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At Your Service

April 17, 2007
by Mark Hagland
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As consumer-driven healthcare shifts into a higher gear, organizations are putting the patient first.

What the folks at Omaha-based Alegent Health are doing could provide a solid page in a playbook for the consumer-driven healthcare of the future. After senior management at the seven-hospital integrated health system that serves southeastern Nebraska and southwestern Iowa had committed to a strategy of consumer-centeredness and hospital pricing transparency — and after CEO Wayne Sensor had publicly committed the organization to doing so within one year — Alegent staff built the first online consumer calculator for hospital procedure prices in the country.

While a handful of organizations nationwide already offer static price-lookup data on their Web sites, the Alegent Health people went further. They decided to use technology conceived internally (then co-developed with the Solvang, Calif.-based portals vendor Medseek) that allows patients to enter information on their particular health insurers and plans. Patients get back very specific data on their co-pays, out-of-pocket costs, and costs to their insurers, for a range of medical and surgical procedures.

The pricing-information solution, for which a patent is pending, is not only unique, but a harbinger of things to come, say executives of Alegent Health (a system sponsored by the Denver-based Catholic Health Initiatives and the Omaha-based Immanuel Health Systems, a Lutheran hospital system).

"We had a common vision: to engage people in their healthcare and connect people with their payment as a tool for achieving that," says senior vice president and chief financial officer Scott Wooten. "And we turned that vision over to a group of people who were not in the executive suite, and we asked them to put together a plan. They did so in spades."

Though the development of the tool was complex and somewhat challenging, the development work was completed within 12 months and the program went live in January, with availability to at least 75 percent of Alegent consumers expected by April.

Senior vice president and CIO Ken Lawonn agrees with Wooten that there were challenges in developing the MyCost solution, but he says that the end result has absolutely been worth the investment of time, money and effort.

Ken LawonnThe initiative has also evolved out of an organizational culture that is strongly grounded in solid strategic planning processes, processes that produce results that make sense for the whole organization. So much so, Lawonn says, that an Alegent-developed two-and-a-half-day strategic planning process that has been used in diverse contexts (the Alegent folks call it their "decision accelerator process") was applied a little over a year ago in IT planning, and continues to move forward the kind of planning that spawned the MyCost tool.

"One of the keys," he says, "is that you have to be forward-looking. You have to think about things more from a consumer perspective, as healthcare becomes more consumer-oriented. Think about how people shop for hotels and airlines. We need to try to make healthcare more like that."

"One of the keys," he says, "is that you have to be forward-looking. You have to think about things more from a consumer perspective, as healthcare becomes more consumer-oriented. Think about how people shop for hotels and airlines. We need to try to make healthcare more like that."

An abundance of initiatives

Nationwide, more and more senior executives at hospitals, physician organizations, and integrated health systems are beginning to think like Alegent's leaders, finding new ways to develop patient services that will differentiate their organizations from local market competitors and engage patients and consumers in new ways. Industry experts agree that access, convenience, improved service and satisfaction, and enhanced provider efficiency will all be crucial to patient care organizations as they compete for volume and market share in the emerging healthcare marketplace.

In turn, CIOs of patient care organizations are increasingly finding themselves helping to lead complex, challenging, rewarding initiatives around these new kinds of services, services that are tied to their organizations'strategic market goals.

Among the many examples emerging across the country:

  • At the six-hospital, Detroit-based Henry Ford Health System, executives and managers already have more than 110,000 patients enrolled in the system's patient portal, according to Bruce Muma, M.D., chief medical officer at the system's West Bloomfield Hospital, and Pamela Landis, the health system's director of Web services. In addition to providing patients with the capability to request prescription renewals, obtain laboratory and other test results, and request physician appointments, patients at four of the system's medical centers are able to engage in e-visits with physicians. The e-visits are of two types — one in which a patient can get rapid response from a clinician on an urgent, but not emergent, condition, and the other in which the patients with chronic conditions regularly provide essential health data such as blood pressure, blood sugars, etc., to their physicians, and receive feedback online. In this, they also use Medseek as their solutions vendor.

  • The two-hospital, 1,272-bed Christiana Care Health System in Wilmington, Del., went live in November with a patient education, communications and entertainment suite solution from GetWellNetwork, Bethesda, Md., that has turned the television set in every patient room into a Web-enabled computer. Using that company's solution, the health system pushes personal health information content to patients and families during hospital stays, guides patients through patient education modules (on topics such as smoking cessation and congestive heart failure), and gives patients the opportunity to make housekeeping requests, and provides for patient compliments/complaints messaging, all through closed-circuit video, says vice president and CIO Steve Hess. Though as of press time, the solution had only been live for fewer than three months, Hess says initial anecdotal evidence confirms that patients love the solution, and that it is not only enhancing the patient care experience, but also making certain processes, such as granting housekeeping requests, far more efficient.

