Rein in National Drug Spending

Drug costs now account for about 20% of all healthcare expenditures.

Putting Interoperability on FHIR

This lack of interoperability leads to incorrect diagnoses, ineffective therapeutic plans, and unnecessary and costly duplicate testing.

Predicting the Future: What to Look for in 2016

The role of a prognosticator is to accurately predict the future. We will see how well I have done when December rolls around.

Choosing the “Good Jobs” Strategy

Provider organizations, for the first time, are now forced to choose between a good- or bad jobs strategy, with many leaders unaware of the available options.

Recent Articles:

Putting the Patient in CRM

December 7, 2015 Featured, Health IT No Comments
Putting the Patient in CRM

As the Affordable Care Act expands coverage and high deductible health plans capture more money from consumer pockets, increasing numbers of patients focus on the quality of services received from providers. These services extend beyond patient care to encompass patient experience metrics that are easily judged by the average consumer including respectfulness exhibited by caregivers, pleasantness of facilities, and wait times. Patients with sub-par experiences often post negative comments on one or more social media platforms to express their dissatisfaction. These posts then form the building blocks for a provider’s online reputation.

As patients act more like consumers, provider organizations with poor reputations experience decreased utilization of services which hurts revenue. With margins small and competition increasing for patients, few organizations can afford a decline in patient visits. For providers to survive in this new era of healthcare consumerism, they must learn from the experiences of other industries such as retail and hospitality, and apply those basic approaches to managing their relationship with patient-consumers.

Excerpts from Putting the Patient in CRM. Hitech Answers, August 31, 2015

Photo Courtesy of  Don Guerwitz Photography

Patient Driven Staffing Levels

October 26, 2015 Health IT, PSQH No Comments
Patient Driven Staffing Levels

For more than 50 years, the Boston Ballet entertained audiences around the world with classical dance such as Swan Lake and the Nutcracker. As information technology advanced, the Boston Ballet deployed numerous systems to manage ticketing, payroll and personnel management in an effort to automate processes and lower costs. In spite of these efforts, the budget for the Boston Ballet rose every year leading to progressively higher ticket prices and a greater need for grants and donations. A performance of Swan Lake requires a minimum number of “swans,” soloists and principal dancers. Mikko Nissinen, the current artistic director, cannot progressively reduce the number of dancers to lower costs.

In many ways healthcare is like Mikko’s ballet company. Although information technology can enhance care planning, assist in medication administration and reduce duplicative testing, it cannot replace the people required to deliver care services to patients. Nurses are needed to administer medications, therapists are needed to provide treatments, and physicians are needed to diagnose illnesses and provide treatment plans. On average, hospitals devote close to 70 percent of their budget to labor costs. Until robots replace humans in the delivery of patient care, selection of the proper skill mix and number of nurses remains a significant factor that determines cost in provider organizations.

Excerpts from Patient Driven Staffing Levels. Hitech Answers, July 20, 2015

Photo Courtesy of  Don Guerwitz Photography

Square Peg – Round Hole Problem

October 26, 2015 Health IT, PSQH No Comments
Square Peg – Round Hole Problem

Last summer the physician Congressman Phil Gingrey (GA) held hearings to highlight the unacceptable lack of interoperability among electronic medical record systems. Gingrey said:

“Congress has spent, as we all know, something like $24 billion over the past six years buying products to facilitate interoperability, only to have…closed platforms. Do you believe the federal government and the taxpayers are getting their money’s worth subsidizing products that are supposed to be interoperable, but they’re not?” (Gregg, 2014)

Further in his remarks he referenced a RAND report that cites a lack of interoperability as one reason why EHRs have not yet reached their full potential. He went on to say, “If the June 2014 RAND report is true, we have been subsidizing systems that block information instead of allowing for information transfers, which was never the intent of [the HITECH Act]. … It may be time this committee takes a closer look at the practices of vendor companies in this space, given the possibility that fraud may be perpetrated on the American taxpayer.”

Excerpts from Ending Healthcare’s Square Peg – Round Hole Problem. Becker’s Health IT & CIO Review, July 6, 2015

Photo Courtesy of  Don Guerwitz Photography

Strategic Operational Plans

October 26, 2015 Health IT, PSQH No Comments
Strategic Operational Plans

Standing up in a canoe is hard enough. Standing up in two canoes with one foot in each while traveling through Class 4 rapids is mind-boggling.

Class 4 rapids are defined as “intense, powerful but predictable rapids requiring precise boat handling in turbulent water. In many ways that sounds familiar to the turbulent waters providers try to navigate as they transition from volume-based reimbursement to value-based reimbursement. One small error in the timing of the transition, either too early or too late, could lead to bankruptcy.

In a recent New England Journal of Medicine Perspective article, Michael Porter and Thomas Lee outlined the importance of strategy in remaining viable as healthcare reimbursement models change. They outlined six key areas that provider organization leadership must focus to remain in business. If applied correctly, health information technology can assist leadership in answering each of the questions posed and set organizations on the correct path to achieve success.

Excerpts from Strategic Operational Plans. PSQH, May/June 2015

Photo Courtesy of  Don Guerwitz Photography

Getting Ahead

October 26, 2015 Health IT, PSQH No Comments
Getting Ahead

The recent release of the Meaningful Use Stage 3 guidelines signifies the waning influence of the HITECH Act on the direction of healthcare information technology (HIT). As organizations finalize their implementation of their EMRs, they can finally look ahead to strategies and HIT tools that can help them reap the benefits of the millions of dollars invested in HIT to date. Beyond the resources invested, professionals wonder about their own reputations now that the EMR behemoth is in motion. Will the decisions made under the pressure of HITECH act incentives prove worth it? What will the impact be upon patients? Will I ever get another job?

