The Future of Healthcare: 9 Capabilities for Post-Reform Success

As with most things in life, health system success with health information technology is more about quality than quantity. Even the hospital with the most iPads or priciest electronic medical record can falter if it doesn't adapt to rapid change or maintain focus on the "big picture." There's a cluster of capabilities hospitals need to possess in order to monitor population health, reduce care disparities, maintain physician morale and remain the chosen provider for their patients. As the nation's healthcare delivery system evolves, here are nine crucial aptitudes hospitals need to thrive today and throughout 2012.  

1. Effective change management processes. Though it may sound trite, the most pressing capability health systems and hospitals need for true HIT success is effective change management. A large part of the challenge boils down to connecting HIT-driven shifts in care delivery to reasons why. Without explanations and context, providers may feel their processes and workflow is subject to arbitrary change. Debe Gash, vice president and CIO at Saint Luke's Health System in Kansas City, Mo., said she needs to thoroughly explain the causes behind any changes in her staff's workflow to earn their engagement. "I need the physicians to enter orders electronically," says Ms. Gash. "I have to build a justification for them to change the way they're doing things today, and provide a reason that resonates with them."

Wendy Whittington, MD, a practicing pediatrician and CMO at Dallas-based Anthelio Healthcare Solutions, says it's also critical to refocus the lens and help providers see the big picture when HIT might change comfortable routines. "It's important to remember what it is we're after here and keep your eye on the ball. Sometimes we get distracted and focus too much on one hurdle, like ICD-10," she says. Each of these "hurdles" — such as Meaningful Use, ICD-10, or computerized physician order entry — should be linked to the larger picture of population health, patient-centered care, and evidence-based medicine. This can help providers tap into the logic and meaning behind change that, at the time, might seem high-handed and purely operational.

2. Ability to develop new workflow and processes. By now it's clear that hospitals must do more than install an EMR to see real success. Work flows and processes need to be redesigned to make EMR use more efficient and streamlined with the process of care. Physicians do not want EMR, or HIT in general, to become another patient that requires extensive time and energy. "It takes skills around process design and process improvement to make that [integration] happen," says Ms. Gash.

Many hospitals are currently wrestling with the best ways to redesign providers' care processes around HIT without risking patient safety or employee satisfaction. Ms. Gash, a member of the Healthcare Information and Management Systems Society, mentioned the organization receives many requests from providers across the country asking for best practices to optimize EMR use.

Hospitals can see employee burn out and low morale if these changes in human behavior are not properly addressed. Alan Cudney, RN, an executive consultant with Beacon Partners, has seen these symptoms firsthand. "One thing I see among front-line staff and clinicians is a high level of anxiety and even frustration when they are asked to change their work practices to use clinical software on a computer. The software usually works better and more efficiently than the manual process. The transformation of familiar workflows and giving up 'tried and true' methods can be stressful for clinicians. Sometimes, even the most educated and experienced clinicians react by putting up a barrier. This may be passive resistance or outright rejection," he says It is prudent to involve clinicians in developing the new workflows and software configurations so that they will be more likely to accept the resulting solutions.

3. Data mining to inform clinical decision-making.
A governance structure is necessary to manage the implementation of analytics capabilities. This is an effort so vital to HIT strategy that the majority of the hospital's C-level team should be involved. For instance, the CMO and CNO need to specify what information they want and the CIO can make that happen.

At its face, an EMR doesn't help physicians understand population health or arrive at conclusions about trends in metrics. This data should be drawn and arranged with a reference point to enable comparisons and benchmarking, which allows physicians to trace population health and compare hospital performance to national outcomes. Hospitals can save costs only if they leverage the drawn information to make it accessible and recognizable to physicians.

"The understanding and knowledge of business analytics and data governance is crucial," says Ms. Gash. "It's an understanding of how to use that data and find ways to standardize care or minimize variation, which can lead to cost reduction." Even though this capability is the first step to improve quality and cut costs, only 58 percent of healthcare organizations utilize business intelligence tools to help with quality reporting, according to a 2011 HIMSS survey. Another 75 percent of organizations that responded to the survey said they still need more IT resources to fully conduct quality measures.

4. Telehealth services to promote patient wellness and preventive care. Traditionally, telehealth was as a tool used to connect urban teaching hospitals with community hospitals in rural areas that lacked specialists. The services were primarily used for critical care purposes, such as patients in the ICU requiring specialized medical expertise. The case for telehealth services is shifting, however, from critical care and becoming more attuned with patient wellness and preventive care.

