20 Tests Healthcare CIOs Must Juggle
With never-ending waves of federal regulations and new technologies, healthcare CIOs face constant change. These issues top the list of leadership challenges.
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Like circus performers juggling flaming torches, healthcare IT professionals must manage multiple high-priority tasks simultaneously: making sure their organizations serve patients' health, meeting government mandates, and operating at maximum efficiency.
Each year brings old and new challenges. In 2014, providers and payers face ICD-10's deadline, the looming arrival of Meaningful Use 2, and ongoing enforcement of HIPAA throughout the provider chain. At the same time, healthcare evolves toward volume-based payments that demand patient engagement and population health programs, all of which require tight integration between technology and its users.
Rather than see these times as challenging, many healthcare CIOs see them as filled with opportunities. They're partnering with doctors, nurses, administrators, and other members of the healthcare and technology ecosystem not only to find computerized systems to replace paper-based workflows, but to replace outdated processes with more-efficient user- and patient-friendly procedures.
When EY (Ernst & Young) worked with one hospital, a radiologist wanted the new EHR to replicate a clunky, multi-step paper process, said Bill Fera, principal at the professional services organization. "We made the process of ordering a radiology examination completely intuitive and somewhat educational," he said in an interview. "These are big opportunities to rewrite broken processes and a lot of times people don't take advantage of that."
ICD-10, margin pressure, and the move to personalized care are increasing demand for analytics and big data. This gives IT the chance to change processes from old-time data analysts taking users' requests to enabling employees to do their own research. This change frees up IT staff to move away from data analytics and focus on business- and technology-oriented tasks, liberating IT budgets for innovation and satisfying business users' demands. Working with individual departments that pursue research grants for technology-based exploration into areas such as 3D or analytics, IT also increases its value.
As leaders, CIOs set the tone for how an organization sees the entire IT department. CIOs who help employees integrate personal health devices such as FitBits, who focus on mobile, who use cloud and collaborative tools to share data, and who simplify -- not complicate -- processes, are seen as partners, several CIOs said.
We've rounded up 20 issues healthcare CIOs must juggle. Which ones top your list? What would you add -- or leave off? Let us know in the comments section.
By October 1 healthcare providers must upgrade to ICD-10 -- the 10th revision of the International Statistical Classification of Diseases and Related Health Problems -- from ICD-9 or jeopardize payments. The update includes about 70,000 diagnosis codes, compared with approximately 14,000 in the earlier version. To comply, EHRs must include the following: the new codes, documentation templates, access to patients' prior visits, and an integrated order system for ancillary services. ICD-10 creates new workflows for physicians. IT professionals must streamline the process to reduce the time each entry requires. A shortage of coders adds to CIOs' challenges.
As some facilities scramble to meet that deadline, others are confident they'll be compliant in time and expect to garner extra insights from the wealth of data available through the more detailed coding. The timing brings extra headaches, though.
"We expect to start dual coding in April and we'll definitely be ready before October," said Doug Lauterbach, assistant vice president of technology and chief technology officer at Ochsner Health System. "The challenge we and a lot of healthcare institutions are facing is Meaningful Use and ICD-10 in the same year. Pushing back the start of MU 3 didn't necessarily provide the relief that people needed. The challenge is trying to meet both those timelines."
To meet Meaningful Use 2 objectives, healthcare organizations must incorporate a slew of new capabilities. They include computerized physician order entry (CPOE), electronic prescriptions, recording patients' demographics including preferred language and ethnicity, using clinical decision support systems, communicating with patients via secure electronic messaging, and allowing patients to view online, download, or transmit their records within four days of the information becoming available to a doctor. IT departments must ensure all these systems are secure, HIPAA-compatible, and integrated with providers' EHRs, plus provide users with necessary training.
Healthcare providers have lots of data, but using that information is challenging. "It's one thing to have the data, but it's a whole other thing to do something with it. Now [that] you have data all over the place, how do you start managing your business that way?" said Keith Figlioli, senior vice president of healthcare informatics at Premier, in an interview. Analytics can drive out costs, improve quality and safety, and evaluate new opportunities, he said.
Bringing their own mobile devices to work might be easy for healthcare employees, but it's a complex job for IT departments that have to ensure devices and data are safe, and the challenge is only growing. Four out of five physicians regularly use mobile devices for medical purposes, and 69% of nurses use smartphones on the job for personal or work tasks. In addition to security issues, IT must address bandwidth constraints, blending private and business purposes, and application rollout and maintenance.
Pictured: The Mayo Clinic uses Apple products, including iPads, iPad Minis, and iPhones, equipped with a library of custom apps.
The Affordable Care Act did not include any mention of interoperability, and that's causing problems for providers and IT. Whereas developers of add-on apps typically integrate with EHRs, many electronic record systems are incompatible with one another, presenting a stumbling block for patient ownership of data. Organizations might have old systems that don't work easily with EHRs and other new technologies. This forces workarounds or duplication of effort.
The influx of newly insured people entering the market, combined with an aging population, will increase data storage requirements. Efforts to reduce duplicate or unnecessary testing might offset that, but only slightly. Now that healthcare is embracing electronic documents and moving toward e-signatures and computerized physician order entry, systems will need to store more images and data in an easily searchable -- yet secure and cost-effective -- manner.
Whether a provider is implementing its first electronic health records system or an upgrade, the EHR is its lifeline, making it critical for IT teams to get it right. EHRs are the groundwork for Meaningful Use iterations and a hub for connecting to other clinical systems. Ensuring a system meets current and future needs and integrates with an organization's systems is vital to future growth.
