When we looked at the state of HIT, business intelligence and performance management in a supplemental report one year ago, we noticed a few themes that came up consistently among providers. First and foremost was a long-term commitment to electronic health records. Another distinct trend saw many large provider organizations and some smaller ones moving to standardize on multiapplication software platforms to provide as much functionality across departments as possible. Finally, there was an industrywide push to integrate information records systems of large institutions with owned or affiliated care facilities, such as ambulatory care groups and other clinical practices.
And one year ago, the health care industry’s use of analytics and the penetration of business intelligence and performance management of the type needed to optimize operations and respond to performance benchmarks were widely lacking or mostly limited to academic or research institutions. Despite the urgency of timelines, much of that snapshot holds a year later. “I’d probably be worried if these issues had shown up and disappeared, because that would mean they were fads and not substantial change,” says John Glaser, the newly minted CEO of the Health Services Business Unit at Siemens. Glaser formerly served as CIO at Partners HealthCare and as an HIT advisor to the Obama administration.
If there is good news, Glaser says, it is that most organizations that have invested in HIT will be able to extend and leverage those investments to support requirements for meaningful use and other mandates.
And that in turn should jump-start the industry’s use of business intelligence and analytics, since the end-game of federal incentives is to create a nationwide care delivery system driven by data-supported best practices that deliver the highest quality care for the lowest possible costs.
Managing the Mix
Near-term IT focus is concentrated on the first stage of deadlines for meaningful use of EHRs. The federal government plans in May 2011 to start sending out incentive checks to providers that document meaningful EHR use. Over the course of the incentive program authorized under the HITECH Act (part of the massive American Reinvestment and Recovery Act of 2009) a typical 200-bed hospital could qualify for up $6 million in incentives, based on the number of annual discharges; physician practices could qualify for more than $40,000 per physician.
With that kind of money on the table, provider organizations are understandably rearranging their IT priorities. The 2010 HIMSS Leadership Survey, released before MU rules were finalized in July, found that 59 percent of health care IT professionals were already making additional investments to position themselves to qualify for meaningful use incentives.
For the mid- to long-term perspective, the ongoing challenge will be managing IT project portfolios and a course of specific timelines. “CIOs are all over meaningful use and the CEOs want their [incentive] dollars, but the C-suite is probably more concerned in the long haul with payment reform, accountable care organizations and cost pressures,” says Glaser, ticking off initiatives authorized by the other game-changing health care legislation, the Affordable Care Act.
“With effects of the capital market implosion still lingering, capital is tight and the bar keeps getting higher. All of this says we’ve got to do EHRs for meaningful use, but perhaps more importantly for payment reform and accountable care organizations.”
The themes this year are to keep a broad focus while measuring the impact of deadlines that might be missed, and a strong distaste for projects that exceed their budget or timeframe.
“We certainly have significant requirements arriving as result of the HITECH Act covering meaningful use and the other ARRA incentives,” says Michael Mytych, principal at Health Information Consulting, LLC. “But there are other major developments in payers and employers wanting to buy health care services on a pay-for performance basis, and the federal government’s health care reform. There is a tremendous amount of activity and planning in different areas going on all at once.”
Marc Holland, principal consultant at System Research Services, says the nature of these projects is “far more extensive and expensive” than what the government will pay to practices or institutions in incentives and support. “But we are looking at the same kinds of challenges as last year with an emphasis on IT adoption – and electronic health records remain the No. 1 priority.”
Analysts including Forrester Research’s Boris Evelson say all industries need to pursue IT strategies that mix bottom-up data projects involving massive amounts of data with a top-down, targeted approach to business intelligence in which metrics play a key part.
The bottom-up strategy has a lot of obvious issues in time, cost and complexity, Evelson says. “And in a top-down approach we talk about starting with your strategies and goals and objectives and then deciding what sort of metrics you’re going to need to support them.” The top-down approach comes with its own challenges as organizations that take time to define metrics may come to realize they don’t have supporting data to populate and calculate them, he adds.
Observers seem to agree that the best practice is probably a mix of approaches.
And generally, the combination of ongoing investment in foundational, transactional EHR information and fact that health care is or has already targeted many performance metrics that link to incentives and funding are already deciding this portfolio.
If technology is a challenge, a greater shock to the health care system will arrive in the form of culture and process change. In contrast to the seemingly smooth admission and treatment processes in medical facilities, information processes remain repetitive, underassigned and relatively uncoordinated.