HIMSS: Optimizing IT for accountable care
LAS VEGAS—Data can and should be used to make care better, said Andrew M. Wiesenthal, MD, director at Deloitte Consulting and former national physician leader for Kaiser Permanente’s HealthConnect project, during a Feb. 20 presentation at the 2012 Healthcare Information and Management Systems Society (HIMSS) conference.

Organizations interested in beginning an accountable care initiative can use clinical systems, he said, or those with efforts already underway can use them more efficiently. Accountable care results in “systematically improving healthcare and becoming, if you want to, a system of care that is accountable for some form of outcome for a defined population, be that a condition or geographic region.”

An accountable care endeavor has some crucial core capabilities, Wiesenthal said, including the following:
  • Clinical leadership and governance: Informatics capabilities are important but making wise decisions about how to allocate money is work best done by doctors and nurses.
  • A culture of continuous improvement.
  • Incentives aligned around quality, service and cost.
  • A guiding strategy that addresses where we want to be in healthcare and how are we going to get ourselves there with the resources we have.
  • Supportive operating processes: "Re-engineer processes in ways that work well for our patients and for us. No information loss when patient moves from one level of care to another. Plan moves with the patient."
  • Care coordination across the continuum and within care levels and sites.
  • Information that supports integration.

“We’re so used to working without patient data that we don’t even notice” when it’s not there, Weisenthal said. But, to keep the quality improvement cycle going organizations have to keep measuring. “There are all kinds of measures, so many that the resources we have are often exhausted by the seemingly exhaustive supply.” The trick, he said, is conducting measurements that support an organization’s strategic goal.

Many believe that implementing clinical IT will solve problems but in fact, clinical IT is a necessary but insufficient element in the creation of information, he said. Measurement is possible but inadequate in terms of quantity, quality and timing in the absence of “good IT.” Good IT helps enable the delivery of sufficient high quality (reproducible and credible) data in real time, when action to improve outcome is possible. In other words, workers in the system can use that information to improve care immediately.

Good IT can lead to good real-time information about clinical operational quality, safety efficiency and cost, he said. That real-time information offers several benefits:
  • Allows clinicians and managers to get processes under control and to improve when desired.
  • Allows error trapping.
  • Allows transparency to patients, families, accreditors and regulators. For example, using statistical process control is extremely informative when it comes to reducing wait times. “If you put yourself in the place of a patient’s loved one, you know that the hunger for real-time information when someone you love is acutely ill is almost boundless.”

Having the appropriate measures can help an emergency department reallocate resources to keep wait times under control. Reallocating staff reduces risks to patient safety, reduces cost per unit of care and increases patient satisfaction, Wiesenthal said. “Using IT to underpin these methods is the good work we can do with clinical systems and reporting.”

Most EHR system configuration is initially geared to maximize adoption. The problem, Wiesenthal said, is that most organizations want to make the system easy to use and as recognizably close to old processes as possible. “If you put technology in the hands of people who don’t know how to use it optimally, you’ve just automated old, clunky processes. If you implement in a manner that replicates your current workflow, you have to go back and optimize.”

Wiesenthal said the choices are either being ready for optimization by doing the configuration work in advance or plan to reconfigure after implementation.”

To optimize an EHR, Wiesenthal said it’s important to target the benefits you’re aiming for because that gets your organization’s chief financial officer on board with the effort. That role is concerned with the clinical quality and efficiency pay-off for this enormous investment. If done right, you have series of concrete measures. He also said “you don’t ever want to underemphasize or underestimate the change management costs of these deployments over time.”

If the process isn’t done right, he said more than 50 percent of the total cost of ownership is lost productivity and change management. “If you aren’t prepared to make this investment with your eyes open and target the benefits and invest beyond the day of go live, this is what you’re going to lose.”