Using telemedicine robots, doctors can interact with patients hundreds or thousands of miles away. Last year, the Food and Drug Administration approved RP-VITA, an autonomous robot, for active patient monitoring in pre-, peri-, and post-operative situations. Meanwhile, many hospitals invested in da Vinci Surgical Systems for minimally invasive operations.
Pundits predict the consolidation trend will continue in healthcare. That means IT must integrate disparate systems and meld redundant databases. Those unwilling to spend are likely to find partners and will need collaboration, messaging, and other tools that empower employees at different firms to work together, share documents, and schedule meetings.
Now that HIPAA has more teeth and every link in the chain is a potential vulnerability, CIOs and chief security officers should work with legal departments to make sure technology and policies protect them. Encrypting data, reviewing password policies, and securing networks, while adequately training staff, are ongoing tasks.
Healthcare providers agree that improving patient care comes first. At the same time, providers are under pressure from regulators and insurers to make all their operations more efficient. That means cutting costs and streamlining processes. Eliminating log-on steps allows a surgeon to perform more pediatric otlarngologic operations, said John McConnell, enterprise architect at Fletcher Allen Health Care, in an interview. Adding IBM System x3850 X5 and IBM BladeCenter HX5 servers to its financial and clinical transaction environment supported the Medical University of South Carolina's virtualization efforts, which reduced transaction backlogs and cut costs.
To improve patients' health and benefit from the move to value-based reimbursement, healthcare providers must use technology to involve consumers in their own care. Tools to improve engagement include in-room systems, secure messaging, and educational website content. Healthcare communications company Emmi Solutions integrates with existing systems, such as EHRs, and wants to find partnerships with in-room system developers such as GetWell Network, said CTO Nimesh Patel, in an interview. Emmi creates educational content that informs patients about upcoming procedures or health issues, reminds patients about appointments, and improves overall health literacy. Mercy Orthopedic Hospital Springfield expects its recently purchased Emmi system will minimize stress and reduce recovery time, while reducing labor costs.
Just as Y2K created a short-lived frenzy for specialists, government mandates have generated high demand for healthcare IT experts. Many CIOs cite staffing as one of their top challenges and some now recruit IT talent from other verticals. In fact, 63% of top executives worry they won't find people with the right skills, according to the recent "Fit for the Future: PwC's 17th Annual CEO Survey." More than three-fourths agree that creating a skilled workforce is a "key business goal," however.
Healthcare data no longer resides solely within an organization. These days they are in clouds and tablets, and on smartphones and portals -- and IT must safeguard every byte. Yet clinicians can't (and won't) spend time on onerous, multi-part security systems. Standard medical equipment, such as surgical gloves, also gets in the way of technologies such as fingerprint sensors.
Healthcare professionals rarely stand still, and neither should the tools they use to communicate, connect, or collaborate. The wireless health market will grow 20.2% between 2013 and 2018, according to a new study by ReportBuyer. More apps for patient monitoring and diagnostics, plus government funding, will drive this growth, the report found. The mobile healthcare market, including connected medical devices and apps, will account for $20.7 billion in sales by 2018, Markets and Markets found. Some medical professionals are examining how to incorporate wearable devices, which are predicted to reach $6 billion in sales worldwide in two years, into patient care.
Because technology is integral to so many healthcare endeavors, CIOs play a visible role in an organization's success or failure. By driving adoption of technology that enables initiatives such as population health and patient engagement, CIOs have the potential to lead the charge to become a safer, more caring, and more profitable organization.
Government changes to Medicare and Medicaid payments and private insurers' adjustments in a post-Obamacare age mean healthcare providers must look for new sources of income. For some, this means merging with or acquiring a competitor. Private physicians might join a hospital's staff. Many healthcare professionals develop apps or services for themselves and peers.
With so many resources focused on meeting government mandates, some CIOs fret that little money or time is available for innovation. Others make it happen anyway. In partnership with business units, IT departments explore how to use RFID tags and sensors, 3D printing, mobile, and other technologies to improve care, cut costs, and enhance productivity. They tap the potential of big data, analytics, social media, and portals. They're working with research departments and universities to pursue grants, teaming up with vendors on pilot programs, and considering alternate ways to fund exploratory ventures. Some want to copy the consumer space, using lessons from businesses such as Uber, the on-demand car service, to benefit healthcare and patients. But even innovators have to abide by regulations, while securing money, resources, and buy-in.
Many healthcare processes are routine but vital, and providers use checklists to make sure employees execute each step in sequence. "The biggest hurdle to being efficient is making sure the right people have the right tools at the right time," said Kevin Corbett, a solutions expert at Hyland Software, in an interview. IT can automate checklists and tie them into dashboards for review, audits, and management. Healthcare management services company WestMed Practice Partners, for example, built 2,200 policy and procedure workflows as the basis for about 1,000 checklists that staff perform each week. The provider is adding clinical access improvement as part of its ongoing goal of accountability.
Pictured: A management dashboard summarizes and groups information.
Many healthcare processes are routine but vital, and providers use checklists to make sure employees execute each step in sequence. "The biggest hurdle to being efficient is making sure the right people have the right tools at the right time," said Kevin Corbett, a solutions expert at Hyland Software, in an interview. IT can automate checklists and tie them into dashboards for review, audits, and management. Healthcare management services company WestMed Practice Partners, for example, built 2,200 policy and procedure workflows as the basis for about 1,000 checklists that staff perform each week. The provider is adding clinical access improvement as part of its ongoing goal of accountability.
Pictured: A management dashboard summarizes and groups information.
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