From the Consultant’s Corner 5/17/13

Vendor Selection Strategy
By Brad Boyd

Many healthcare organizations are evaluating the potential benefits and tradeoffs associated with replacing their legacy application vendors with a core vendor to meet their enterprise-wide patient access, clinical, and revenue cycle requirements. Core vendor solutions promise a variety of benefits, including streamlined workflow efficiencies, business intelligence enhancements, reduced operating costs, and tools to help a healthcare provider meet the various changes facing our industry (ex. bundled payments and value-based contracting).

Making an uninformed decision can have far-reaching consequences in terms of costs, patient care, and revenue cycle performance, so it’s important to approach this evaluation process in a holistic manner.

The CIO of an integrated delivery network recently asked me what I thought were the five most important things to keep in mind when evaluating core vendor solutions. The following contains some of the details of our conversation:

1. Know yourself first. It’s critical to have a full appreciation of not only your current business and clinical needs, but most importantly, the future state requirements of your organization. A comprehensive discovery process should engage C-suite leadership, physicians, patient access executives, revenue cycle management, practice managers, and department administrators.
2. Perform a total cost of ownership analysis. Not all vendors offer similar licensing and support models, and there is great variance in vendors’ implementation methodologies and staffing models, as well as post-live support requirements. As a result, an organization must calculate the costs of acquiring, implementing, and supporting each vendor. For example, a system may be expensive to buy and implement, but the costs of maintaining the system over time could be relatively low. Another system may be less expensive upfront, but the costs of long-term maintenance could be higher. To get a true appreciation of the financial implications of a potential choice, spend time calculating the total cost of ownership over 5-10 years—considering the costs to acquire, implement and maintain the technology.
3. Understand the vendor marketplace. Consolidation is the name of the game in this industry and companies are constantly being acquired and sometimes dissolved. Know where a potential vendor sits in the marketplace and how stable that position is. The last thing you want is to pick a vendor only to have the company acquired, forcing you to convert to another system because the acquiring company will no longer support the initial vendor’s product.
4. Have a conversation with the vendor without the sales people. Although the sales staff serves a purpose in explaining the product and its benefits, I find it valuable to talk with a vendor’s executives without the sales people present. During this time, ask the executives where they think the healthcare industry is going and what the vendor is doing to navigate those changes. I’ve found that this type of strategic discussion can reveal a vendor’s research and development priorities and give a sense of how the organization is preparing for the future.
5. Look at the culture. Basically you want to know whether a vendor is going to play nice in the sandbox. If the vendor is committed to implementing its product in its own way and is not willing to customize the process for your organization, that’s something to know upfront. While I think a detailed plan for implementation is valuable, the vendor should be willing to compromise in certain areas to ensure your organization’s unique needs are met.

As with any big decision, it’s important to garner multiple perspectives. I recommend putting a team together that represents all potential users of the system. In my opinion, an organization should also bring in a consultant who can offer an unbiased perspective on different vendors, cut through the sales speak, and get to the real value and help your organization fully understand the ramifications of your choice.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

From the Consultant’s Corner 4/12/13

The Next Available Appointment Is…
By Brad Boyd

Have you ever gone to the doctor for a routine checkup, only to be told that you should really see a specialist to take a closer look at that issue you’re having? Perhaps you have frequent migraines or your asthma symptoms are getting worse. As you try to make the appointment, you are told that the only time you can see the specialist is in six weeks, on a Tuesday, at 10:45 a.m., because the doctor is not available any other time.

This situation is not only irritating for you—the patient—it is also aggravating for your primary care physician. When patients have trouble gaining access to specialists, it can mean delayed treatment, potentially compromised patient care, and more headaches for the primary doctor. I’ve observed that some primary care physicians cope with this problem by referring patients to specialists outside their network, which presents issues for both the physician and the network.

As healthcare organizations pursue clinical alignment and integration initiatives—such as Accountable Care Organizations and other value-based reimbursement strategies—I have found they focus on steps like implementing integrated information technology systems, standardizing medical management, and fostering greater physician alignment.

While these are important aspects of an integrated approach, what many organizations fail to realize is that they also have to address patient access issues. If patients have trouble getting in to see their doctor or specialist, there could be some pretty significant patient care, satisfaction, and revenue effects.

I’ve noticed this problem happens most often when academic institutions seek clinical alignment and integration with non-academic organizations, such as physician practices. In these situations, physician compensation in the academic medical center may not be aligned with productivity expectations. In other words, the compensation model for specialists doesn’t incentivize them to see large numbers of patients. They may limit the number they see, choosing instead to focus on research activities or other priorities.

Improving patient access and the overall patient experience requires a holistic view of the academic institution-physician practice partnership, taking into consideration governance, leadership, and management issues. I recently tackled this type of holistic assessment for one of my clients, an academic group practice. Together, we developed a patient access optimization program which we piloted across two departments.

