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When Clinical Transformation and Technological Change Come Down to Process and Cultural Change

April 15, 2014
by Mark Hagland
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Achieving the Triple Aim will require a lot of process and cultural effort, as well as technological support

Achieving the Triple Aim—the idea of improved quality, enhanced patient engagement and satisfaction, and improved cost-effectiveness in healthcare, as promoted by the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI)—inevitably will involve a great deal of both technological change. But as members of discussion panel being held at the Atlanta Health IT Summit April 15-16 said on Tuesday, April 15, the challenges are as much cultural and process-based as technological.

In a panel titled “Achieving the Triple Aim: The Future of Healthcare,” panelists discussed a range of challenges and opportunities going forward. Moderating the panel was Cynthia Burghard, research director at IDC Health Insights. The other panelists were Charles DeShazer, M.D., chief quality officer of BayCare Health System (Clearwater, Fla.); Mr. Anna Ramanathan, director of Clinical Transformation at Georgia Regents Health System (Augusta, Ga.); Mary Carroll Ford, formerly senior vice president and CIO at Lakeland (Fla.) Regional Medical Center, and now senior partner and CIO at MBC XPERT, a consulting firm; Sameer Bade, vice president of clinical Solutions at the Bellevue, Wash.-based Caradigm; and Bob Schallhorn, vice president of product management at the Chicago-based Merge Healthcare. The panel was the first panel discussion session in the Atlanta event, sponsored by the Institute for Health Technology Transformation (iHT2). Since December, Healthcare Informatics and its parent company, Vendome Group LLC, have been in partnership with iHT2.

Regarding the question of moving towards clinical transformation and population health, BayCare’s DeShazer said, “BayCare has historically grown up as a hospital system. What has happened over the last two or three years, largely in response to the ACA [Affordable Care Act], is that BayCare has decided to create an integrated delivery system. Currently, we’ve got 11 hospitals, and now a clinically integrated network of 1200 docs, including 300 employed docs. We also have home health—in fact, one of the largest programs in the country. So I would say over the last two or three years, we’ve begun this transformation.”

DeShazer went on to say that  “One of the challenges is that currently, these initiatives are not well-reimbursed. We’ve got to start up an organization and make the initial investments, and be prepared when the reimbursement model shifts, and take on risk. This will be different from the late 1990s; then, folks didn’t really prepare for risk. This is a totally different game, and you have to have a totally different infrastructure and capability. And, per the Triple Aim, you really have to engage patients. Population health is really about managing risk and engaging patients,” he added. “So we’ll be testing something called the patient activation metric, which really measures how well patients are engaged in their care; we’re testing that out this year.”

Mary Ford, who spent nine-and-a-half years as senior vice president and CIO at Lakeland (Fla.) Health before joining the Smart Solutions Health Care Group, a consulting firm now part of the WeiserMazars tax and audit firm, said of the CIO role in transformation,  “The biggest critical success factor is to learn to trust one another. So if I’m the CIO, there’s a great deal of trust when I go to the chief quality officer and say, let me help you. Because what he really thinks is, you’re going to make me use this system, and then it’s not going to work, and then you’ll send me to some low-level lackey, and then I’ll be hanging out there in front of all my colleagues.”

The thing about trust-building, Ford said, was, “Once you start to round with physicians, you realize that the [IT solutions] you bring to them, while they might work nicely in a tabletop demo,” need to work in the real-world setting of day-to-day physician care delivery and workflow. At the same time, leadership will be required to get towards the Triple Aim via health IT facilitation, she emphasized. In the case of Lakeland, she reported, that meant coming to an agreement with the organization’s chief medical officer that computerized physician order entry (CPOE) needed to be made mandatory to work. As a result of that decision, she said, “One year later, the physicians came back to me from the medical executive committee and said, Mary, we as physicians want to set a date as to when all of our documentation will be on the computer. I was stunned,” she noted. “But that’s where the real collaboration starts. So it’s about trust, and when you go that physician and say, I’m going to help you, you’d really be better helping supporting, and working.”

One very important element, said Anna Ramanathan, is that “Your strategic framework is going to be very important. That’s something that we’re now institutionalizing,” he noted. “And a key part of that is the integration part. How do I  bring things into my physicians’ day-to-day workflow? I’ve learned that you never force things on physicians or other clinicians. So we need to engage them so they see the value of it. So part of clinical transformation is engagement with your end-partners and coming up with good formative processes. One thing we’ve been looking at is nurse workflow,” he added. “How do we move away from the old traditional bell system? How do you leverage technology and keep your costs in mind? We have looked at that as an opportunity.”

When it comes to the role of health information exchange in promoting the goals of the Triple Aim, Bade said, “I think all of us have sort of been through that phase that HIE is one of those ways to collaborate within regions, around admissions and discharge data. But those models typically were not sustainable. There was no real business or clinical imperative to support that type of exchange. So one of the things we’ve seen around the country is that large health systems are starting to build their own exchanges, to share deep levels of clinical information around the patient. But the collaboration doesn’t really top there.” Also, he noted, “When I left MedStar Health [in Maryland] about seven years ago, Maryland was a brutally competitive environment among the hospitals there. And now nine independent facilities are coming together not just to share the technology necessary for accountable care and analytics, but also to share the expense involved with that, the staffing involved, and we’re responding to that, and one of the interesting challenges is that it’s no longer a world that is all-Epic or all-Cerner; you’re bring in physicians in many types of environments. And the challenge is no longer just sharing the data, but what actually happens with that. And when you introduce care management in the mix, it goes far beyond just episode-based management.”






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