Healthcare IT Insights: Healthcare IT Expanding in 2012

The market for healthcare IT is predicted to expand even more than it already has, the consumer/customer relationship should improve, and the payer and provider markets are becoming intertwined. We had the opportunity to interview Janice Young, program director for Payer IT Strategies at IDC Insights. She weighed in on these issues as we discussed her role in healthcare IT, her reflection on 2011 and what she sees coming in 2012.

HCITS: What is your role in healthcare IT?

Young: I am a technology analyst for the healthcare payer insurance market. We look at business evolution in the marketplace and then we assess and advise our clients on the technologies that may be best suited to help them be successful both in the current marketplace and in the future as the market evolves. Obviously, in the world of healthcare reform in the U.S. right now, there is an extremely rapid evolution of market and business dynamics, and technology follows very closely behind that. So we provide strategic assessments and direction as well as assessment of particular types of technology and how they can be deployed and used most effectively.

We do essentially a “hype cycle” analysis to identify when a technology might be new and when it might be ready for broader use in the industry, when it is being tested, when its cycle has come to an end and when new technologies will be acquired in its place. We talk about business strategies of how to do that.

HCITS: In your opinion, what is happening on the payer side that is truly impacting the provider side?

Young:  Especially in the U.S., the payer and provider markets are becoming more and more intertwined. One of the main focal points includes the evolution and introduction of accountable care organizations and medical help, where healthcare plans are shifting risk to providers for responsibility for both financing and care of individual members and, simultaneously, health plans are beginning to acquire technologies, if not provider organizations as well, to develop their own accountable care organizations. In the U.S., the notion of who manages the insurance risk and what entity provides the actual care is becoming a little bit more ambiguous between health plans and provider organizations. I see a lot of investments in health plans in provider technologies, and I see a lot of investments in technology organizations that traditionally have focused on the healthcare payer marketplace.

HCITS: What technologies were hot in 2011? What is your insight for 2012?

Young: The most significant technology investments in 2011 in the healthcare payer marketplace are generally focused on business intelligence strategies and care management. When we polled our healthcare payer audience in late 2010, the top investment categories were in three specific areas, all of which link directly to reform mandates and initiatives. The first investment strategy was the finance consumer sales strategy and the investment and analytics to understand more about consumer investment in solutions and tools that one can deploy in a portal environment to enable a consumer to choose and select benefit plans and to improve the sales process. The other two categories that were even more widely adopted and of higher priority than the consumer focus were healthcare business intelligence/analytics tools and health and care management technologies and solutions. In order: one, business intelligence; two, health care management; and three, automated consumer sales and solution tools.

HCITS: Based on your prediction for 2011 that healthcare payers will increase investment in and acquisition of technologies, do you think this has occurred thus far?

Young: I do. Heath plans have certainly invested a lot in the three categories I just pointed out and there is clear and continual investment—and a lot of activity—in the health plan arena in health management strategies and business intelligence and analytics, without question. We are also hearing, as we come to the end of 2011, there will be some additional investment in provider technologies and some movement toward the finance side, or the provider side, and provider revenue cycle management solutions as well.

One of the underlying assumptions around the predictions of increased investment in technology is that health brands have deadlines for healthcare reformat that they have to comply with for medical loss ratio as well as other features. And, for any sort of player in the accountable care organization market, now is the time to invest in and deploy those technologies and even provider assessments as well. It is a very hot topic; the technology sector for healthcare in the U.S. is probably one of the hottest employment areas and we can see that it is a very feeble job market, so there is lots of investment and lots of activity. The final thing that we should mention is that there is an ICD-10 mandate coming in the next year as well so health plans need to continue to invest to demonstrate that they are complying with the ICD-10 mandate. Over 60 percent to 70 percent of health plans that we surveyed said they would be increasing their technology investment in 2011 and, given all of the mandates, it may be even higher than that.

HCITS: What do you expect in 2012 around consumer/customer relationship management?

Young: 

What we expect in 2012 around consumer/customer relationship management is the following trends. The first is increased automation and investment in portal solutions so consumers can go into a portal to look at benefits, to select benefits, to have automated enrollment. So, first is the investment in the general automation of the customer relationship management process and to integrate various process steps including some of the financial aspects of enrolling and then paying for being in a health plan—the billing process and the rest. That’s pretty fundamentally strictly defined consumer/customer relationship management capabilities. So, there is a lot to do in healthcare—a lot of automation, a lot of investment that could still take place to improve both independent processes and the integration of those processes.

Secondly, we expect investment in health plans to understand more about consumer dynamics as they enroll—the application of technologies that have been used in retail markets and financial services markets to understand what types of consumers enroll in particular products, how best to reach out to them, what types of triggers and additional information we should provide at the point of sale at the end of the automated process, etc.

