Executive Director Oregon Health Network USA.
The worldwide healthcare landscape is more complex and multidimensional than ever. Over the past five years, acronyms, federal mandates, and funding streams have bombarded decision makers in a number of healthcare-related industries. From core operational infrastructure systems to billing, scheduling, electronic medical records use and administration, healthcare has transitioned from a delivery system designed and managed within a silo to one that needs to communicate in real time to the rest of the policy-making continuum.
Healthcare executives, providers, and administrators, along with local and federal politicians, are charged with addressing the pressing healthcare, economic, and workforce needs of their constituents. These issues are increasingly difficult to deal with, particularly because decision makers are not given the broader context of health information technology to help them prioritise solutions. The new emphasis on patient-centered care requires collaboration and coordination at the federal, state, and regional level, as well as full interoperability at the hardware, software, payer system, and patient care levels.
Formerly reserved for those with money and resources to invest, today’s health IT is no longer optional: it is a core requirement for all providers and agencies playing any role in the healthcare continuum. Furthermore, its adoption and use go beyond the traditional quest for pure competitive advantage; health IT is truly the only effective means to not only survive, but to thrive.
Oregon Health Network (OHN) is building a statewide broadband telehealth network in Oregon with hopes that this network model is then taken nationwide. OHN supports the Triple Aim, the revolutionary philosophy adopted by a number of key organisations, including the Office of the National Coordinator and the Centers for Medicare & Medicaid Services (CMS). The goals of the Triple Aim are to: enhance the patient experience of care (including quality, access, and reliability), improve population health, and reduce – or at least control – per capita costs.
These 12 health IT best practices are recommended guidelines for healthcare providers to understand what is required to achieve success, what they can influence (and what they cannot), and which partners and support systems are needed for success. This framework is not based upon the latest grant, mandate, or technological advancement, but upon the proven business and technological expertise and resources required to develop a viable health IT programme.
Until recently, the healthcare community did not have a commonly shared health IT solution goal. Decisions were made at the ground level, within the system walls created by providers, executives, and administrators. But the recent adoption of the Triple Aim changes all that – there now is a framework to build from and within.
The first step to any well-laid health IT plan is to take the time and effort to clarify your strategy and goals. Form must follow function. Think about your goals as a healthcare provider or facility: How do you (or will you) measure success as a result of your health IT strategy and plan? And even more importantly, how does your plan align with that of the surrounding communities, and within state and national plans?
Plan and build with the end in mind: an integrated healthcare delivery system.
Investing in—and integrating into—the national provider community is the most effective and affordable means to reduce costs and improve patient outcomes. Collaboration also addresses the pending healthcare provider shortage through expanded referral partnerships and supplements your health IT best practice areas.
Here in the USA, the Federal Communications Commission (FCC), the Office of the National Coordinator, and the Centers for Medicare & Medicaid (CMS) are working to improve and incentivize the quality of healthcare. These improvement efforts include mandating the meaningful use of Electronic Health Records (EHRs), funding Regional Extension Centers to assist physician practices in achieving meaningful use, and adding telemedicine services to the approved list of CMS services.
Like most healthcare organisations, the US federal government is in the early stages of facilitating true interagency coordination. This collaboration develops the programs and mandates that we work synergistically to support, not hinder, the transition from old to new. We are all in the same boat, and we need each other to achieve success. Each of us is empowered to play a positive role in transitioning to a better future: one strategy, decision, and sound investment at a time.
Regardless of whether we represent a public agency, a for-profit or nonprofit healthcare facility or provider, the pressure to do more and better with less is a common denominator. Under the developing new models, we’re all charged with thinking about how our facility, community, and state will connect to the healthcare delivery system via information technology.
The key to success in this new age of healthcare delivery is not only the interoperability of what is running on the network, but the broadband network or ‘highway’ itself on which health IT applications and hardware run. And once the network is built, it must be adequately supported and used.
Reliable, high-speed, high-quality connectivity is a crucial, but often overlooked, component for success. This is why Oregon Health Network is working to expand existing, and build new, broadband infrastructure across the United States to support the health IT requirements of the next generation healthcare delivery system.
What is your plan to serve your greater health IT strategy? What resources, tools (broadband internet, hardware, software, etc.) and supporting processes will be required to do so? And how will it be implemented to achieve success?
Success in this area requires more than funding; it also requires appropriate expectations based on measurable outcomes, research and measurement, and the right expertise to design a thoughtful implementation plan. While many of these plans are comprehensive in nature, a larger set is executed based on a specific use or application such as telemedicine / health, EHR, health information exchange, networking, video and others.
