The recent merging of Aetna and CVS has me thinking about the potential implications of two disparate elements of the healthcare system—insurance companies and pharmacies—working together as part of a whole.
In my years as a hospital administrator and strategist, I witnessed firsthand the enormous burden that poorly integrated IT systems have on the state of healthcare for everyone involved. It’s all too common that separate departments within a single clinical setting use different software, making it nearly impossible to transfer data from one unit to another. In fact, Deloitte found that seven out of 10 physicians say that electronic health records (EHRs) reduce their productivity. To this end, Lewis Sandy, M.D., UnitedHealth’s executive vice president for clinical advancement, said: “I wince when I see how much physician time is devoted to data entry.”
From outdated legacy systems to intentional data blocking to mitigate risk, interoperability is one of the greatest challenges facing the healthcare system today. And, it’s also one of the most dangerous. Researchers from Johns Hopkins have found that over 250,000 deaths per year in the U.S. are due to medical error, which makes it the third-leading cause of death in the country, after heart disease and cancer.
A major part of that medical error? Uncoordinated care.
According to Martin Makary, M.D., professor of surgery at Johns Hopkins University School of Medicine: “Developing consensus protocols that streamline the delivery of medicine and reduce variability can improve quality and lower costs in healthcare.”
Suffice it to say that interoperability is no longer a luxury or a future dream state for healthcare. It’s a moral imperative. Still, the problem is expensive, vast and can seem overwhelming. Based on my time leading a transition team at WellStar in Atlanta and consulting on several others, I can recommend five best practices for decision-makers to consider as they guide their teams in making a transformation in their IT infrastructures.
1. Start with a stop-gap analysis
One of the biggest obstacles when updating an IT infrastructure is being prepared for all the decisions you have to make in a relatively short period of time. So, start early. Before selecting an EHR software vendor, do your research. Examine the precise functionalities the different vendors provide for both clinical and financial needs and find out how they rank against their competitors. Talk to other hospitals that have implemented their solutions. Compare your current infrastructure to your optimal goal state and document an analysis of where you are, where you want to be, and what gaps exist. A key element of this process is accurately documenting your current workflows across every department that will be affected. The task is onerous but will make all the difference in the success and longevity of your new system.
2. Plan for loss of productivity
Naturally, the first question that arises when upgrading or replacing an IT system is cost. Set yourself up for success by being realistic about the true cost of the undertaking—financial and otherwise. Updating any hospital-wide system is going to majorly impact your organization’s entire staff. Consider cost of downtime, cost of training time and cost of decreased productivity leading up to and after the initial launch. There is typically a minimum four-to-eight-week ramp-up period from the time you introduce a new EHR to the workforce to the time your system is back to full functionality, and that is if all things go well. That lost time impacts physicians, nurses, administrators and patients, and can quickly become one of the biggest line item burdens in the project’s overall budget.
3. Involve your clinicians
In a recent white paper on interoperability, DSS Inc. found that, anecdotally, “organizational stakeholders often resist working with a system that was built without the benefit of their input …There is much to be gained by collaborating with end-users who understand the day-to-day nuances attached to their particular workflows.” To put it more simply, driving adoption is the best way to drive value—and effective change management begins with organizational buy-in. Instead of beginning with an RFP and capabilities assessment, engage your end-users as early as possible, and use their needs to drive your search.
4. Don’t let vendors guide the decision-making process
When you’re considering multiple solutions, every vendor is going to be pushing their own agenda. Be ruthless about asking questions. Grill them: What are the capabilities of this IT system to integrate with multiple others? Do you have the capability to create a data-sharing mechanism within our IT system? How easy is it to do that? Will a custom integration be required for every system pairing? The answers you’re looking for will vary from practice to practice, but it’s generally true that the less customization required, the better.
I recently spoke with Mike Schatzlein, M.D., chairman emeritus of the board of directors for the Center for Interoperability, on this very matter. “I was involved at Saint Thomas in Nashville for several years,” Schatzlein recounted. “We had somewhere between 200 and 300 custom interfaces that we maintained among and between all the different devices and EHR systems.” But that approach simply wasn’t sustainable. “The general intent should be to reduce the number of interfaces,” he advised. “If I were a healthcare administrator, one thing I would say is that ‘I’m not going to buy your thing if it requires a custom interface.’”
The major takeaway? Don’t let IT vendors be the ones to dictate how your system should function. Prioritize your end-users and find a vendor that will do the same.
5. Extend your testing time
I’ve already mentioned the immense time investment required for updating your systems. Don’t fall into the trap of rushing through the testing phase to save a few days or weeks. You might be tempted to do minimal testing, taking perhaps five claims from charge entry through to documentation. Don’t. Have the foresight to test complex claims, using real patient scenarios, and test the entire process from beginning to end. Wake Forest Baptist Health System experienced two years of eight-figure losses due to a poorly implemented transition to Epic’s EHR system. One of the major issues that led to this was insufficient testing. Learn from that mistake and trust that the time you spend rigorously testing your new system is a worthwhile investment that could save you millions down the road.
The best advice I can offer is to understand that the quest for gaining greater interoperability is a seismic shift for your entire organization. It requires examining in minute detail the way you’ve been doing things and choosing to do them differently. It also requires significant research prior to solution selection and implementation, and change management afterward. Change is never easy, but the benefits can be substantial, including a more efficient practice, greater employee satisfaction and, most importantly, providing a higher quality of care to every patient who walks through your doors.
Sarath Degala is VP at venture capital firm BIP Capital, where he leads its healthcare investment activities. He offers 16 years of healthcare administration experience achieving noteworthy operational and financial results within a variety of healthcare settings.