The result was a 25 percent increase in appointment slots and a 14 percent growth rate in ambulatory revenues. Satisfaction scores also improved for employed and aligned practices as well as their patients because patient care was better coordinated across the health system. In addition, referrals to competing health systems went down substantially. Based on the success of the pilot, the organization is deploying a new standardized "patient care model" throughout the remaining clinical departments.

Spending time looking at patient access and figuring out ways to increase specialist availability can ensure that any clinical integration program you pursue is successful. By addressing this issue, you can make the road toward clinical integration a little easier and ultimately reach your goals in this effort.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Bowtie Confidential 4/7/13

Revisiting Healthcare Service Line Strategy and Development

In the past 10 years, service line development has proliferated. The topic was on the cover of the latest HealthLeaders and has been presented at several industry conferences. The heart of the issue is the need to collaborate internally and develop an integrated approach to service line development  versus a siloed approach.

The intent of service line operations is to provide better quality of care with focused resources while managing costs in an effective manner. Typically, service lines are limited to a group of well-defined sets of services and/or interventions. Examples include orthopedics, surgery, cardiovascular services, and oncology. If designed well, they provide pathways to increased operational efficiencies and financial success.

Developing and implementing a service line requires a significant amount of planning. The planning effort needs to take into account ongoing monitoring, evaluating, and modifying operations. Key components of service line development include:

• Governance and organizational structure
• Executive sponsorship – alignment with organizational goals, objectives, and mission
• Physician sponsorship
• Capital budget allocation
• Market analysis (brand management, competition, community need, pricing/cost, ROI, etc.)
• Continuum of care process: vertical vs. horizontal care delivery
• Resource analysis and requirements (clinical, financial, operational, etc.)
• Patient/community input
• Workflow and dataflow analysis
• Data analysis and requirements
• Reporting metrics
• Systems and technology analysis
• Evaluation and tracking methodologies/processes

I have experienced changes in service line modeling over the past few years  — specifically, a trend from vertical to hybrid vertical/horizontal models, which leverage a multidisciplinary approach. Models continue to focus on improving the coordination of operations and data acquisition, which allows organizations and executives to analyze the health and status of the service line(s) for greater profitability and enhanced operations. This is predominantly due to changing regulations, policies, costs, information technology, and other environmental elements.

Strategically, service line thinking needs to be re-evaluated to gain the full benefits that it can offer. Physician, patient, and community participation needs to be considered and included. Clinical service lines provide an opportunity for a comprehensive integrated care delivery model. This model can address patient and community needs throughout the delivery process by enhancing clinical quality and patient satisfaction and simultaneously improving operational efficiency and lowering the cost of care delivered.

In addition, more organizational attention needs to be placed on data governance and management. If your organization is developing a new service line, I recommend the following action steps:

• Use the key component bullets above as an evaluation checklist
• Commit to a well-structured strategic planning effort
• Develop a data governance planning and management strategy
• Build in a periodic service line assessment that provides metrics and dashboards to leadership

The importance of data cannot be minimized or overlooked. Data governance, management, and infrastructure are keys to service line success. Data provides the eyes for information on populations, best practices, overall operations, improving patient experiences, etc. Without a well-structured data governance process, the quality of data and information is suspect, potentially leading to errors in critical decisions.

The key to success in service line operations is to rethink current service line operations and data management. Review current service line strategies, operations (tactics and metrics). Seek support and involvement from the organization’s constituency – physicians, executive leadership, community, staff, and others within the sphere of influence. Look for synergy and integration between service lines and providers to obtain the best path for efficiency, effectiveness, and improvements in the continuum of care (quality). Lastly, seek external support, guidance, and direction for industry best practices and strategy development.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

Practice Wise 3/15/13

Electronic File Management – Protecting PHI

The final HITECH related HIPAA rule has been published. There is so much more work to be done to protect your practice data. Before you can set policies around how to keep your electronic data safe, you have to fully understand what electronic data you have and what levels of security are necessary for each category.

As I investigate new technologies to help us track and protect electronic PHI, I realize I’m a huge failure at keeping my past New Year’s resolutions. In particular, file maintenance. Back in the days of all paper files, we had an annual ritual of making bankers boxes, cleaning out files, archiving the old, moving forward the new, labeling the boxes, and putting them in storage. You knew exactly what files you were archiving and where they were going to be stored. It was a satisfying exercise, a visual accomplishment. A truck from the secure storage site came and picked up the boxes and we let them manage the security of the PHI in those boxes. Task completed.

We are focused on helping our clients understand the final rule as it relates to managing their electronic data and keeping PHI secure. Most small practices are unaware of where all their data is stored (consider all the desktop and My Documents folders of each user). There are two issues we are focusing on — data storage size and security.

Our first steps are to help the practices decide what to keep and what to discard. Right now for most offices, if it’s scanned, it’s kept. Nobody is going back to look at what is in patient EHR charts or computer/network directory flat files. They are not aware of the growing issues they are creating. We are seeing huge leaps in database sizes as everyone is scanning documents into their EHR and forgetting about them. Nobody is doing document maintenance as far as I can tell.

