Tuesday, 13 December 2016 19:40

Health IT in Challenging Times Featured

Written by Larry Wolf, Strategic Health Network

We have just experienced a heated presidential election featuring uncertainty about what will happen next. Beyond this change in the president and a new Congress, healthcare is in the midst of a decades-long shift from fees for service to payment for value. There are both short-term and long-term unknowns.

In times of uncertainty, focus on basics, make good use of what you have, and prepare for growth in the future. Don’t let the hype and the rapid news cycle distract you from what you and your organization need to succeed.

Regardless of the specific payment model, delivering high value is necessary for success. Value is a combination of quality outcomes and the costs necessary to deliver those outcomes. Used well, healthcare IT can help with both.

This article will focus on three areas where a healthcare provider can take action given the uncertainties:

  • Provide quality care and demonstrate it with quality measures
  • Make small adjustments and build on existing capabilities

Provide Quality Care and Demonstrate It with Quality Measures

There are a large number of quality measures. They are developed by professional associations, researchers, and individual providers, and are the result of a rigorous testing process. Many are National Quality Forum (NQF)-endorsed and used in payment programs (learn more online at www.qualityforum.org).

Selecting the quality measures that are right for you and your organization is a process that encompasses two demands: external requirements from other providers, care coordinators, payors, and regulators, plus internal requirements to run your organization and improve care. Know how the outside world assesses your performance and pay heed to what is needed for compliance.

There are many questions to ask in selecting and using quality data. Do the measures offer a full view of the quality provided? Are there areas where you can focus on a few measures that are representative of the larger set you have to collect? How do you measure these outcomes? How do you collect and analyze the data? How do you share it with staff and outside partners? Can you drill into the underlying data? Group it by patient and provider characteristics? Find actionable patterns? How do you act on the measures as part of the care process? Can you use the measures to understand the underlying processes, to learn about the patients and the providers? How can each interaction with a patient lead to better outcomes? What individual risks need to be addressed? What aspects of a care plan need follow-up?

Make Small Adjustments and Build on Existing Capabilities

We are in a period of unprecedented investment in healthcare IT (read more on acute-care hospital adoption at https://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-EHR-Adoption.php and physician practice adoption at https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php). Many providers have implemented systems to meet the Health Information Technology for Economic and Clinical Health (HITECH) Act incentives program. Now it’s time to get real value from that investment.

As with almost all software, getting the system up and running is just the beginning. Once the technology is in place and users have made it through the first year or so of use, it’s time to revisit what was done and look at where small adjustments can make a big difference. Look for the activities that are the most painful, and engage your users. Are some more successful than others? What can they teach the others? There are often multiple ways to accomplish a task. Each approach may have tradeoffs in the workflow, the number of steps, or the ability to reuse information. Assess the tradeoffs in the different approaches. Also look to your vendor for training materials and for system upgrades that might address your pain points.

Before you consider major changes, look for incremental adjustments, as these will often provide the most value. It is not unusual for bad habits to be learned during initial training. With the focus on getting the job done, this is the right place to start. However, when all the systems are up and running, it’s time to revisit the details of how the systems are used. Small adjustments are the least disruptive to workflow, require the least amount of retraining, and can be further refined over time.

Beyond adjustments in using the software, look at capabilities that exist in what you already have, but may not be using properly or using fully. Initial implementation tends to focus on “getting data in” and not how that data can be used effectively by the individual provider or by the organization. The real value from the software will come from building on these unused or underused capabilities. This can range from documenting care and writing orders to how billing is done and how the performance of the organization is reviewed. 

Furthermore, look at how you communicate with other providers and the tools you use to coordinate care. This is an area where the certified electronic health records (EHRs) offer capabilities that may have been implemented to meet the minimum necessary for the meaningful use program. Some small adjustments in what you send, or what others send you, could make a big difference in the usability of the information. Given the difference in timing of when different providers implemented their systems, they may have made choices that should be revisited, given that other providers now have increased capabilities.

In Conclusion

By focusing on basics, you can have a base to build on for the changes that will come. This is a good time to reflect on what’s working, where small changes would make a difference, and to learn how the technology you’ve invested in can deliver more for you. It’s a good way to use a time of uncertainty to be ready for the future.

About the Author

Larry Wolf is Principal at Strategic Health Network, a health policy advisory service. Larry has forty years of experience in health IT with an emphasis on clinical systems across a wide spectrum of care settings. Larry has a strong foundation in the development of clinical systems and a track record of strategic use of data. He is exceptionally able to work across traditional boundaries, bridging the technical, clinical and business worlds; ambulatory care, acute care, postacute care and longterm support services. He builds consensus and shared vision, even among the conflicting positions of members of Federal workgroups.  Larry is a national leader using health IT to improve care coordination. He is a member of the Federal Health IT Standards Committee and chair of the HIMSS Public Policy Committee. He is an organizer of the annual LongTerm/PostAcute Care Health IT Summit and an author of the biannual LTPAC HIT Roadmap. He provides advisory services on strategic direction and information systems architecture.

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Last modified on Wednesday, 14 December 2016 23:12