Philip Loftus is vice president and CIO of Aurora Health Care, a 13-hospital system headquartered in Milwaukee, Wis. He recently spoke with HCI Senior Associate Editor Daphne Lawrence about the strategies he is employing to keep Aurora competitive during the country's financial downturn. (For information about how other organizations are coping with tough economic times, please see the cover story on page 36.)
DL: The downturn happened so rapidly - what's your strategy to deal with it?
PL: We face the same challenges as everybody else: budgets have been cut, staff has been cut because of the economy; while paradoxically, we are being asked to do more than ever. There are three key components to our strategy that we're following. This is a time of limited resources and there are critical things we need IT to do. Let's, as a business, and not just as IT, understand what our critical things are and focus resources on a smaller number of high impact projects - really focus on the critical things and don't do the marginal things.
DL: What are the three components to your strategy?
PL: In our case, we have two primary goals: one is patient care and the other is patient satisfaction. We started deploying our EHR 10 years ago, and what we're doing now is deploying our next generation EHR. We're taking clinical best practice, standardizing it, embedding it in the system and deploying it uniformly across the whole Aurora network.
This part of the Aurora strategy is designed to lift patient care to the next level. And we made the strategic commitment to keep on doing that because it was the right thing to do for our patients.
The second one that is becoming increasingly important for us, as it probably is for other providers, is we want to make sure we achieve a high level of patient satisfaction. We (recently completed) online appointment scheduling - that's not just to request an appointment, it's to make the appointment. And that's been very well received, and one of the areas that IT has been able to contribute to. Increasingly, our patients want to interact with us online, so we (deployed) online appointment scheduling at all of our clinics. We also provide them with all the hospital and clinic bills online, and they can elect to pay any co-pays online. And that has taken off really well. For the vast bulk of our patients, at the end of the month this is just another bill they want to pay.
DL: But weren't you doing these things already as part of your strategic plan before the downturn? How have you introduced flexibility into the plan?
PL: Those two things were our strategic goals as a business even before all the turmoil. As far as flexibility goes, instead of trying to do seven or eight projects we've focused it down to two. In these very tight times we ask what can IT do for the business that will actually give a measurable financial return in the short term? How do we contribute? We look for a real concrete financial ROI.
DL: Any examples?
PL: We deployed Zynx (Zynx Health, a part of Hearst Business Media, is a provider of evdidence-based clinical decision support) in all of our EDs to do better billing and data capture, and that has been very successful for us and produced very tangible financial return. As the economy tightened, we looked at what can we do to help. The second one in the same vein was transcription. We had a very big spend, so we completely re-looked at that and put in new eScription software (Boston), and again we've got measured savings of more than $6 million already. A final one is in radiology, code-writing software to improve the accuracy of charge capture and identification. These were very deliberate attempts to say, ‘Let's really look at our opportunities where we can get a leveraged short term return on the investment.’ So instead of using IT to reach our long-term goals, we're using IT to help us improve the cash flow and profitability in the immediate net couple of years. That has been well received.
DL: And the third piece to your strategy?
PL: Our third piece is the incentives. Like everyone else, we spent some time trying to get our minds around it and look at what's in it. And what's in it is very significant - the incentives for a system our size could be in the $40-to-$100-million range. As a business, not an IT function, there is a significant incentive here that obviously we would want to be able to capture.
So do we wait till the government comes up with the requirements of meaningful use and certified system? What we decided was no, we couldn't do that, because with a system of our size, if we really wanted to make any significant changes to it that would put us way behind, and we didn't want to wait.
We put a business document together that was based on our best guess of where we think the dust is going to settle on meaningful use and qualified systems, and we developed three scenarios for the system. The first is qualify all your hospitals and physicians in 2010 and start to get incentive payments in 2011. We already decided we couldn't get there that quickly; it was a bridge too far. Our goal scenario says we couldn't get there in 2010, but if everybody got on board and if we set this as one of the top three business priorities for Aurora sponsored by the CEO, we probably could get there in 2011 and get the incentives payments in 2112. And we developed others that weren't even that aggressive. We don't want to wait till 2013 to be fully qualified because we'll miss a big chunk of the incentive payment.
DL: Has your relationship in the organization changed as a result of this?
PL: We're recognizing that this is a complicated and fast moving world. We don't want to throw the strategic plan completely out of the window, so we focus it on the critical things and keep those going as long term goals, recognizing that we need to give a quick immediate business response in ways we had not traditionally done in the past by producing these financially measurable short term returns to the business as a way of contributing to the need. And that was very new for us as a way of behaving. It involved different constituencies; it was very much about working with finance, it's a very different model, much more hard edged and business oriented than our traditional models would be. There are options but all our choices have some tough compromises and are going to involve some tough decisions.