  • Steve HessThe 483-bed Mercy Hospital in Miami has begun using a video foreign-language interpretation service from Las Vegas-based Language Access Network that provides clinicians and patients with interpreters for numerous foreign languages (including American Sign Language) via closed-circuit television. The economics and dynamics of the healthcare interpreter market have been such that it's been difficult to provide adequate interpreter services 24/7 in the variety of languages needed in diverse healthcare markets such as South Florida's, notes Francis Richardson, vice president, acute inpatient services, Mercy Miami. In addition to improving the patient experience, the video interpreter service also optimizes the efficiency of physicians, nurses, and the entire emergency department, Richardson says.

  • In Columbia, Mo., the 24-physician orthopedists' group in town, Columbia Orthopaedic Group, was at press time rolling out a combination electronic health record and patient portal solution from Scottsdale, Ariz.-based Integreat. CEO Gene Austin says that his group's selection of that particular EHR vendor had to do with the flexibility it offered in terms of a combined EHR with patient portal capability. Among other things, he is hoping that the patient registration process will be significantly streamlined — to everyone's benefit. "It is a dual strategy," he says. "It is about efficiency, but it is also to enhance the patient experience."

  • The 100-physician Westchester Medical Group in White Plains, N.Y., has implemented the MediKiosk solution from Galvanon, Orlando, Fla., to automate patient registration, the last remaining paper-based process in a fully automated group practice. Simeon Schwartz, M.D., president of the medical group, notes that patients "want to be able to walk into the physician and quickly be seen. Anything we can do to that minimizes the amount of time the patient has to spend checking in or going through the paperwork of the practice, improves the patient experience," and adds to the group practice's operational efficiency.

  • In Roanoke, Va., the eight-hospital Carilion Health System has been live for three years with a bed management/capacity management solution from Pittsburgh-based Tele-Tracking Technologies. The hospital system has gone from 20 percent of "bed awareness" to 81 percent, according to Tammy Kemp, executive director of nursing support services. Higher bed awareness means that managers at the health system know 81 percent of the time when an inpatient bed has become empty and is ready for cleaning and for a new patient, she explains. Like other busy, popular health systems, Carilion has developed capacity issues in the last several years. Using a capacity management system, Kemp says, has "helped streamline processes and hopefully be able to accommodate patients who needed acute care services more effectively."

The CIO's task: turning strategy into gains

The above examples illustrate the broad range of emerging technologies that are helping patient care organizations improve the patient experience while, at the same time, optimizing operational efficiencies. Automating the patient registration process, for example, pleases patients, while cutting down on the staff needed to do paper-based intake. Providing remote-based interpreters via closed-circuit video not only makes the linguistic interpretation experience far more palatable, is less costly, more efficient, and provides more opportunity for quality care improvement.

The challenge for CIOs is to translate broad mandates for patient satisfaction and operational efficiency improvement into specific investments, and to manage a growing laundry list of initiative-based priorities. "As CIOs, we often get hung up with day-to-day things, but you have to keep mindful of (your organization's) overall strategies, and where healthcare is going," Alegent's Lawonn says. "We've always tried to align all of our IT projects around our corporate business strategies."

And though these patient service programs can to some extent make CIOs' work more complicated, they can also provide supports for helping CIOs achieve strategic objectives. For example, Christiana Care's Hess says the GetWellNetwork patient education solution enhances his organization's progress on strategic goals. For example, he says, "We have to find ways to help patients manage pain, but existing pain management systems are geared towards pharmacy and nursing operations and require a lot of two-way conversations with the caregiver, who then has to enter information into the system." With an automated, patient-controlled input system that allows patients themselves to initiate input using a TV remote, he says, "That contributes to the care process. When you think of it as an entry point to your systems, I see it as an enablement rather than as an impediment."

"We have to find ways to help patients manage pain, but existing pain management systems are geared towards pharmacy and nursing operations and require a lot of two-way conversations with the caregiver, who then has to enter information into the system".

What's important, Hess continues, is for CIOs to collaborate with other executives from the stakeholder departments in their organizations affected by these patient service enhancements, in order to develop processes to evaluate their success over time. He and his colleagues, he says, are interested in measuring the degree of patient satisfaction, staff efficiency, and care quality improvement that the GetWellNetwork solution brings to their organization. As a result, he reports, "We created some milestones and goals around nursing efficiency, quality of care, and some ROI in terms of revenue as well, for the solution." Documentation of such improvements will be strategically important going forward, he says.

"We created some milestones and goals around nursing efficiency, quality of care, and some ROI in terms of revenue as well, for the solution."

So will the local market differentiation that can be achieved, of course. "An important component of our strategies is to provide something not common in the market, but that we possess," says Henry Ford Health System's Muma. "And the easiest way to describe that asset is teamwork. We have a fully employed, large medical group at the core of our health system, and we're totally connected. We went paperless with our EMR about five years ago, and our IT connectivity gives us a big advantage in the market, and the patient portal just leverages that even better. So the faster and better we can connect patients to care, the better."

Finally, there's no question that healthcare consumers are becoming more and more aware of the potential for technology-based enhancement of the patient care experience, just as they have become accustomed to ATMs in banking and online reservation-booking in the airline industry. "One factor in all this," says Columbia Orthopaedic's Austin, "was the realization that this was the direction in which things are moving, and that there's a growing perception on the part of patients that using this kind of technology has a positive impact on the quality of care."

Mark Hagland is a contributing writer based in Chicago.

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