In case you missed it, we recently concluded our blog series on What the Market Says You Need in Your Patient Portal. Two of our healthcare experts, Melody Smith Jones, Manager of Connected Health (@melsmithjones) and Nick Lecker, Director of Architecture and Interoperability teamed up to take a deeper look into the 7 features that the market wants in your patient portal:
Healthcare consumers are at the center of the industry’s evolution and patient portals are going to continue to be a vital tool for connecting, engaging and empowering them.
In a recent issue of PC Today (www.pctoday.com), there was a quote by Cindi Howson of BI Scorecard that really stuck in my mind: “There are far too many cases of companies having good data, good tools, but a culture that’s a barrier to using that data for action.” Frequently, outside consultants are brought into an organization, especially in healthcare, to pull data out of silo’ed applications, cleanse it and land it in an enterprise data warehouse (EDW). Then the real fun begins as the organization tries to determine what their expectations are from this treasure trove of data. More importantly, this struggle to determine the value of the integration of clinical, operational and financial data can stall the return on investment for this important and difficult effort.
In conducting a business intelligence (BI) strategy, it is very important to investigate those silo’ed data sources to determine which elements can benefit which part of the organization and to notify internal groups of the new resources. In other words, the Enterprise Data Warehouse needs exploration and promotion to the key stakeholders or by the key stakeholders to gain new insights and derive the new value. Matching data to the right people is fundamental to success and deserves its own tracking mechanism in data governance. Moving beyond the original stakeholders and their requirements in a BI strategy and getting down to who really will use the data and how it is used helps drive stronger outcomes for the use of the integrated data. It truly isn’t just start with the end in mind, but exploring how the new integrated views of information can drive improved operational processes and solve daily problems in a real-time manner.
It is often frustrating to data warehouse builders because they understand the value stored inside but don’t know who needs the information to take action. It is worth educating and promoting this big investment! If a key data source is overlooked for real improvements in an important corporate process, then find it and add it. If data has moved past its useful life, then it should be moved to an archive to keep the enterprise data warehouse relevant and in step with the organization. Many organizations set up BI Competency Centers to help govern and develop the enterprise data warehouse, but my suggestion would be to make those centers a place for brainstorming, exploring and deriving value on an ongoing basis.
In healthcare, as we strive to lower costs and adopt a lean process improvement methodology, our process of using high-quality data should help identify new revenue opportunities, serve our communities more effectively and encourage us to explore possibilities. That exploration should start with the data that we work hard to acquire, extract, transform and load in our enterprise view. As data comes in faster, we need to respond quickly by connecting the data with the right users.
To summarize, in moving beyond the build stage of an enterprise data warehouse and gaining the return on investment, there are four key steps:
In our last conversation about “What the market says you need in your patient portal” we discussed the needs of integration and interoperability. This is an area that, while interesting to the IT team, often does not get a lot of attention. This is not because this topic lacks interest, rather, it’s just not the most appealing topic to talk about. For example, when you are remodeling your bathroom, you discuss the fixtures, the new shower, the new faucets, even the fancy commode; but do you get excited talking about the plumbing? Likely not, however it is the ability to move and connect the items of interest together that makes the project all come together. If you do not connect something the right way you get water all over…or worse.
So, what does this have to do with clinical and financial data? For one, the data is generally in various systems and data stores throughout the organization and generally it comes from multiple organizations. For example, if you look at these concepts from a health plans point of view, the clinical data is coming from HIE’s, provider facilities, clinical labs, purchased data sources, and others. The financial data is coming from claim systems across multiple lines of business, GL systems, AR/AP systems, and others. All of this data still has to be aggregated, cleansed and organized to make it useful. This is not an easy task and having the strategy, the information models, the plan and the governance are all key to ensuring success of these efforts.
Another reason integration is important is it helps define the consumer of the information. Typically, financial data has been reserved to back office functions or it is used to help define/negotiate the cost of services whether they be premiums, reimbursements, subsidies, etc. With the advent of consumerism, the patient is demanding more information in this arena. Patients want to know what their total cost of services are. They want to know the details of the fees. They want the ability to compare costs, values, outcomes so they can make a well-defined choice. Patients generally look at the cost as the driver, yet there are behavioral changes that need to be overcome; e.g. the higher priced option must be the best, right?
