The coming storm in healthcare #healthcare #BPM #EMR

Regardless of the Supreme Court decision on Healthcare Reform at the end of March, many elements of healthcare reform are here to stay. At issue in the Supreme Court decision is the ability for the Federal Government to mandate that every citizen have healthcare or face tax penalties. But there is much more to a broader agenda of healthcare reform that will drive new business activities and technology.

These will be on of the biggest process and technology transformations in our history. If we’re smart, we’ll involve events, rules, social, mobile, continuous improvement, supply chain and every other ‘new’ way of doing business. You’ll find the details in the following three articles, but before you fall asleep reading the titles, read below:

Each one of these ideas is a critical part of where healthcare is going in the future and will very much affect everyone’s treatment and its price. All of this change will be an enormous undertaking for the healthcare industry (Insurers AKA ‘Payers’ and Providers). Nothing this big happens easily.

Outcome vs. fee-for-service

The greatest transition is the move from health care providers as stand-alone silos of increasingly costly service to a cohesive network of organizations measured by patient health outcomes. You can’t dispute that this is a necessary thing, but why is it so difficult?

For starters, medical professionals have been compensated for discreet services that have an associated fee. This was the reason for the creation of the ICD-9 codes that are now obsolete (more on that in Part 2). Measuring outcomes is an attempt to end ‘coin-operated’, silo’d healthcare. Restructuring this model from a payment and technology angle is an enormous challenge.

Healthcare collaboration

Breaking down treatment silos also means being able to move data in a privacy-protected way (those privacy protections are known as HIPAA regulations). Electronic Medical Records are the first step and will be covered in Part 1. This is much more than reducing the stacks of paper in storage. When doctors notes, treatment plans and prescriptions are on paper, there’s no way for that information to be used by the physiologist, the radiologist or the outpatient facility. It is very difficult to expect a collaborative outcome if there isn’t a modern, protected way for everyone involved to share information. The outcomes are also much more difficult to compare and analyze. Keep in mind collaboration doesn’t have to be through traditional means (nor should it be).

Secure, enterprise-level social media is powerful form of EMR and a brilliant collaboration platform that can bring together the patient, the medical professionals and the patient’s support community (i.e. non-medical).  This is game-changing and needs to be thought through.

Information transparency

Once everything becomes electronic, it can be moved between applications in a standard way. This won’t happen if traditional healthcare technology vendors continue to build applications and systems that won’t expose data easily so that it can be shared.

At some point, avoiding this becomes a critical part of the healthcare reform plan (more on that in Part 3). Many systems have been built on keeping data ‘inside the walls’, which coincidentally ensures that healthcare IT customers are forever stuck with software. This practice is known as vendor lock-in. The traditional ‘vaults’ of information need to be opened or replaced, and that won’t happen without a fight.

A recent TechCrunch article compared the state of healthcare IT to where Newspapers were a few years back…acquiring, taking on debt, and not modernizing.

OK, now you’ve gotten the overview of the storm that’s coming. When the dust settles, we should have something better than today, regardless of political issues.

Next up, Part 1 – EMR Shortfalls

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Categories: Featured, Healthcare

Author:Chris Taylor

Reimagining the way work is done through big data, analytics, and event processing. There's no end to what we can change and improve. I wear myself out...

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15 Comments on “The coming storm in healthcare #healthcare #BPM #EMR”

  1. February 4, 2012 at 3:12 pm #

    Gives a good idea of the healthcare HC issues and the central role of DATA. The opportunity for IT and BPM to ease HC can be seen. Let’s see how they (we) can avert or at least minimize the damage of the gathering storm.

    Please provide more links to authentic HC-IT-BPM sources.

    • February 4, 2012 at 3:16 pm #

      Putcha, let me know what you mean by more links to authentic HC-IT-BPM sources.

    • February 8, 2012 at 3:32 pm #

      Hi Putcha,

      I’ve collected almost a thousand links (should pass that milestone later this month) on the HC-IT-BPM nexus and publish them (about couple dozen a week) at http://ehr.bz . It’s sort of a two-dimensional, annotated set of bookmarks I created for my own use but decided to publish. If you search the homepage for “BPM” you’ll get a couple hundred hits. A majority of the links are about BPM, workflow management systems, workflow engines, adaptive case management, process-aware info systems etc. and relevance to healthcare, particularly EMRs, EHRs, and HIT. I also tag them using a merged HC-IT + BPM taxonomy (of my own devising, not yet exposed, but working on it). Most of the links on http://ehr.bz pass through http://twitter.com/EHRworkflow where I tweet about (from the current bio) “EHRs, EMR Workflow Systems, Process Mining, BPM Business Process Management, Usability, Cognitive Science, mobile health”.

      Hope either resource might be useful to you.

      Cheers

      Chuck

      Chris,

      Love your stuff, especially about BPM and healthcare!

      –Chuck

      • February 8, 2012 at 3:36 pm #

        Thanks, Chuck ( or is it Dr. Chuck)? I’ve enjoyed writing the healthcare ones as they are also deeply personal. I will check out those links.

