Kim Lamb, executive director of the Oregon Health Network, shares real-world advice on what makes an IT implementation really work.
Editor’s Note: Kim Lamb is the executive director of the Oregon Health Network, a membership-based nonprofit organization building the first statewide broadband telehealth network in Oregon. Part of the FCC’s Rural Health Care Pilot Program, the network’s mission is to provide all Oregonians, regardless of location, with access to the best possible health care.
America’s health-care 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 health care-related industries. From core operational infrastructure systems to billing, scheduling, electronic medical records and administration, health care has transitioned from being a delivery system that's designed and managed within a silo to one that needs to communicate in real time to the rest of the policymaking continuum.
Health-care executives, providers and administrators, along with local and federal politicians, are tasked with addressing the pressing health-care, economic and work force needs of their constituents. But these issues are increasingly difficult to deal with, particularly because decision-makers aren’t given the broader context of health IT to help them prioritize solutions. The new emphasis on patient-centered care requires collaboration and coordination at the federal, state and regional levels — and full interoperability of hardware, software, payer systems and patient care.
Formerly reserved for those with money and resources to invest, health IT is no longer optional. It’s a core requirement for all providers and agencies that play a role in the health-care continuum. Furthermore, health IT’s adoption and use go beyond the traditional quest for pure competitive advantage; health IT is truly the only effective means to survive and thrive.
At the federal level, the government is working to remodel the country’s core health-care delivery system. Through the Rural Health Care Pilot Program (RHCPP), the FCC is building the next-generation broadband infrastructure for health-care delivery.
Oregon Health Network (OHN), a participant in the RHCPP, is building a statewide broadband telehealth network — the first in Oregon and one of the first in the country. OHN supports the “Triple Aim,” a revolutionary philosophy adopted by several key organizations, including the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services. The goals of the Triple Aim are to improve the population's health, enhance the patient's experience of care (including quality, access and reliability) and reduce — or at least control — per capita costs.
As executive director of OHN, I’m very familiar with the challenges providers face. We developed the following list of best practices to help health-care executives, providers and administrators recognize the critical elements required to implement and support a viable health IT infrastructure at the facility, state and national levels. This framework isn’t based on the latest developments in grants, mandates or technology. It’s grounded upon the proven business and technological expertise and resources required to develop a viable health IT program. These 12 health IT best practices are recommended guidelines to help you and your team understand what’s required to achieve success, what you can influence (and what you cannot), and the partners and support systems needed for success.
1. Strategy and vision: Form follows function
Until recently, the national health-care community hasn’t had 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. We now have a national 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 strategy and goals. Form must follow function. Think about your goals as a health-care provider and/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 surrounding communities, and with state and national plans?
In Oregon, the Health Information Technology Oversight Council, the Department of Human Services, Oregon Association of Hospitals and Health Systems, the Oregon Health Network and many individual hospitals throughout the state look to the Triple Aim to guide strategy, planning, coordination and investment efforts.
Plan and build with the end in mind: an integrated national health-care delivery system.
2. Collaboration: Don’t reinvent the wheel
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 health-care provider shortage through expanded referral partnerships and supplements health IT best practice areas.
Along with the FCC, the Office of the National Health IT Coordinator and the Centers for Medicare and Medicaid are working to improve health care and create incentives for stakeholders to encourage their participation. These improvement efforts include mandating the meaningful use of electronic medical records, funding Regional Extension Centers to assist physician practices in achieving meaningful use, and adding telemedicine services to the approved list of Centers for Medicare and Medicaid Services. And these are just a few of many federally funded strategies and programs under way.
Like most health-care organizations, the federal government is in the early stages of facilitating true interagency coordination. Collaboration is helping develop the programs and mandates that will facilitate the transition from old to new. We are all in the same boat, and we need one another to achieve success. Each of us is empowered to play a positive role in transitioning to a better future — one strategy, one decision and one sound investment at a time.
3. Connectivity: Building the infrastructure needed for success
Regardless of whether we represent a public agency, for-profit or nonprofit health-care facility or provider, the pressure to do more and better with less is a common denominator. Under the developing new nationwide model, we all must think about how our facility, community and state will connect to the health-care delivery system via IT.
The key to success in this new age of health-care delivery is not only the interoperability of what’s running on the network, but the broadband network that health IT applications and hardware needs to run on. And once the network is built, it must be adequately supported and used.
Reliable, high-speed and high-quality connectivity is the crucial but often overlooked component for success. This is why Oregon Health Network and the other RHCPPs across the nation are working to expand existing broadband infrastructure or building entirely new networks that will support the health IT requirements of the next-gen health-care delivery system.