In the paper days, you thinned your charts. You didn’t keep old copies of registration forms. You didn’t file preliminary lab results when you got finals. The same edict needs to be applied to your electronic charts.

This may not be easy or a desirable task, but here are some thoughts:

• Review your patients by visit history and clean up charts on all those not seen in the last three years, just like when you pulled charts off the wall by their end tab year stickers. You can also do these tasks on current patient, as you touch their charts.
• Remove all but the latest registration forms (verify if your EHR tracks changes made in the system so you have historical data if needed.)
• Remove all preliminary lab result attachments (if your labs are attached as documents and not discrete data elements), leaving only the final results attached.
• Remove historical patient photos. For instance, if you are a pediatric practice and take photos at different stages in the child’s life, consider getting rid of all but the latest image. Photos are usually the biggest attachment files.
• If you routinely take photos for clinical purposes (i.e., dermatology), check your image size default on your camera(s) and see if you can use smaller images with satisfactory viewing results.
• Although it should go without saying, remove anything that doesn’t belong in the chart to begin with.
• Review your clinic protocols for scanning in charts from other offices. I routinely see clinic staff getting 50-plus page charts from other offices and scanning the entire thing into their EHR. Set a practice-wide protocol of what documents you need from other providers or your previous practice if you have moved. Be concise! You can always call the other office if there is something you need.
• Be aware of chart custody laws; who is responsible for PHI from external sources that are now a part of your chart records.
• If you are preparing to go live on EHR, now is the time to think long and hard about what you will scan and attach. I highly recommend using a professional scanning company to handle back scanning of your current paper charts into your new system. They have better scanners than you have in your office, which compress images much smaller than your office scanner. Also, they should be able to help you make critical decisions about what to scan and what to discard in your paper charts. Thin your charts first!
• Resist the urge to hire a bunch of students to come in and scan charts. They don’t have an understanding of your data, don’t know what to keep, and won’t identify when something is amiss in the chart. The file sizes will be much larger than a professional scanning solution.
• Look at billing documents you’ve scanned. Apply the same IRS record retention rules you do for paper charts and start removing all those images of EOBs etc. that you no longer need to maintain.
• For the sake of space, continue to be ruthless in deciding what you keep and what you don’t. If the documentation can be retrieved from another source (insurance company, referring doctor, lab or hospital) let them be the file managers for you when you can.
• For security, have your staff clean up their Desktop and My Documents directories, get that stuff off the local machines, and especially laptops if they leave the office, and onto a secure drive on your network. Have your IT support turn off group policies that re-direct My Documents directories to the server and teach the end users how to use the shared network drives instead. It’s much easier to secure data when it’s all contained in one place.

Julie McGovern is CEO of Practice Wise, LLC.

From the Consultant’s Corner 3/12/13

Bringing the Outside In: Two Ways to Capture External Data in Your Business Intelligence Efforts
By Brad Boyd

The term “business intelligence” has been tossed around for years as a way to describe the process of capturing, analyzing and interpreting data—and then using it to make organizational decisions.

Many of the healthcare organizations I work with have engaged in business intelligence activities for a long time, focusing on collecting and leveraging internal data and information. However, as the industry shifts from volume-based reimbursement to value-based reimbursement, I believe the need for data will shift as well. Moving forward, organizations will discover an exponential increase in their data requirements—not only internal data, but also external data from other healthcare providers, payers, and others.

In my opinion, organizations must figure out how to integrate external data and incorporate it into current business intelligence efforts. The big question is: What’s the best way to do this?

I advise one of two main approaches. The first one involves bringing external data into your organization a little bit at a time. For example, you could import data into distinct buckets within an existing data warehouse, and access that data through a variety of reports. If a clinician, administrator, or other staff person wants to see the data, he or she could ask for a report to review.

Although this approach is cost effective and requires minimal resources to set up, it doesn’t provide a seamless integration between external and internal data. External information is accessible from a segregated reporting perspective, but isn’t available in an integrated way through the EHR or other IT systems.

In fact, the whole process can be rather clunky, given that you could quite possibly have to leave one source of data to view another. In certain situations, this could be very frustrating. In addition, it fails to provide a comprehensive view of both internal and external data.

If this approach seems too time-consuming and cumbersome, I would think about marrying external and internal information upfront, storing them both in IT systems right away. Engaging in this type of wholesale move provides quicker, more streamlined access to comprehensive data for individual and population health management.

However, I have to caution that this avenue is much more costly and resource intensive. It involves updating and reworking your current IT solutions and your business intelligence strategies. Given all of the other competing priorities in your organization—ICD-10 and Meaningful Use, for example—pursuing this type of large-scale integration may not be feasible.

Whether you choose to absorb external data incrementally or all at once, there’s no question in my mind that you will need to gain access to it and share it across your organization. The current healthcare environment demands it.

I highly recommend that all healthcare organizations start seriously thinking about the best ways to incorporate external data into their business intelligence efforts. It’s essential to weigh the pros and cons of different approaches and map out a strategy. Otherwise, you may be left unprepared for the data-enriched, value-based future of healthcare.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.