Thirdly, the additional linkage point for customer relationship management will be moving into integrating with health and wellness and care management aspects. As we know, if you catch a human earlier in the disease process or before the human gets sick, you can avoid cost of care, cost of illness, cost of services—so, the idea is once upon enrollment to know more about the individual customer or consumer and be able to present them with health and wellness, or care services, that are appropriate and will drive toward improved outcomes and reduce illness.

So, the three things to expect are: one, creating a better automated process, which other retail and financial services banks have succeeded at; two. creating more integration around care and health earlier on in the process to learn what the consumer market requires and how to move solutions more rapidly; and three,using analytics to understand the sales process and also consumer behavior as you present options for health and wellness and disease avoidance. So, those three are the integration parts that we see with CRM.

HCITS: What are the top two things that you get from the Healthcare IT Summit? Why do you feel people should attend the event?

Young: The top reason to go to the Healthcare IT Summit is the opportunity to speak to peer organizations and to create some friends and some industry contacts and collaboration around the challenges that we all face in the industry. It creates a good opportunity to understand, share and talk about the best practices and solutions that you might be facing in your own environment; the discussions are good.

The second reason is for the content; the event has really nice content, which can provide both the current-day solutions and challenges and a road map into future environments. The content is a way to both understand how to solve current tactical problems as well as to get your intellectual business juices flowing so that you begin to look a little further down the road and understand that what you are doing today needs to fit into other decisions that you will be making next year. We know that it is a rapidly changing market, and it is more important to have a strong handle on your tactical decisions as well as really continuing discussions on where the future will go and what opportunities you might want to take advantage of and how your current-day technology or business decisions affect what you might want to do in the long term—maintaining flexibility and improving your ability to remain agile and adaptive. A lot of shared insights can be helpful for developing both that business and technology strategy.

Vendor Spotlight: Control Your IT Spending With NPI

How do you implement compliance solutions without severely impacting your IT budget? How do you know if you’re spending too much? What are the common mistakes made in the IT purchasing process? Jon Winsett, CEO of NPI Financial, answers those questions and more. NPI provides spending management consulting services and helps companies reduce IT costs while organizing their IT budgets.

HCITS: What are you doing to help healthcare CIOs control IT costs?

Winsett: IT spend management in the healthcare industry is critical—more so than it’s ever been before. Compliance pressure is causing the industry to buy new solutions that many CIOs have little experience in purchasing—EMRs, HIE, etc.—and these new applications are, in turn, driving infrastructure upgrades—in some cases, unanticipated and rushed.  The conditions are ripe for overspending.

NPI reviews thousands of IT purchases each year. We have benchmark data that enables us to determine what’s a fair price and what isn’t. Because we’re intimately familiar with vendors’ behavior and contracting tactics, we know how to optimize the contracting process for the buyer. All of this knowledge typically translates into a 20 to 30 percent reduction in an IT purchase price.

HCITS: Given the nature of your business, what is your relationship with healthcare IT vendors?

Winsett: Our responsibility is to protect our clients from overspending, but that doesn’t mean we’re ‘anti-vendor.’ In fact, we take great care to respect our clients’ vendor relationships. When we advise healthcare CIOs through the purchasing and contracting process, we make sure that we’re creating a win-win for everyone. It’s not in our clients’ best interest for their IT vendor not to be successful. We just want to make sure pricing, terms and conditions are fair. Because of that, NPI has earned the respect of IT vendors.

HCITS: How prevalent is IT overspending in healthcare?

Winsett: Extremely. NPI has found that healthcare organizations typically pay 20 percent too much for the average hardware, software and telecom purchase. For a large McKesson implementation or Microsoft Enterprise Agreement, the difference can be in the seven figures. That savings can fund other initiatives, preserve jobs or go straight to the bottom line.

HCITS: What reaction do you get from CIOs when you tell them they’re paying too much?

Winsett: Most healthcare CIOs are diligent in the IT purchasing process so they’re surprised to learn the extent to which they’re overpaying. We have to remind them that this isn’t due to sourcing or IT’s oversight. The average IT or sourcing department only sees a handful of new, large-scale purchases each year. We see thousands. With that comes real-time, objective pricing and contracting insight that they could not possibly acquire on their own. We arm our clients’ sourcing professionals with data and vendor-specific expertise that makes them more effective.

HCITS: In your experience, what is the single most common mistake made in the technology purchasing process?

