Jim Adams believes health care organizations are on an IT journey with a distant finish line and a lot of mile markers in between.
Outlining many of those action steps, Adams, executive director of research and insights for The Advisory Board Co., delivered the opening keynote during the 2013 Digital Healthcare Conference produced by WTN Media.
Adams, former director of IBM’s Center for Healthcare Management, views 2013 as a year of accelerating transition in health care information technology. At DHC, he shared what he called the “Health Care IT Top 10” for 2013, identifying the tasks that should be on everyone’s “to-do” list this year, and the action steps required for each.
“We think the issues are somewhat interrelated,” he said. “They go beyond the Affordable Care Act because even without that, we’re seeing tremendous pressure to change from commercial insurers, employers, and other consumers of health care.”
In this first of a two-part series, we present the first five assignments on Adams’ top 10.
#1: For meaningful EHRs, remember the patient
Adams says that if health care providers are going to thrive in an accountable care environment, they need to establish a culture of perpetual improvement, which requires executive-level sponsorship for electronic health record incentive programs. “These programs must be treated as foundational initiatives that support other goals,” he noted.
Step one is to establish what Adams called a corporate-level, change-management committee that includes champions and experts from departments throughout the organization. The second step is to initiate a “no-one-left-behind” campaign and execute it by providing continuous support to ensure adoption and policy compliance. Step three is to begin a patient-engagement journey. “Patients are playing a more important role and ultimately will determine your organization’s success,” Adams stated.
#2: Corralling those elusive EMR optimization benefits
Thanks to Meaningful Use incentives, most hospitals now have sophisticated electronic medical records systems, and their functionality is improving. However, Adams worries the high levels of business benefit anticipated by Meaningful Use legislation might never be realized. That’s because EMRs are now implemented much more rapidly than in past years, using a “big
bang” approach that leaves a great deal to be optimized after implementation.
Adams said that within the first year of use, technical and process optimization is essential to improving EMR usability, efficiency, and safety, but additional focus on business value is required to produce measurable benefits. For this step, the benefits-driven action items outlined by Adams are as follows:
- Help clinical and operations executives clearly define the desired outcomes of EMR implementations.
- Organize your optimization effort to include both technical and process remediation, with a specific focus on achieving key strategic business outcomes.
- Study and adopt best practices for benefits-driven EMR implementation and optimization.
“It has to be pretty specific,” Adams said. “You don’t just say, ‘We’re doing this to improve quality.’ It’s about the specific quality metrics, the time frame, and laying out plans to get it done. It sounds basic, but many organizations haven’t done it.”
#3: Riding the revenue cycle
To pass ICD-10 (coding) and accountable care tests, keep in mind that evolving payment models, combined with the drive to improve revenue cycle performance, will lead to more demands on the revenue cycle systems of health care organizations. Due to increasing complexity, the forthcoming conversion to ICD-10 also would have a significant impact on revenue cycle staff productivity, said Adams.
Several enabling technologies exist to improve efficiency, and the large number of system updates that will be required for ICD-10 remediation over a short period will bring a significant testing burden. Automated testing tools, or outsourced testing services, can reduce this load, but the action steps are:
- Implementing an electronic charge capture system, either embedded in the enterprise EHR or as a standalone product.
- Organizations with a significant amount of structured documentation should implement a computer-assisted coding solution.
- To extract structured data from existing narratives, one should evaluate natural language processing solutions. Adams believes this technology offers significant potential for revenue cycle and clinical uses.
- Evaluating your current enterprise testing strategy and determining if automated tools will reduce risk.
The government has delayed ICD-10 for one year – it’s now set for Oct. 1, 2014 – but some providers believe another delay is likely. Adams wouldn’t bet the farm on it. “My basic advice is to take this seriously and get going with it,” he warned.
(Continued)
#4: Make mobility happen
Adams reminds health CIOs that mobility in health care settings is driven by the need to access a growing number of clinical applications, to connect clinicians and to engage patients. These needs are being met by a new generation of mobile operating systems, devices, and networks, so Adams recommends:
- Upgrading WLANs to ensure strong 3G/4G coverage.
- Supporting “bring your own device” through the implementation of mobile device management and mobile application management.
- Pressing clinical vendors to embrace mobility on major mobile platforms, including iOS, Android, and Windows.
- Deploying a unified communications infrastructure and connecting it to things like nurse call, alarm management, patient flow, and care management.
- Considering deploying a Wi-Fi-based, real-time locating system (RTLS) to track high-value assets such as infusion pumps, and then expanding it to locate wheelchairs, patients, housekeeping, and clinicians.
- To improve care, combining mobility, unified communications, and RTLS with business process management.
“Mobility brings the ability to extend access and make these systems more accessible,” Adams said. “It’s doesn’t do you a bit of good if you have a great EHR system if you can’t access it where you need to.”
#5: Addressing Meaningful Use Stages 2 and 3
Adams noted that proposed Meaningful Use Stage 3 rules would drive significant new interoperability requirements. These changes will require organizations to develop methods of sharing data outside of the existing enterprise architecture. Since interoperability is long-term project and requirements will evolve over time, plan on doing incremental interoperability based on partner readiness, and start with textual data and move to structured data where possible. Adams’ game plan for this step calls for:
- Evaluating your Meaningful Use Stage 2 plans against the Stage 3 rules and considering implementing Stage 3 interoperability functionality wherever possible.
- Determining what organizations will be included within your network and conducting an assessment of their interoperability readiness.
- Determining your overall person resolution strategy; deploy an enterprise master patient index if you do not currently have an adequate strategy.
- Considering the implementing of an eHealth Exchange, provided you don’t already have a private health information exchange.
- Since Consolidated CDA (clinical document architecture) will be the lingua franca for data exchange, push your vendors to provide all data in CDA-compliant documents, and make CDA your internal standard for clinical document repositories.
Editor’s note: Part II of this article will outline items 6-10 in Adams’ “Top 10” list.
This article originally appeared on the WTN News website.
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