There is a lot still to overcome in this area as providers have typically held on to this information and patients may not be able to understand the complexities of where the money actually flows. Integrating the clinical and financial data is a stepping stone in the path to a full consumer-driven healthcare model. Government mandates are forcing the need for change, however, breaking down the walls to integrate information will not be easy. Meaningful Use Stage 2 (MU2) will be one of the drivers to help make healthcare interoperability a reality.
Core to solving these problems is having a clear understanding of the business capabilities and processes that drive the solutions. Understanding (documenting) the business capabilities, defining the information needs (again documenting) and then defining the business processes (yes writing it down) that act between the capabilities and information will be the blueprints and guides to setting and achieving the vision. With the vision established, we then can begin the process of connecting the dots of where the information lives to where it needs to go and the format which it needs to be in. There are a number of technical challenges given that interoperability is not just a simple plug-n-play solution. The movement of the information needs to follow standards (which by-enlarge exist) yet all of the connections and the subtleties of the content need to be clearly outlined in the road map of integrating clinical and financial data.
This concludes our “What the market says you need in your patient portal” blog series.
For the sixth year in a row Perficient has been recognized as one of the largest healthcare management consulting firms by Modern Healthcare. This year we were recognized at #13 on the list, which is comprised of the 70 largest healthcare management consulting firms in the US, ranked by 2013 revenue from provider consulting fees.
Being ranked one of the largest consulting firms in the healthcare industry is an honor and we are proud to be recognized alongside other influential healthcare firms.
The full list is available for purchase from the Modern Healthcare website.
So far in this discussion about “What the market says you need in your patient portal” we have been driving toward changes that are core to new engagement models. However, we have not addressed a core enabler: “It’s all about the data!”
Consumers demand access to information that meets their needs and they are not complacent with becoming hunters and gatherers for the information is truly about them. Consumers in today’s market demand accurate and up-to-date information about their health profile, just like they do with respect to their financial profile. However, the systems and processes to make that information available are not all there.
There are various sources of the information that are relevant to the patients/consumers (and also to the providers providing care to their patients). Much of this data has been distributed through the provider community. Some of the data is in the provider’s own systems. Some of the data is in the hospitals EHR systems. Some of the data is in outpatient facility systems. Other data is isolated and hard to locate.
With the push to HIEs some of the data is now becoming more available to the providers and to the patients they serve. However integrating the data into a holistic view is still a challenge. The information still needs to be gathered / extracted from the source systems, transformed into a structure that the HIE can understand and then there are the issues of translating the codes and values to normalized/consistent terms following a defined set of vocabularies. Additionally, ensuring a unified view of the individual can be a challenge. Enterprises IT groups are leveraging Enterprise Master Person Index (EMPI) solutions to construct the golden record of the individual but this also has its challenges.
Once all of the data is assembled (assuming that it is) the next challenge is to get the information to the right person at the right time. The HIE now needs to be integrated to the rest of the enterprise. Exposing the information in terms of the services or APIs can now begin. Finally the Portal (and this is just one of the consumers) can begin to consume these services and make the information available to the consumers. What’s also of importance is that the consumers can access this data from multiple perspectives. The provider can see full episodes of care across multiple care locations. The patient can see their health profile all in one location.
Having a single view of one’s health profile (or even the illusion of) is a powerful tool. Not only does it provide insights for better care, it breaks down the walls of information silos that have challenged providers and patient’s alike. Again, it is all about the data, and integration and interoperability are the key.
Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space. In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:
The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.
In our next installation from the “What the market says you need in your patient portal” series we bring you avatars. These avatars are closely related to our last post on gamification and serious games, but their real value proposition is in what I like to call “high touch digital healthcare.” Many may think that “high touch” and “digital” cannot exist in the same concept, but oh they can. We are actually beginning to see that in some cases patients prefer high touch digital to face-to-face care.