Winsett: The biggest mistake is not benchmarking pricing for their existing vendors. Healthcare companies are deeply entrenched in their incumbent vendor relationships. They don’t often take the time to compare Microsoft’s pricing against an alternative solution because they could never imagine leaving Microsoft. If they did, they would realize that they could gain leverage that would help them negotiate down their licensing agreements and improve their incentives and discounts.

Another mistake is buying bundled offerings. At NPI, we like to tell our healthcare CIOs to “beware of the bundle.” Oftentimes, it’s a slippery slope that leads to buying more product/service than you actually need.

HCITS: Where will healthcare CIOs overspend the most in 2012?

Winsett: NPI has identified seven IT purchases that are ripe for overspending in the coming year:

1) Coding and billing Systems

2) EHR/EMR

3) Storage and archiving

4) Business intelligence

5) Security

6) Ethernet

7) High availability

In nearly all of these areas, there is a major compliance or business driver that is increasing demand for these solutions—which, in turn, gives vendors more leverage in pricing and terms.  

Which EMR/EHR System Do You Use?

IT leaders in the healthcare provider space must choose their electronic medical record software very carefully— it houses their patients’ pertinent information and is somewhat of a lifeline to the providers’ service. 

I spoke with four different healthcare IT leaders about which EMR system they use and why it is successful. As something so important to their IT infrastructure, I expected there to be a repeat of at least one system, regardless of their varying areas of healthcare expertise, in the hopes of finding one system that is said to be the absolute best among CIO opinions. However, instead I came to find that not only did all four IT leaders give me different EMR systems as their answer, but they also had significant reasoning as to why they chose it and why it is successful for them.

           One EMR platform mentioned was UNI/CARE Pro-Filer, which “I think a couple of the key reasons for its success are the customer support from UNI/CARE and the fact that it is utilizing a Microsoft SQL database,” says David Bozwick, the Director of Technology Systems at Community Health Center in Akron, Ohio. “Profiler™-2011 supports multi-company processing and multiple business lines within a single database. This means it can collect unduplicated information -- such as client demographics -- as well as financial and basic clinical information, such as allergies, vitals and diagnoses. For CIOs, this means all their companies utilize the same database, and multiple companies’ reports are easily accommodated. And supporting one database is much more efficient. In addition, CIOs like Profiler™-2011’s Service Oriented Architecture. It utilizes standard Microsoft tools for easy deployment and support, allowing them to achieve rapid adoption and interoperability,” says Dr. May Ahdab, CEO of UNI/CARE.

          “CIOs also look to us for support. Our support services rely on a ticket tracking tool that documents requests, establishes a prioritized action plan, and then tracks the status of our response and final solution.  Our system allows CIOs to monitor and document requests and their resolution.”

           Longitudinal Medical Record (LMR) was the second EMR platform mentioned in my conversations with the IT leaders. Moshe Coriat, the Systems Engineer at Partners HealthCare Systems said that they use LMR because they are able to spend more time with their patients and easily share data with other clinicians across the organization. “LMR was developed in-house and it represents a key component of the Partners information system strategy. World-class medical informaticians and researchers within our organization are closely involved in the product design and development,” said Coriat.

           Another EMR platform is the Misys platform. Craig Cypress, the Director of IT at ProngerSmith Medical Center said that they currently use the Misys platform, but are moving over to an AllScripts Enterprise product 1^st quarter next year. “I believe at the core the success is in the efficiencies gained by all,” said Cypress.

The last EMR platform of choice by these IT leaders was ShareCare from the ECHO Group. This electronic medical record system is for a Behavioral Healthcare environment; therefore, Dr. Earle Charles, the CIO of Kedren Mental Health in Los Angeles, CA, presented this system as the EMR that he uses. “We have had it for a few years but have not fully implemented all of its modules…over the next months we are planning to assess ShareCare as well as other products to address my fundamental need for a solution such as this, which is ‘ease of use’ for my users, especially the Clinical staff,” said Dr. Charles. Of course features, functionality and quality are just as important and they are expected to be in all candidate solutions that we will be looking at. The parts of this product that have been implemented are successful, however, the remaining modules would require a fair amount of customization for our users and I am not certain that I am going to go down that path at this time.

Regardless of what system you use or what software you implement in your healthcare provider organization, it is important to consider the varying options that are out there—your EMR/EHR system can never be too good, it can only get better. Your patients put their personal information in your hands with trust so it is only fair to them to ensure that it is completely safe and ready for use whenever needed. 

CIO Spotlight: How IT Succeeds In Long Term Care

Scott Ranson, Chief Information Officer, Brookdale Senior Living

Brookdale Senior Living is the largest long-term care provider in the U.S, with 660 locations and the capacity for nearly 70,000 senior Americans. Brookdale covers independent living, assisted living and memory care and is the nation’s provider for free-standing memory care for dementia customers.