Although the decisions of the past cannot be changed, realization of near turn trends and opportunities provides a roadmap on where to turn our attention next.

Excerpts from Getting Ahead. PSQH, March/April 2015

Photo Courtesy of  Don Guerwitz Photography

Relationships Matter

October 26, 2015 Health IT, PSQH No Comments
Relationships Matter

Yelp. TripAdvisor. Angie’s List. Healthgrades. No person or organization maintains immunity from scrutiny by consumers. Although reviews can be both uplifting and embarrassing, they surely capture the attention of both the reviewer and the reviewed.

As the Affordable Care Act expands coverage and high deductible health plans capture more money from consumer pockets, increasing numbers of patients focus on the quality of services received from providers. These services extend beyond patient care to encompass patient experience metrics that are easily judged by the average consumer including respectfulness exhibited by caregivers, pleasantness of facilities, and wait times. Patients with sub-par experiences often post negative comments on one or more social media platforms to express their dissatisfaction. These posts then form the building blocks for a provider’s online reputation.

As patients act more like consumers, provider organizations with poor reputations experience decreased utilization of services which hurts revenue and the bottom line. With margins small and competition increasing for patients, few organizations can afford a decline in patient visits.

Excerpts from Patients/Consumers: Relationships Matter. PSQH, January/February 2015

Photo Courtesy of  Don Guerwitz Photography

Still Babbling

Still Babbling

According to the Rand study on interoperability by Garber et al., the rules for meaningful use payments watered down the requirement for interoperability and connectivity: “The practical effect was to promote adoption of existing platforms, rather than encourage the development of interconnected systems.”

Although 20:20 hindsight may seem unfair, the impact of a Meaningful Use strategy that failed to foster true interoperability saddled our health IT infrastructure with high-priced systems that will prove both difficult and expensive to update to full interoperability.

While the opportunity existed to drive innovation and the potential benefits of shared medical information, provider organizations focused on implementing systems to secure incentive payments funded by HITECH. The government committees that promoted the Meaningful Use rules put in place by the Office of the National Coordinator focused on the current state of technology rather than encouraging the development of new capabilities.

Systems designed before HITECH never valued interoperability as a product feature. In fact, the lack of interoperability significantly raised switching costs, something that served the interest of EHR vendors.

In addition, the rush to deploy EHRs after did not allow these systems to include the health information exchange features that facilitate efficient and complete interoperability. Instead, health information exchange and interoperability became future functionality while systems lacking these capabilities became embedded in provider organizations. The difficulty and expense associated with large system upgrades doomed these provider organizations to many years of crippled clinical systems.

Excerpts from Still Babbling about Interoperability. PSQH, January/February 2015

Photo Courtesy of  Don Guerwitz Photography

Think Like a Retailer

October 25, 2015 Health IT, PSQH No Comments
Think Like a Retailer

It is all about the consumer. With more than 68% of the U.S. economy driven by consumer spending, retailers clearly know how to identify and motivate consumers to take action. Techniques and information technology tools utilized by these organizations offer a model for providers to deliver effective population health management.

These approaches include two specific actions: 1) Apply analytics to identify a subset of the population and within it, individuals requiring attention, and 2) Deploy patient engagement activities to continuously influence the behavior of the targeted individuals.

The sophistication of data collection and analytics tools for tracking consumer behavior expanded with technological advancement and broader distribution of consumer technology. As more consumer data became available, the ability to influence behavior became more sophisticated and impactful.

Excerpts from Population Health: Think Like a Retailer. PSQH, November/December 2014

Photo Courtesy of  Don Guerwitz Photography

How to Effectively Choose and Assign Clinical Staff

October 25, 2015 Health IT, PSQH No Comments
How to Effectively Choose and Assign Clinical Staff

On average, hospitals devote close to 60% of their budgets to labor costs with the large majority of those costs associated with nurse staffing. Until robots replace humans in the delivery of patient care, selection of the proper skill mix and number of professionals remains a significant factor that determines cost in provider organizations. Although information technology cannot replace the staff delivering care to patients, it can assist organizations in choosing the best talent available, help develop that talent, and determine the best way to utilize the skills of these professionals. In addition, once the proper employees are chosen, information technology can apply evidence-based workloads to ensure each patient receives all necessary care driven by the correct staffing levels.

Excerpts from How to Effectively Choose and Assign Staff. Systemwide Transformations that Improve Healthcare Quality and Efficiency, Fiercehealthcare eBook, November 2014

Photo Courtesy of  Don Guerwitz Photography

A Symphony of Evidence-based Staffing

October 24, 2015 Health IT, PSQH No Comments
A Symphony of Evidence-based Staffing

For more than 100 years, the Boston Symphony Orchestra (BSO) entertained audiences in Symphony Hall, one of the finest musical halls in the world. As information technology advanced, the BSO deployed numerous systems to manage ticketing, payroll, and personnel management in an effort to automate processes and lower costs. In spite of these efforts, the budget for the BSO rose every year leading to progressively higher ticket prices and a greater need for grants and donations. Like other orchestras around the world, the playing of Beethoven’s Ninth Symphony required a conductor and a minimum number of violinists, cellists, horn players, percussionists, and other musicians. No amount of information technology deployment could reduce the number of people required to play instruments to deliver the music.

In many ways healthcare is like a symphony orchestra. Although information technology can enhance care planning, assist in medication administration, and reduce duplicative testing, it cannot replace the people required to deliver care services to patients. Nurses are needed to administer medications, therapists are needed to provide treatments, and physicians are needed to diagnose illnesses and provide treatment plans.

Excerpts from: A Symphony of Evidence-based Staffing. PSQH, September/October, 2014

Photo Courtesy of  Don Guerwitz Photography

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