Envelope Please?

Back in 2009, when President Obama signed the Recovery Act that contained a number of healthcare provisions, including the Health Information Technology for Economic and Clinical Health Act (HITECH), we all heard naysers say “this wouldn’t reduce the cost of health care,” “only a few, or better yet, the well endowed practices could implement EHR before the deadline,” and ”this would reduce the number of practicing physicians because of the demanding requirements and surrounding meaningful use.” Well it’s been a little over 3 years, and by all measures HITECH has exceeded expectations.

Ezekiel Emanuel in a Reuters article, An unsung victory in healthcare, reported:

It’s now been a year since the administration released the regulations specifying meaningful use and what it takes to be certified — the nuts and bolts of implementing the law. The results have been nothing short of spectacular.

As of December 2011, the use of EHR among office-based physicians has nearly doubled to 34 percent with e-prescribing exceeding 40 percent. Over 41,000 physicians have received more than $575 million in incentive payments. Going electronic will allow physicians to more closely track patients, especially the chronically ill, enabling the seamless exchange of data across multiple physicians, hospitals and other providers.

The story is much the same among hospitals: 35 percent have adopted EHRs, and nearly 2,000 of the 4,700 hospitals have, collectively, received more than $2 billion in incentive payments. Every month has surpassed the previous month as measured by the number of physicians and hospitals that have signed up with the government for the EHR program, suggesting that these numbers will continue to rise.

Another great byproduct of the law is that the entire healthcare IT industry has been refocused away from developing new, improved ways for physicians and hospitals to code and bill the insurance industry and the government for payment. Instead, they now focus on making electronics work to improve care, enhance coordination among physicians and facilitate physician-patient communication.

HITECH has presented an myriad of IT opportunities, i.e. data warehousing, business intelligence, EHR implementations, etc. so this is great news for those of us in the IT industry. However, it’s even better news for those of us who will be patients because improving patient care while controlling costs is the corner stone imperative for implementing EHR.

Meaningful Use with BI and DW

Data warehousing (DW) and business intelligence (BI) are increasingly becoming more essential for healthcare providers as how best to meet meaningful use requirements.

BI and DW have been pegged as the best method to address the quality reporting requirements spelled out in the meaningful use criteria, according to Laura Madsen (author Business intelligence and the case for meaningful use).

The advantages among Madsen’s key findings to taking a DW/BI approach to meaningful use:

Consistency. DW/BI provides consistency, not just today, but more so for future reporting years as additional tracking and outcomes are driven as a result of higher EHR adoption. BI reporting addresses the complexity of meaningful use requirements.

Reducing FTE time. Creates all required regulatory reports from one source. Defining and governing data becomes quite manageable when there is a single source of the truth, thereby reducing FTE's.

Ability to manage data definitions for a broad set of regulatory requirements. Consistent definitions enable a broader use of data. This often involves self-service BI reporting, and it allows multiple departments to proactively pull reports of measures long before submission, giving you the extra time needed to make process changes and exceed goals.

As more providers adopt meaningful use requirements, they will be force to take a hard look at how they access and aggregate data. DW/BI likely won’t be the only technology adopted, but it will be at the forefront for health care providers as they slice and dice their data to demonstrate meaningful use compliance, and how to improve upon it.

EHR Progress in Spite of Politics

In spite of the proverbial cloud politics hung over the HITECH Act, Harvard School of Public Health professor, former Health IT Standards Committee co-chair and current Veterans Health Administration senior advisor for quality and safety Ashish Jha, M.D., said that the HITECH Act is accomplishing what it set out to do three years ago, expedite health information exchange (HIE) and electronic health record (EHR) implementation.

Jha reported during the Massachusetts Health Data Consortium’s recent HIT ’12 conference that the National Center for Health Statistics showed that 35% of U.S. physicians are using either a basic or comprehensive EHR system. Although he could not comment publicly on hospital HIT adoption, he stated that when those figures are release next month they will show a dramatic upward trend also.

Jha also stated small offices, which administers half of healthcare treatment in the US, are still lagging behind. On the upside of this warning, there are still plenty of IT opportunities to be had for healthcare IT integrators.

Implementing Strategic BI Initiatives

I stumbled upon a white paper, Business Intelligence Strategy: A Practical Guide for Achieving BI Excellence by Boyer, Frank, Green, Harris and Van De Vanter which is a perfect follow-up to my previous post, Business Intelligence in Healthcare.

Many organizations are struggling to implement strategic BI initiatives that can help improve enterprise-level access to the information needed to support business improvement. Unfortunately, many organizations have found themselves with silos of knowledge that are difficult to reconcile, complex to comprehend, and limited in their ability to provide the needed insight.

Why is there such a discrepancy between the needs of business and the ability to meet these needs with business intelligence (BI) initiatives? We believe the reasons are often because many implementations are treated solely as a technology initiative—but the challenges exist beyond the technology. Many issues, in fact, are non-technical in nature and may not be addressed as a
BI program is rolled out.

In other words, the obstacles to a successful BI implementation are not solely technological in nature; in fact, they are often societal within the organization itself. The result is that a BI initiative can easily be derailed by these factors, producing less value due to inconsistent behavior and thereby losing momentum in an organization. The projects that succeed are most often the result of a successful combination of people, process, and technology strategies because it is difficult to have a successful technology endeavor when the other ingredients are not present.

Businesses in all industries are having similar challenges as healthcare organizations with implementing BI. However, there’s one consistent theme cutting across all industrial boundaries, BI cannot be implemented in a silo.

To implement a BI initiative successfully requires an enterprise-wide approach. Divisional leaders must commit to working across divisional and functional lines, and provide SME resources to the BI project team. The SME’s must be able to understand their data, how it interoperates with other divisional data, and willing to champion BI to their respected division/area.

At least then, you will have the "people" ingredient referenced by Boyer, Frank, Green, Harris and Van De Vanter correct for achieving a successful BI implementation.

Business Intelligence in Healthcare

America’s Health Insurance Plans (AHIP) regulations, Health Insurance Portability and Accountability Act (HIPAA) mandates, advancement in healthcare and technology, and the general nature of healthcare services, have healthcare organizations overwhelmed with data. Without a business intelligence (BI) program in place to target, gather, deliver and analyze the most relevant data, these organizations will continue to adhere to the old adage, “data rich but information poor.” Fortunately however, the forward-thinking healthcare organizations have realized BI must be at the center of informed decision making in order to improve patient and services outcomes.

To achieve the full benefits of BI, organizations must take an enterprisewide strategic approach. This strategic approach to BI must cut across the organization, have buy-in not only from corporate bean counters and top executives, but also physicians and clinical staff.

Joe Mullich for BusinessWeek Research Services noted practitioners that adopted BI reported the following results:

Cost Savings. Healthcare organizations are using BI to eliminate waste and mine data stores to examine and recoup denied claims.

Improved margins. Since implementing a BI/balanced scorecard program, Nemours-one of the largest pediatric health systems in the United States-has improved its gross margins by roughly 2 percentage points each year.

Improved patient satisfaction. A new study from Aberdeen Group found that best-in-class healthcare organizations achieved a 15 percent increase in patient satisfaction scores by using BI and analytic tools.

Better care. Denver Health and Hospital Authority is leveraging BI tools to improve patient outcomes using point-of-care information to identify high-risk and non-compliant patients.

Significant gains can be had by healthcare organizations that adopt BI. However, they must take a more enterprisewide, platform-based approach to BI rather than focusing on point or departmental solutions.