        Chris

      • February 8, 2012 at 5:50 pm #

        Thanks Chris:

        Can you please provide introductory links to “Healthcare needs and how IT is to be used”?

  2. Tom Bellinson
    February 5, 2012 at 5:53 am #

    Healthcare processes often contain the classic supply chain process issues — cooperation. That cooperation extends beyond various caregivers and diagnosticians to the patient. And, therein lies the problem.

    I am reminded of an excellent book on Consulting, Perfect Consulting, by Peter Block. Peter has spent his whole career talking about Stewardship (another of his books) in one form or another. In his consulting book, he points out that most consulting clients expect a doctor-patient relationship with their consultant and it is the consultant’s job to build a partnership where both parties have equal ownership of the outcome.

    The fact that the doctor-patient relationship is analogous with a caregiver providing treatment to a passive participant strikes at the root of the problem. People in other countries that have better healthcare systems “own” their health. Many health problems stem from simple life choices: obesity, high cholesterol, heart conditions. These are the biggest killers and they are avoidable if the patient does simple things like eating right and getting regular exercise. Doctors tell their patients these things; that is their part of a good process. But, the patient must perform this part of the process…and most of them don’t. So, instead doctors patch them up with expensive drugs and surgeries.

    The legislation as proposed has some good modernization steps in the IT realm and maybe when some patients can see the notes about their health in the official record it will wake them up, but ultimately, nothing gets fixed until people start owning their health in large numbers. To that end, I’d rather see the government spend the money on a massive marketing campaign aimed at getting people to take responsibility for their own health. Yeah, right.

    • February 5, 2012 at 9:32 am #

      Tom, while I agree that everyone needs to own their own health, that isn’t the focal issue of healthcare transformation, nor something that we can bank on. I would argue, in fact, that this is the political issue behind most people’s stance on healthcare (what is the government’s versus the individual’s responsibility). Regardless of the success at getting people to own their own health, this is an industry that is more than 12% of the GDP, antiquated and crying out for modernization.

      BTW, I spend a good amount of time in Europe and Canada and they don’t own their own health more than anywhere else, to this humble observer.

      • Tom Bellinson
        February 5, 2012 at 10:50 am #

        That’s an interesting observation about Europe. The statistics I have seen show that obesity and heart condition issues are considerably lower in all of Europe, although some countries more than others.

        Regardless, I would agree wholeheartedly with you about the medical industry’s need for reforms. The good news is, they are starting to get on-board. All the major hospitals are begging for lean training right now. I have a friend who is part owner of a company that serves the medical industry (www.arshlt.com) by providing inventory control systems along with new processes to gain better control of inventory (which is a source of huge losses). Their phone is ringing off the hook.

        They may be coming late to the dance, but the medical industry has awakened.

      • February 5, 2012 at 11:14 am #

        Yes, obesity and heart condition issues are lower in Europe, but on the rise as their diet moves more toward an American one. When lousy food is cheap and plentiful, and people are stretching a budget, the results will be the same regardless of country. That lousy food is becoming much more plentiful and the effects are showing up.

        I’m glad you brought up Lean. What has been standard in manufacturing has been ignored in healthcare. What I’m hoping to see is an end-to-end focus instead of SWAT-team tactics that solve only one problem at a time. That end-to-end can’t be possible without information flows and activities that can be understood and improved.

  3. February 7, 2012 at 11:36 am #

    Chris,

    Great article. I think there is another major force that is working on many of the large healthcare institutions right now around how they are reimbursed for services provide to patients using the Government-funded insurance plans (Medicare, Medicaid, etc.). Unfortunately, it is another acronym, HCAHPS, and it basically holds back a portion of the reimbursed funds that an institution is allow based on the results of the patients’ treatment experience with their institution.

    Many institutions are scrambling to understand the patient experience better and ensure they offer a great experience to maximize the amount they are paid for a service they’ve already incurred the cost to provide.

    I think there is a huge opportunity here for systems to use the data, process, and information sharing tenets you pose above to ensure a strong patient experience. Basically, strong process and data management will ensure the patient is well taken care of, not just treating their disorder/disease, but also how well they are treated before, during, and after their visit. Basically, many of the principle Ranadive and Maney set forth in “The Two-Second Advantage…”.

    Sound process, data, and collaboration management will result in not only better cared for patients, but also better cared for customers. Something healthcare has struggled to realize for a long time. Patients are customers…

  4. February 7, 2012 at 3:05 pm #

    Ron, great response. There’s another piece coming out shortly that will go into EHR/EMR and HIE (health information exchanges) and the problems we face when data is fragmented and locked in silos. The whole idea of data is for it be useful ‘in motion’ rather than ‘in silos’. For that to happen, there needs to be a concerted effort to do more than gain certification, but to develop the predictive analytics to spot problems before they occur, see issues across patient populations and communities, and reach the goal of better care at an affordable cost. Thanks for the comment!

Trackbacks/Pingbacks

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