Lessons Learned on Making Health IT Investments

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"With health IT, there's a lot more that's promised than becomes reality," says Phillip L. Polakoff, MD, the senior managing director and chief medical executive of FTI Consulting, a global consulting firm. "And it's a major issue people in the industry are trying to address."

Dr. Polakoff, along with FTI Consulting Director Chris Carson, recently compiled insights into health IT investment best practices gained from working with healthcare clients. "A lot of what we've heard people say is, 'We learned the hard way,'" says Mr. Carson. "We've also learned healthcare people aren't too proud to listen to what other people have done and learn from it."

For most hospitals and health systems, many IT projects require hiring a vendor or outsourcing. Some of the larger systems may have their own IT infrastructure, but they're an exception, not the rule, says Dr. Polakoff. Many hospitals will contract out at least some of their IT infrastructure needs surrounding different objectives.

Based on lessons learned at other hospitals and health systems, Dr. Polakoff and Mr. Carson offer suggestions on vendor selection for five much-needed IT systems.

1. Population health. One of the biggest challenges in selecting a population health management system is ensuring it is interoperable with a hospital's existing systems. The number of vendors with population health products has grown rapidly, from large companies like Epic to smaller, niche players, says Mr. Carson.

The right vendor for the hospital may not be the one with the most advanced and intricate solution. "Some health systems say they need the absolute 'best of breed' solution," says Mr. Carson. "These health systems are the ones that put themselves at risk of not having that interoperability and having to purchase other systems." He recommends looking for a system with demonstrated interoperability with the hospital or health system's existing systems.

2. Data warehouse. A data warehouse stores and integrates data from disparate clinical, operational, financial and patient-derived systems. Not all hospitals and health systems have or are pursuing data warehouse services — but they should be, says Mr. Carson. Contracting out to a third party often means "when it's time to move in a different direction with a new vendor, the hospital no longer has access to the data or has to pay a high ransom," he says.

Owning data is important, but using it wisely is more important. "There's often a major gap between clinical and administrative data," says Dr. Polakoff, and often organizations are working off retrospective clinical data when real-time data is available through a hospital's electronic medical record system. A data warehouse should work with both an organization's existing IT infrastructure as well as its goals for data-mining. "We need to think about what the real data is we're getting and how we're using it," he says.

3. Disease registry and care management. Disease registries and care management systems can greatly improve patient care if integrated into the hospital's existing systems, and they can cause broken workflows and inefficiencies if not, according to the report. And in the new age of healthcare reform, the right system can greatly assist in disease reporting requirements as well as providing the new standard of care. "These systems help ensure we have the data we need," to provide the best care, says Dr. Polakoff.

"Again, this is about taking data and making it useful," says Mr. Carson, whether by a hospital looking to track population health or by government health officials. "It's about managing a population, on any scale, and managing the risk."

4. Health information exchange. "There's more than 100 vendors out there offering some kind of HIE solution," says Mr. Carson. To help choose between vendors, Mr. Carson recommends looking to state HIEs. "They're the ones doing the heavy lifting" with HIEs, he says. "It's key to understand what the vendors working with those states have done and what we can learn from it."

5. Patient engagement. "Patient engagement is still a rather elusive topic," says Dr. Polakoff. "It should be a marriage between provider and patient that allows for the best care, though I'm not sure we're there yet."

From a technology standpoint, the multifaceted requirements of patient engagement mean no one solution, or one vendor, will be able to offer a patient engagement system to a hospital. It will be a combination of existing systems, new products and hospital initiatives. "It's about building on what's already there to engage patients and populations," says Mr. Carson.

Healthcare organizations are currently faced with many decisions about technology acquisitions, but they have an advantage. "In healthcare, people are willing to share lessons learned," says Mr. Carson. "There's a frustration around IT, but also a willingness to reach out to colleagues, and more importantly, a willingness to share."

More Articles on Health IT Infrastructure:

ONC Releases First Beacon Community Program Learning Guide
Infrastructure, Trust Created as Result of Beacon Community Program
6 Lessons Regarding Local EHR, HIE Adoption 

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