Leading Healthcare IT

Managing to Succeed

Susan T. Snedaker

• Publisher: Productivity Press
• Year: 2016
• ISBN:
  9781351722216
• Edition: 1
• Topic: Commerce
• Subtopic: Opérations

Healthcare IT is a complex and rapidly evolving field. Success in this arena requires the ability to create a vision, set a strategy, foster collaboration, develop a plan and execute flawlessly every day. This book provides a clear, concise roadmap for professionals who currently manage, direct or oversee healthcare IT. Through case studies and examples, the author includes highly relevant topics such as delivering and communicating HIT values, managing information security, and connectivity challenges, as well as organizational strategy, alignment and vision of HIT, risk management, performance management and process improvement using Lean methodologies.

Chapter 1

Healthcare Information Technology Overview

Overview

Healthcare information technology (HIT) has quickly become the center of many healthcare organization’s operations. No longer relegated to the backroom or the data center, HIT is now front and center. Being a HIT leader has grown to be an increasingly pivotal role. The challenges we face are new, evolving, and accelerating. This book covers a variety of technology topics related to HIT, but it’s not a technology management book. It also covers topics all managers need to know, but it’s not a management book. Instead, we’re focusing on skills, behaviors, and traits you’ll need to succeed as a leader in HIT. We’re going to review frameworks, structures, tools, and techniques leaders in this field are using today, as well as ideas that are beginning to gain critical mass. We’ll also discuss behaviors and traits that drive success as a leader in IT, particularly in healthcare today. References at the end of each chapter will steer you toward additional resources if you want to take a deeper dive into a particular topic. Ultimately, this is intended to be a reference book, a playbook, filled with highly actionable information and advice that you can use when things get chaotic, when you get stuck, or when the path forward is unclear.

We begin by looking at the current state of HIT. We’re going to briefly discuss current trends to set the context for why we need new leadership skills.

Background

A few decades ago, most healthcare organizations were using paper charts and had rooms full of files—charts, x-ray films, lab results, release of information forms, etc. Some early adopter organizations were using electronic systems for stand-alone functions, but there was no integrated electronic medical record (EMR, sometimes referred to as electronic health record or EHR) nor were there integrated systems delivering data across the organization. Fast-forward to today, most healthcare organizations are running some form of an EMR, many have integrated systems such as radiology information systems (RIS) and laboratory information systems (LIS), and some have secure mobile solutions for their organizations that provide patients access to their own health records and that allow care providers anytime, anywhere access to the EMR and other electronic systems.

From an industry perspective, HIT is still a bit behind the curve compared to other industries like finance or retail (e-commerce, specifically), but the complexity and criticality are unlike just about any other industry. This complexity inhibits rapid change and the sometimes risky adoption of new technologies—whether software, hardware, or infrastructure. When keeping patients safe and enhancing patient care are the ultimate objectives (vs. maximizing profits or selling more products), HIT work needs to be very well thought-out, well reviewed, and well implemented. Unfortunately, that often translates into a slower, more measured pace that lags other industries.

That does not mean, however, that rapid change is impossible. In fact, change accelerators, innovative HIT leaders and their collaborators, are found in many forward-thinking healthcare delivery organizations. These companies are partnering with technology vendors, researchers, data scientists, and other thought leaders to rethink and re-envision the way we provide care. This is widely referred to as transforming healthcare, and we’ll discuss that in detail in Chapter 10.

In today’s healthcare environment, there are many factors that impact healthcare delivery organizations of all types. Consider that a healthcare organization today must

■ Meet federal, state, and local regulations

■ Meet financial objectives to remain viable

■ Be responsive to the health needs of its population

■ Implement medical devices/systems that are often 10 or more years behind from a technology and security perspective

■ Meet meaningful use (MU) requirements

■ Evolve toward a value-based delivery and reimbursement system

■ Interface or interoperate with community providers, state agencies, and federal entities

■ Remain compliant for Joint Commission standards (or other accrediting organizations)

■ Address the technology needs of a wide range of users (BYOD, mobile, cloud)

■ Improve care while reducing length-of-stay (or similar metrics for non-acute care facilities)

■ Prepare for personal medical technology advances

■ Address the needs of an Internet-educated patient population (self-help, self-diagnosis, better informed)

■ Deliver excellent customer service in a variety of areas including clinical care (physicians, nurses, physician assistants, patient care technicians, environmental/janitorial services, food services, facilities services), business office functions, scheduling, communication, social media and more

■ Keep the patient safe and provide quality, compassionate care

■ Stay competitive in a rapidly changing market

That’s a long and varied list of requirements for any organization, and it’s not exhaustive by any means. Each of these requirements typically involves HIT in one form or another.

