This is Part 2 in a series on healthcare spending. In this post I’ll focus on the four areas where health delivery organizations can focus their ever-shrinking resources to achieve greater value. Part 1, Are We Spending Too Much on Healthcare Information Technology?, can be found here.
1. Look Outside the EMR
As important as electronic medical record (EMR) companies are in the delivery of healthcare, they are just a component. As much as most EMR vendors want to push healthcare information technology back into a monolithic, one-size-fits-all architecture, healthcare IT is still a very heterogeneous application and technology environment. Critical data exists in many different areas on widely disparate platforms. Very important data lives in places like laboratory systems (hospital and reference), radiology systems (hospital and imaging centers), pharmacy systems (hospital and retail), payers (claims, eligibility, and member), as well as various wearable technologies that a growing number of patients are using on a daily basis.
2. Customers and Processes
Think about your business differently—maybe in terms of a social network and horizontal processes. As shared risk models become more prevalent, and as the number of stakeholders grow, this will become increasingly important.
Who/what is the social healthcare network? Certainly patients, but what about family, extended family, friends, physicians, nurses, pharmacists, technicians, etc.? All have a need for collaboration and a vested interest in the patient’s or member’s health. Additionally, processes are often managed and optimized within departments in hospitals (or silos). For example, radiological exams are scheduled, resources optimized, and tests performed with great precision within the radiology department.
The macro process, perhaps discharge, has many dependent steps that cross departmental or siloed boundaries. If the patient needs an ultrasound exam before being sent home, but the radiology department has no visibility into the fact that it’s holding up discharge, the department may give it a lower priority, resulting in an additional day’s stay for the patient. Gaining visibility into the process horizontally instead of vertically provides a great catalyst for improved efficiency. Doing it in real time changes the game exponentially.
3. Use What You Have Wisely
Health delivery organizations (HDOs) have been piling up data in warehouses and application databases for decades. Additionally, the most valuable, yet most wasted, resource the organization has is events. The fact that events occur—admission, medication order, heart rate spike, allergic reaction, handwashing, discharge, light switched on, or nurse call system activated—form a context, but are often missed. We use HL7 transaction standards to largely populate databases with more data to decrease missing events. The confluence of events and huge amounts of historical information is a powerful tool in the areas of population health, care coordination, chronic disease management, and critical event detection, to name a few.
4. Treat Integration and Interoperability as Mission-Critical Applications and Embrace SOA
None of the above mentioned values can be achieved without enterprise-class integration. The evolution across industry verticals has been to the enterprise services bus (ESB) and service-oriented architecture (SOA). Healthcare has been slow to move from HL7-centric interface engines to ESBs, which in turn has reduced openness and interoperability (frankly playing into the EMR vendor’s hands). The concept of SOA in healthcare is long overdue and will dramatically improve the ability to leverage events, advanced analytics, BPM, and other capabilities, while reducing overall total cost of ownership and complexity of interfaces.
The message here is really this: Take advantage of what you already have in place—data and events. As investment shifts from EMRs to value, the focus really does move to the middle in terms of data and interoperability. To achieve this, no rip-and-replace of existing technology will be required but HDOs will most definitely need to invest in new, advanced tools like ESBs, complex event processing, in-memory data grids, master data management (MDM), and analytics—like those provided by TIBCO. TIBCO’s integrated technology stack, existing solutions, and services can bring all this together in ways that will help HDOs transform their businesses, as well as the industry.
This didn’t answer the original question of whether we are spending too much. However, investment will continue and most likely in new areas. By focusing on the dynamics mentioned above, and with the right advanced tools, it will become much easier to see the value being created.