HCITS: What are your IT initiatives for 2012? What projects are you working on?

Ranson: The long-term care industry is a little bit behind the technology curve of acute-care hospitals and doctors offices; however, we are innovating a large enterprise wireless deployment next year with 52 million square feet of communities to cover in wireless next year so, we have a very large initiative on that. We are also working on our electronic medical record platform for long-term care. For hospitals, organizations like Cerner and Epic have been staples in that industry and there is no Epic or Cerner in long-term care, so we are implementing a best-of-breed solution to come up with our electronic healthcare record applications inside Brookdale for interoperability as denoted in the Obamacare announcement a couple years ago.

In this pretty tough economy we aren’t doing as many projects as we would like, but we are going to be doing a risk assessment on the technical side of IT and will be doing some security audits and analysis around our security. It has been said that people over 70 years of age are one of the largest growing segments for use of the Internet. So, we are also working on a very progressive program where we are rolling out Internet Cafe´s into our communities and are staffing it with training folks to help seniors get on the Internet and do things like Skype, Facebook and work with internal applications inside the community. We have a big initiative on helping seniors get on the Internet to connect with their kids and grandkids—we have heard some really inspiring stories about grandmas who are texting with their grandkids in high school so it’s really great.

HCITS: As a CIO for a healthcare provider, what issues do you face?

Ranson: One of the things that we face in our industry is the data access vs. privacy—if you lock everything down you might inhibit the business from getting done so there has to be a fine balance between data access and privacy. That certainly is a challenge that we look at every day.

As I mentioned earlier, our strategic projects such as our electronic medical/healthcare records and interoperability pose a big challenge for us because in the stimulus package there was a lot of money for acute-care hospitals and doctors offices while the long-term care industry got virtually zero money. If you look at the people over the age of 70, they spend more time with us than they do at the hospital (they may spend four days at the hospital but stay 20 years with us), so we are challenged to make sure that long-term care is plugged in to the continuing healthcare of our senior Americans, but yet we haven’t gotten the same amount of money to do the same thing that the hospitals and doctors offices are asked to do.

HCITS: Do you have a good relationship with your organization’s business leaders (CEO, CFO, CMO etc.)?

Ranson: I would say absolutely yes—each one of those titles are members of my IT steering committee and we meet on an every-two-week basis, more often if needed to. There are six senior management individuals who comprise my IT steering committee and they drive the direction of the projects that IT works on. Any conflicts or “are we doing the right thing?” questions are always brought up in that group. I chair the IT steering committee, but those folks certainly have a huge interest in making sure the needs of the business are met by IT and they drive our decisions.

HCITS: What are you doing to improve that relationship?

Ranson: To make sure that IT is aligned with the business we have two other programs such as business process owner meetings with the VPs in the various departments and they meet with an IT management person—my person in charge of IT finance meets with the controller or VP of Accounts Payable, etc. They meet on an every-two-week basis so they make sure that the items that come out of the IT-steering committee have been driven down to a lower level and are executed on. Every business management person in the organization has someone on the IT staff that they are paired up with.

Likewise, the top 15 executives in the company are paired with a director, I call this the “IT buddy system,” and the VP or CIO in IT and we attend their staff meetings to make sure that we are listening to how the business is being run and we give that executive an avenue into IT. A lot of times they don’t understand IT and are afraid to ask the question, but if they have a good relationship with their IT buddy or executive sponsor, they develop this relationship and are comfortable calling them up and asking those necessary questions. That program has paid big dividends. I’ve done this for years and in a lot of conversations with other CIOs I’ve mentioned this program and it has paid big dividends for them as well once implemented in their organization.

HCITS: What are you doing in the area of BI?

Ranson: In the coming year, we are probably not focusing as much on BI as we have in the last two years. In the last two years we have significantly invested in the area of business intelligence by building our first data warehouse, implementing the now 20 terabytes of data in our BI data warehouse—next year is going to be spent expanding the use of that data. We have built it and some have come to use it; not as many are using it as effectively as they should. So, we are going to focus on reintroducing and re-educating our business leaders on the vast amount of data and knowledge that they have inside of our BI program. It is going to be more of a training year in our BI area as opposed to a building year.

HCITS: If you haven’t done so already, are you implementing a mobility plan?

Ranson: The answer to that is absolutely yes- the EMRs and the electronic healthcare program that I talked about today is intended to be deployed on mobile devices, specifically Androids, and we will probably be deploying 2,000-3,000 of those this coming year. We have a very detailed mobility policy, and it will encompass all of those devices as well as the 5,000 other mobile devices that we have such as BlackBerrys, smartphones and iPads today and we are, in a nutshell, giving all of our people eligibility for their choice of an iPhone, BlackBerry or an Android-based phone.