Consider this a critical ‘translation’ step of reconciling the approved strategy with the realities and limitations of the environment. These include, but are not limited to: access to resources (people, money, knowledge) and buy-in from leadership to set the implementation team up for success with their investment and awareness of all the 12 best practice areas.
The current HIT focus is on EHRs, but in the context of the other 12 best practices, it’s easy to see how EHRs plays an integral—but only supporting—role within the broader health IT framework. Our focus isn’t only about EHRs. It is about information. And more specifically, it is about getting the right information to the right person at the right time.
Why? At the risk of sounding redundant: to serve the Triple Aim. The demand for quality information will continue to increase worldwide. The key is to learn not only how to obtain and manage that information efficiently and effectively, but also to be able to share it easily and freely throughout the entire healthcare continuum.
Once a network is designed and implemented, it is important to ensure that we have the resources needed to support the strategy and solution that have been implemented. There will be continuous modifications and subsequent investments that tie directly to the measurement and education of your solution. It is paramount to ensure that you have the right people and resources to work well with your technical, business, and clinical staff. Support should be considered throughout the life-cycle experience: from the network level all the way through to the provider and patient or end user.
The goal of gathering information is to reduce costs and improve outcomes. Therefore, it is critical to regularly evaluate the success of health IT programmes and modify or adjust to meet those goals. The benefit of having access to ‘real-time’ information supported by health IT is that it provides organisational leadership with opportunities to adjust the course before you hit a wall. Consider it a proactive check and balance system. Therefore, it is not only important to allot time and resources for evaluating your programme’s success but also to measure performance in a way that directly aligns with clearly stated goals and metrics.
There is a wealth of information and metrics to gather, so be strategic and specific when identifying what you’re tracking and why. Here are some questions to consider
How has your new ENR system or telemedicine program served the Triple Aim?
How can you work with other healthcare providers and organisations to identify what and how the statewide community measures success?
What action will you take if you discover your program is not living up to your expectations?
Implementing new health IT solutions (from hardware to process refinement) is just the beginning. To experience the full benefits and improved outcomes of health IT, you need to encourage users at all stages and phases of the process, from inside your organisation to outside (i.e. other providers and patients themselves) to make full use of the solution.
Targeted, simplified, user-focused communications are a core component of strong education programmes. Simplifying complex information is a challenge, particularly when you are required to ask the user to change existing behaviours such as how to enter or retrieve information in a new system. Because people absorb information differently, consider providing the materials and trainings in a variety of formats-hard copy literature, electronic files, visual representations, and in-person trainings.
Strong health information technology is the number one incentive to attract higher wage-earning primary care physicians and other health professionals to a community. Keeping healthcare in local communities stimulates local economies by:
Increasing patient confidence (thus keeping the patient—and payment—local)
Increasing physician confidence (doctors across the region know that they have the support they need to answer some of medicine’s toughest questions, regardless of where they practice), Retaining and recruiting doctors in historically underserved rural communities
Attracting higher-wage jobs.
CMS and other organisations are working at the policy level to address the challenges faced with licensing, credentialing, and privileging for telemedicine. It’s important to keep an eye on progress, and to support the state and national organisations lobbying to make the much-needed changes.
Similar to licensing, credentialing, and privileging, making sure your physicians and clinicians are paid for the work they do via telemedicine (medicine across borders and facilities) is where the 'rubber meets the road.’ Thanks to several nonprofits, state agencies, and countless volunteers, Oregon is well on its way to overcoming reimbursement issues. However, work remains at the state and federal levels, and with insurance payers. This challenge can be overcome with innovation and collaboration, ensuring that all members of the healthcare continuum are reimbursed appropriately for all levels and types of care.
Legislation and policy refinement at all levels is critical to helping providers invest in solutions that serve the Triple Aim. From broadband network deployment policy to licensing, credentialing, privileging, and reimbursement, local and national organisations are working on your behalf to reduce the barriers to full use and adoption of a national system. Your voice and support is critical to their ability to do so.
All 12 best practices cannot—and should not—be performed by any one provider organisation. They require our community working together: provider, policy and funding sources, and nonprofits. The key, as a healthcare provider business, is to consciously determine what you can feasibly address on your own, and where you need to look to others for assistance. Gone are the days of doing it alone; providers have a wealth of experience and resources to share with the healthcare community.
Kim Lamb is the executive director of the Oregon Health Network, manages Oregon’s first statewide health care network, designed to support all providers with an infrastructure and suite of services necessary to support the next generation of integrated care. As the face of OHN, she educates diverse audiences about the value of health information technology, OHN’s vision and the importance of collaboration in serving the Triple Aim goals of CMS.