Pressures to create more value in healthcare is steering providers toward clinical integration. This will undoubtedly improve transitions of care, clinical visibility across patient encounters, the patient experience and, ultimately, care outcomes and costs—but not without a well-planned and -funded IT infrastructure.
Since healthcare organizations have been busy of late installing multi-million dollar EHR systems, now more than ever they need to become more strategic about the initiatives they tackle and where they direct their resources. And they must do it amidst an unusually disruptive election cycle that could well end in a whole new round of regulatory upheavals. The good news is that focused leadership and a strong IT plan can help providers weather through the uncertainties to quickly achieve a higher order of clinical integration. Here are five "must-do" steps:
1. Define what you want to achieve and get it ratified by the board. Once your leadership team has established a strategy for becoming a clinically integrated organization, identify a leader to head up the program and establish clear goals for the IT department. Too often, the tendency is to act off an ad hoc list of IT projects. Start at the end with what you hope to achieve, setting goals the board as well as senior and clinical leaders agree to support—and link them to specific results.
For example, a goal of reducing the cost of duplicative imaging tests would be paired with metrics that quantify the fewer number of tests and associated savings. Alternatively, you may want to focus on improving efficiency and enhancing the patient experience by enabling patients to fill out paperwork one time and making that information available to providers across the system. Measure what you want to achieve—e.g., the proportion of chronic disease patients completing paperwork by a set date via a health portal.
2. Rank integration goals from highest to lowest impact. Achieving clinical integration is a multi-step process that can take several years, meaning you'll need to prioritize which projects get done first based on the return they offer your organization. Evaluate the necessity of each project under consideration: Will it bring about better care outcomes or an improved patient experience? How, if at all, will that improve your facility's market position and financials? Spending $1 million to develop a local health information exchange that doesn't link your entire clinical network or standardize data would logically fall much lower on the priority list than projects that optimize an electronic medical record to provide a better physician experience or improve patient access (e.g., healthcare portals and mobile device applications). Make sure the board, leadership and IT teams are directionally aligned and have a standard process for achieving your selected objectives.
3. Develop an IT business plan. To succeed at clinical integration, you'll need a comprehensive technology roadmap. This business plan should describe in detail how you will achieve all objectives that involve IT focusing on electronic health record (EHR) systems, legacy systems, interoperability, data analytics and consumer-based applications.
The efforts of most hospitals begin and end with the implementation of an EHR system. While this is a great starting point for collecting transactional data, your plan also needs to address how you will mine data to create better evidence-based protocols and improve care coordination for patients. For this higher level functionality, the EHR must be properly optimized. Clinical integration also requires looking at the patient care experience beyond the purview of an EHR, including primary care and specialty practices, imaging centers, surgery centers and urgent care to ensure clinicians in those settings are also accessing the most up-to-date information possible—including analytics and benchmarking data.
Since healthcare data plays a pivotal role in clinical integration, your IT business plan should address how the information will be stored. Consider removing all legacy systems after your EHR installation is complete and move the data to a searchable archive for convenience and to reduce software maintenance.
If yours is like most healthcare organizations, it probably does not even know if current IT systems are collecting data that is useful to improving patient care, the patient experience or hospital goals. Stronger data platforms will be a requirement as clinical integration plans evolve and payments become increasingly tied to patient outcomes. The Holy Grail—having the metrics, predictive analytics and comprehensive patient information together at the point of care—is what enables clinicians to provide the best possible care.
4. Align IT resources for maximum impact. There is a growing disconnect between hospital leadership and IT departments when it comes to determining the number of hours, expertise and complexities involved in creating health information technology necessary for true clinical integration. IT departments are now managing EHR systems in new settings—including ambulatory care, surgery centers, urgent care, rehabilitation hospitals, imaging centers and long-term care facilities—which in many cases stretch the limits of internal skills sets and resources.
Consider bringing on a healthcare IT partner for operational support and to offload some of the work. If it offers a shared services model, all the better, as this will enable you to outsource EHR and IT support (e.g., network, reporting and data center) to gain expertise and economies of scale while allowing your local team to focus on strategic initiatives. Ideally you can also leverage your IT partner to fill gaps in skill or bandwidth for security audits, EHR optimization, and business intelligence and regulatory compliance projects.
5. Create governance standards. It's important to think and act proactively on clinical integration. Start at the executive leadership level and create a governance structure and standards for managing the IT process and monitoring results. This may require bringing in project management, strategic consulting capabilities, and deploying a Lean or Six Sigma methodology. Taking the time to set this up will minimize operational disruptions.
Finally ... Keep your IT plan singularly focused on driving high-quality outcomes. The culture of your IT organization will need to become more patient- and consumer-centered, so every investment in systems to improve workflow and care processes is money well spent.
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