And, if they don’t want to use a company-provided device, we do allow bring your own device to work and we can connect and secure it, but there are some releases that they need to sign that says we are able to wipe the device if it is lost or stolen. We’ve already dipped our toes into the “bring-your own” program, and it has been a very popular program for us because some of our people don’t want to have both a work and a personal device, but instead allow those to melt together.

HCITS: Do you have a cloud-based infrastructure in place?

Ranson: Today we do not outsource much, although with our EMR and our electronic healthcare programs, two of the three best-of-breed solutions that we’ve chosen are software as a service. In 2012, we will be utilizing some applications in the cloud. We are working really hard to make sure we have all of the contracts and security correct as we roll out our solutions in 2012.

HCITS: What advice can you give other healthcare CIOs to improve their IT strategy?

Ranson: I would say to never lose sight of the business and business plans. You never want to hear that the company can’t do something because IT can’t move fast enough. And, I think that is a key differentiator for us in that we do have the CEO, CFO, CMO, COO and several other business executives involved in all of the IT decisions and help drive the projects that we do. We always want to be ahead of them trying to anticipate what we need to be flexible on in order to change so that the business can move forward.

HCITS: How is your role as a CIO transforming/changing?

Ranson: I mentioned earlier that long-term care is behind the technology curve—being the CIO for the largest provider for senior housing in the US, we are constantly on the bleeding or cutting edge of what we are trying to do. There are a lot of pieces of software out there for the long-term care industry that support 10, 15, 20, 50 maybe 100 or 200 communities, but nobody out there supports 660 communities like we do with some of our applications. So, we had to write a tremendous amount of the applications that Brookdale uses simply because the software is not available in the long-term industry. We can’t buy off-the-shelf software that was meant for a hospital or a doctor’s office and make it work in long-term care. From an IT perspective inside Brookdale, our role is very different than the IT role in other long-term care industries because we have 12,000 people logging onto our networks vs. their maybe 6,000 people. The scalability that we have had to figure with little help from the government or outside company has been very difficult.

Mobility On Our Minds

Mobility has become one of the main topics of discussion among healthcare provider CIOs today. Whether or not to mobile devices such as iPads and tablets within hospitals, doctor’s offices and other provider organizations is something that these IT leaders are strongly considering. As with everything in this world, mobility has its pros and cons within this space, so how do you know which route to take? Hearing the opinion of other CIOs may help, as well as understanding the benefits and drawbacks of either side of the decision.

From a patient point of view, it is definitely nice to not only see a healthcare provider embracing the evolving technology in the medical space, but it is also progressively nice to have them easily and manageably access their data from a handheld device right on the go within the hospital, office or center. When you need medical attention, why wait? We have the technology available—so, taking advantage of that to speed up the providers’ process is a huge advantage. Craig Cypress, Director of IT at ProngerSmith Medical Center, said, “This year we will introduce the iPad to our doctors. It makes sense for doctors to have access to data whenever they need it.”  

It has come to the point in time when it is impossible to ignore how an internal mobility strategy can impact your healthcare organization. Therefore, if a CIO hasn’t already implemented mobility, he or she is definitely considering it or piloting/testing the solution “Our senior team has begun a business process re-engineering effort in order to be prepared for what we believe will be the full onslaught of healthcare reform. We have not yet launched a mobile strategy, however, I fully expect that to be one of the natural outcomes of this BPR project,” says Dr. Earle Charles, the CIO of Kedren Mental Health in Los Angeles.

Although a majority of CIOs are embracing mobility, there are still some skeptics. The main concern with mobility in healthcare provider organizations is the safety of data. Although data security is important in all businesses and organizations, healthcare CIOs can argue that it is even more crucial in their space because they are dealing with very sensitive and personal information. HIPAA really cracks down on the safety of patients’ information. “At this point, I don’t have a mobile strategy. Due to HIPAA concerns, I try to not let any data escape beyond my walls. I can control my data, but not always the users,” said David Bozwick, director of technology systems at Community Health Center in Akron, Ohio.

The question on the minds of CIOs is not necessarily which mobility platform to use, but whether or not they actually want to implement a mobility strategy at all. This question is a difficult one to answer as security challenges pose substantial issues while new mobile technologies continue to catch the eyes of CIOs. It is because of these tough decisions that I can safely say that I’m glad I don’t have to make them! The ball is in your court, IT leaders—choose wisely, and consider all elements when making your decision.