In talking with managers and directors from a variety of healthcare organizations from around the globe, it is clear there are still many large technology hurdles to overcome. These include the reliance on legacy systems running obsolete operating systems, applications that can barely be supported anymore, managing mobility and data security, and leveraging new technology in innovative ways. These are all challenges facing HIT leaders today. While the pressure is immense, the opportunity to make a positive impact on the way care is delivered and on the lives of the patients we serve is exciting. For these reasons, there’s probably no better place to work in IT today than in healthcare.

The Current State of U.S. Healthcare

It’s important to stay up-to-date on the latest news and trends in healthcare because almost all of them impact your organization. As an IT leader, you need to be aware of the larger environment in which your company operates, and the pressures and drivers that cause the organization to make the decisions it does. Many of these developments end up impacting the work of the IT department.

For the past several years, healthcare providers have been working toward meeting the U.S. government’s MU requirements. Beginning in 2011, the Medicare and Medicaid EHR incentive programs were created to encourage providers to adopt and demonstrate “meaningful use” of certified EHR technology. These incentive programs provided financial payments for organizations who successfully demonstrated MU. This also meant that HIT organizations needed to review MU requirements with clinical leaders to determine the best path forward. (For more on MU, visit the Centers for Medicaid & Medicare website, QR1.3.)

At the same time as working to meet MU standards, organizations also have to figure out how to begin moving from volume-based to value-based reimbursement. Examples of value or quality programs include reducing hospital-acquired conditions, reducing hospital readmissions, and implementing value-based purchasing programs. According to the U.S. government, by 2018, 90% of Medicare payments will be tied directly to quality programs and outcomes (Burwell, 2015, QR1.2). The challenge today is that we’re in a transition state so providers and payers are having to straddle both payment models.

In addition to downward pressure on hospitals and other provider revenues, healthcare purchasers are also looking for ways to reduce costs. The government programs of Medicare and Medicaid are pushing down reimbursements and increasing requirements around outcomes. Many companies across all industries have implemented wellness programs in hopes of simultaneously improving their employees’ health and reducing their costs for healthcare insurance for those employees. Finally, individual consumers are increasingly price-sensitive for insurance premiums through government, employers, or public exchanges. As consumers continue to become more informed about healthcare options, they continue to press for higher quality at a lower cost as well.

This is by no means a comprehensive look at the business of healthcare, but gives you some key data points that should spark some questions. As a HIT leader, are you paying attention to the larger picture? This is the new reality for your organization and its future. It’s what your Board of Directors and your executive team are focusing on and responding to. So, it’s important to be engaged and aware so you can participate in a significant way. These changes have significant IT implications. As a leader, you can rise up to meet the challenge if you’re well informed.

Changing How Healthcare Is Delivered

We just explored the changing landscape of the business of healthcare. Now, let’s look at another dimension, healthcare delivery, which in most cases is disjointed and fragmented. Just about anyone who has had a direct experience with the healthcare system has experienced some form of disconnect somewhere along the continuum of care. From lengthy waits in emergency departments to lack of coordination of care during a hospital stay to confusing discharge summaries to lack of follow-up after an acute care stay, these kinds of gaps and disconnects happen every day to millions of patients. This happens despite most healthcare organizations’ serious commitment to delivering excellent patient care. There is increasing emphasis being placed on continuity of care and population health. If there is such a strong commitment, why do these gaps in care exist? There is a long list of interconnected reasons, but most experts in the industry point to

■ A legacy model of care

■ Increasing acuity (patients are sicker)

■ Complexity of medical device and IT systems

■ Regulations/requirements by payors (including the government) regarding reimbursement policies

■ Changing demographics and social structures (elder parents no longer live with their families, children are more mobile and no longer live near elder relatives, etc.)

■ Aging population

These are just some of the reasons why care is not always smoothly or consistently delivered despite best intentions.

Many organizations are implementing rigorous standards and protocols of work to improve patient care. Many are looking to workflows and standard practices such as Lean to provide a framework for sustainable change (for more on Lean IT, see Chapter 9). Many are also looking to information systems and technologies to assist in the consistent delivery of high-quality care. These efforts thus far have yielded varying levels of success, but they continue to evolve.

The Expanding Scope of HIT

There is an accelerating rate of change in the development and deployment of healthcare-related technologies. The list here is just a sampling of current topics being discussed in this industry. We’ll pick up some of these threads again in Chapter 10.

1. EMR optimization

2. Interoperability

3. Mobility/Internet of Things/personal health devices

4. Medical device management and security

5. Information security and privacy beyond the data center

6. Business intelligence/big data/data analytics/quality reporting

7. Population h...