4. Implementation: Answering the question of ‘how’
What’s your actual plan to serve your greater health IT strategy? What resources, tools (broadband, hardware, software, etc.) and supporting processes will be required to do so? And how will it be implemented to achieve success?
A successful implementation requires more than funds; it also requires appropriate expectations based on measurable outcomes, research and measurement, and the right expertise to design a well thought out implementation plan. While many of these plans are comprehensive, others are executed based upon a specific use or application, such as telemedicine, electronic medical records, health information exchange, networking or video.
Consider this a critical “translation” step of reconciling the approved strategy with the realities and limitations of the environment. These include but aren’t limited to: access to resources (people, money, knowledge) and buy-in from leadership to set up the implementation team for success.
5. Information: Quality improves outcomes
Currently we’re all focused on electronic medical records, but in the context of the other 12 best practices it’s easy to see that electronic medical records play an integral — albeit supporting — role within the broader health IT framework. So the topic isn’t only about EMRs. It’s about information. And more specifically, it’s 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 only continue to increase, so 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 health-care continuum.
6. Support: Making it work every day
Once a network is designed and implemented, it’s important to ensure the needed resources are in place to support the strategy and solution that have been implemented. Expect modifications and subsequent investments that tie directly to the measurement and education of the solution. And most of all, make sure you have the right people and resources to work well with the technical, business and clinical staffs. Support should be considered throughout the life cycle: from the network level all the way through to the provider and patient or end-user.
7. Measurement : Access real-time information for improved decision-making
Because the aim of gathering information is to reduce costs and improve outcomes, it’s critical to regularly evaluate the success of health IT programs and modify or adjust them to meet your goals. The benefit of having access to real-time information supported by health IT is that it provides management with opportunities to adjust course before hitting a wall. Consider it a proactive check and balance system. Therefore, it’s not only important to allot time and resources for evaluating a program’s success, but it’s also critical to also to measure performance in a way that directly aligns with clearly stated goals and metrics.
A wealth of information and metrics can be gathered, so be strategic and specific when identifying what you’re tracking and why. Here are some questions to consider: How has your new EMR or telemedicine program served the Triple Aim? How can you work with other health-care providers and organizations to identify what and how the statewide community measures success? What action will you take if you discover your program isn’t living up to your expectations?
Set metrics to know whether or not your efforts have been successful.
8. Education: Shortening the divide from ‘have’ to ‘use’
Implementing new health IT solutions — from hardware rollout 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 both inside and outside the organization, including other providers and the patients themselves — to make full use of the solution.
Targeted and user-focused communications are a core component of strong education programs. Simplifying complex information is a challenge, particularly when you are required to ask the user to change their existing behaviors, such as how they enter or retrieve information in a new system. Because people absorb information differently, consider providing the material in a variety of formats: hard-copy literature, electronic, visual and in-person training sessions.
9. Recruitment and retention: Increase and then meet demand
Strong health IT is the No. 1 incentive that attracts wage-earning primary care physicians and other health professionals to a community. Keeping health care in local communities increases patient confidence, keeping the patient — and the payment — local. It also improves physician confidence, as doctors across a region will know they have the support needed to answer some of medicine’s toughest questions, regardless of where they practice. Health IT also helps retain and recruit doctors in historically underserved rural communities, and attracts high-wage jobs.
10. Credentialing and privileging: Care without borders
The Centers for Medicare and Medicaid Services and other national organizations are working at the policy level to address the challenges associated with licensing, credentialing and privileging for telemedicine. It’s important to keep an eye on progress, and to support the state and national organizations that are lobbying to make these much-needed changes.
11. Reimbursement: Ensuring payment for the next generation of care
Similar to licensing, credentialing and privileging, making sure physicians and clinicians are paid for the work they do via telemedicine is where the rubber meets the road. Thanks to several local 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 to ensure that all members of the health-care continuum are reimbursed appropriately for all levels and types of care.
12. Policy: Top-down collaboration and support of the continuum
Legislation and policy refinement at the state and federal levels is critical to helping providers invest in solutions that serve the Triple Aim. From policy for broadband network deployment to licensing, credentialing, privileging and reimbursement — local and national organizations are working 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 organization. They require the health-care community working together: provider, policy and funding sources, and nonprofits.
The key, as a health-care provider, 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 going it alone; providers in each state have a wealth of experience and resources to share with the health-care community. Information on lessons learned, cultivating new strategic partnerships and referral patterns, and investments poised to be leveraged at a state level are all areas that benefit from a strong health IT network.