"Picture the hypertensive diabetic patient who lives in the middle of nowhere," says Dr. Whittington. "Say she slips her arm in a sleeve to measure her blood pressure, blood glucose and other vitals. Those results are then beamed to an RN in a case management center." A simple process like this could save the hospital and patient transportation costs. It also helps patients remain proactive in their care, as they are more likely to "put off" appointments when the physician is an hour or more away. Telehealth for the management of chronic illnesses and conditions — rather than strictly critical cases — also has large implications for integrated systems with their own payor or within an accountable care organization.

5. Technology to support providers' mobility. Physicians' and other clinical providers' understanding of HIT continues to grow more sophisticated. Now, just as they are accustomed to mobility with their own mobile devices and tablets, physicians are expecting the same in their workplace. Ideally, providers will be able to access patient data anywhere, at any time, on any device.

"What we're hearing is that physicians want to be able to do rounding in the hospital with access to data without having to stop and return to a computer to log in," says Ms. Gash. Providers are beginning to expect more from technology — and the hospital as well. This could include accessing a patient record on an iPad or iPhone, or accessing data in the format they need while outside of the hospital.

6. The adoption and maintenance of updated HIT security measures. A hospital's strides in HIT innovation and adaption are in vain if it fails to address its security needs. Falling victim to a breach can significantly ding a hospital's reputation. Despite these high risks, 25 percent healthcare organizations still don't conduct security risk assessments, according to a 2011 HIMSS survey. These are not only required by the Health Insurance Portability and Accountability Act and for meaningful use incentive payments, but are a simple best practice to identify areas of vulnerability.

"If you're going to have mobile solutions, you need encryption technology. If you're providing remote access to an EMR, you may need to have two-factor authentication or adaptive authentication similar to what is used in the banking industry. You may need tools to protect the hospital's perimeter from intrusion," says Ms. Gash. These are just a handful of the protective capabilities hospitals and systems need in order to avoid HIT's pitfalls, like breaches, unauthorized access and data theft.

7. Transparency with employees and patients. Despite the high need for privacy and security around HIT, transparency around the adoption of new technology is vital for employee engagement. There will likely be much more emphasis around the issue of patient access to health information in the coming years. "I think we're in the early stages of information exchange," says Ms. Gash. "Even if you look at Stage 2 of Meaningful Use, there are more requirements for patient transparency to medical records — more patient portals and standards around data exchange between providers."

There has been an increasing amount of attention to the relationship between physicians, patients and health information. There may be more opportunities for patients to adapt active roles in their care as they grow more comfortable with EMRs. A recent study published in the Annals of Internal Medicine found 92-97 percent of patients think open visit notes, made accessible through electronic links sent to the patient, are a good idea. Regulatory demands, along with patients' increasing interest in HIT participation, are something for providers to keep an eye on.

8. A governance team that provides the unique perspectives of various stakeholders. A hospital should ideally have a multidisciplinary HIT governance team that includes physicians, members of the executive team and other stakeholders. This variety ensures different departments have a voice in the direction of the hospital's IT strategy and innovation — preventing the silo effect — and gives physicians and other providers a chance to describe their daily processes and workflows.

A balanced governance team can create a sense of shared ownership among stakeholders by allowing them an opportunity to align strategy with IT implementation. "What I'm talking about when I say "governance," is the process where you link your organization's strategy to IT, are make sure both are aligned. Strong and successful [hospitals] will be really good with IT governance," says Ms. Gash.

9. An attitude of innovation. Leaders who embrace change and encourage innovation within their healthcare organization are more likely to rise to the top when it comes to HIT. Along with clinical and technological innovation, hospital leaders should also work to encourage positive attitudes towards change. Or, in other words: less whining.

Dr. Whittington says ICD-10 has been a big source of moans and groans in the industry as a whole. "It's my personal opinion that we have skated the ICD-10 deadline for a long time now," she says. "It's true there are other pressures upon us, but it makes me chuckle when I hear [people] say, 'Let's wait until this storm passes, and then we'll tackle ICD-10.' Well, I'll be amazed if this storm passes in my lifetime!" Linked to the first point, each member of the C-level team should link the steps of HIT implementation back to the broader goals of not only the hospital, but healthcare reform, to prevent begrudging attitudes towards change and innovation.

Related Articles on Healthcare Reform and Hospitals:

10 Technologies to Keep Hospitals Competitive
The New Health Age: The Future of Healthcare Delivery in America & the Changing Role of Providers
Spurring Innovation in Healthcare Delivery: 5 Best Practices of Health System Leaders


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