicted that this increased demand for interoperability will slowly drive foundational EMR apps towards commoditization. If the future is an outcomes-focused ecosystem of Accountable Care Organizations (ACOs), then regardless of whether health information exchanges are public utilities or toll roads, the real prize is not data but the meaning mined from all this information. Implied between the panel’s anecdotes was the hope that vendors will focus less on drawing battle lines around their EHR repositories, and more on reinvigorating healthcare with what the tech sector does best: designing tools that enable business intelligence.
Of course, even if competing vendors will interoperate with each other and enable information exchange, health systems still face a laundry list of mission-critical initiatives competing for time and resources. If Meaningful Use, ICD-10 / 5010 conversion, HIPAA compliance, publicly-reported patient satisfaction, EMR use, quality initiatives and the good old delivery of medicine aren’t enough, sufficient facilities infrastructure must also be built to enable technology and process initiatives. As the panel observed, health systems must cultivate first and foremost a core competency of prioritization. Which, let’s face it, is easier said than done. When the panel asked anyone in the audience to raise their hands if they thought their organization was good or very good at prioritization, not a single hand went up.
Acknowledging the challenges of prioritization, the panel suggested focusing on small tasks for which even a week-long micro-experiment could help deliver progress. For example, a single discharge sheet that is the final touch point between the hospital and patient has the potential to be incredibly impactful if well designed, reducing re-admissions and improving the continuity and quality of ambulatory care. But it is not always simple for health systems to focus when they must continuously deliver a full suite of care to a genetically and socioeconomically diverse population.
So what are the metrics that health systems should use, via electronic medical records etc., to identify how to prioritize initiatives? Here the panel offered many talking points but few guiding principles. Fortunately, a question from the audience was raised to the panel about where patients fit into all this strategic planning. The panel’s candid answer was that today patients are not engaged by providers enough, but that health systems need to adapt as patients increasingly become the center of medical homes and ACOs, not to mention the arbiters of their own consumer-driven health plans.
Redesigning bottlenecks of capacity or quality like the discharge sheet with the patient-as-customer in mind is the best way to create long term value for health systems in the future world of information liberation. It is the delivery of this value to the market – or the threat of competitors delivering it first – that may help convince even the most frugal CFOs of the business case for building tomorrow’s intelligent health system.
Stuart Kamin
MBA/MPH Candidate 2012
Haas School of Business
University of California, Berkeley
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