Here are some examples:
Overall, avatars and other forms of digital high touch are a win-win-win. They are low cost (win), add a sense of fun to otherwise lackluster processes (win), and increase quality all at the same time (win). Stay tuned for our final posts in the series where we start to discuss the importance of health information exchange and interoperability as they relate to the patient portal.
More than half way through our “What the market says you need in your patient portal” series I bring to you one of my favorite topics: healthcare gamification and serious games. Games are great at explaining complex systems. There are fewer places one can find complex systems than in the micro and macro worlds of healthcare. In healthcare we’ve seen games of multiple types. Here are some of my favorite examples:
Gamification is the term we use to describe serious games that go beyond strictly trying to entertain. They have a “higher purpose”, so to speak. Designers use game techniques to get players to do something not game-like at all. The possibilities for embedding serious games into patient portals are seemingly endless, but my favorite is in the realm of personalized prevention. The patient portal is a powerful repositiory of patient data and can also function as an empowerment tool. Similar to the build of the patient portal itself, if you want to develop a serious game that works, you must, better than anyone else, understand the purpose of your game. You must know to whom your game is targeted. You must devote a lot of time to figuring out what motivates your intended audience. That understanding must be crystal clear before you even consider how the game should be designed. Document, in detail, what your experience needs to communicate with the gamer. What kinds of puzzles best match this experience? Then consider what type of game genre matches these puzzles. Lastly, consider what platform would need to be used to help the gamer bring action to play.
Building a game that is based on what motivates your audience is what makes a serious game a game. The market will continue to push this functionality onto the patient portal.
Next in our lineup of “What the market says you need in your patient portal” series is social collaboration. This topic brings us to the core of a term that we hear a lot in the industry: patient engagement. What is that, really? Any form of engagement requires communication. Right now communication between provider and patient is getting better, but I’d still say that the relationship is in its “healing” phase. The best way to speed that healing is through creating mechanisms that support healthy communication between the healthcare provider and the patient.
Traditional methods of communication focused on the brick and mortar. There has been noticeable resistance to the idea of email, and far fewer providers offer social capabilities. So why will the market push for it? Because patients are accustomed to using social collaboration and they know it is far more convenient to use that tool over, say, picking up a phone or driving to the office. Providers will find that it is also much more cost effective than standing firm on the old way of doing things.
Patients use social to gather information. The healthy byproduct of this dynamic is a greater emphasis on managing wellness. Every social communication does not require direct communication between patient and physician. Instead, social relies on content to navigate a user towards answers and provides readily available mechanisms to find answers to questions. These “conversations” have the power to personalize experiences on an individual level, as well as deliver rapidly consumable healthcare information that can be personalized to the individual and their health needs. A social collaboration strategy is a success when you are able to engage and interact with the patient in a way that drives them towards the overriding goal of wellness. Everything that you do, or want to accomplish, on the patient portal should support that experience. This not only guides your content and communication objectives, but it can also result in lasting interactions that elevate consumer experience.
To make social collaboration effective, it is important to present content in a fashion and format that makes the most sense to the user. Let’s be honest, social collaboration can be a bit nerve wracking in a HIPAA regulated environment. As such, it is crucial that every social collaboration initiative include a formal governance program. This program will ensure that patient communications stay relevant to the overall goal of wellness. However, with the right strategy, you can embrace the power of social to influence the conversation and amplify the health of your population.
Embracing data-driven decision making in a healthcare setting requires agile thinking to pinpoint and respond to the short- and long-term needs of the organization. This shift requires finance departments to transcend from the typical focus on aggregating data to a value-added analytical view of hospital data. This new approach will provide greater visibility into changes in variables and assumptions and will require organizations to fully understand and ensure transparency exists for key performance indicators.
Micro-costing was introduced as the way to discretely measure and quantify true inputs to the cost of patient care. Healthcare costing has historically been isolated from true costs and has relied on averages of averages and “step-down” allocations that are often many layers thick. Most healthcare entities still use spreadsheets for costing and primitive methods that date back to an assembly line model – tools long abandoned by the manufacturing industry that created them. The result is rudimentary cost allocation that fails to match resources and related costs to their services. Allocation methods based on square footage to distribute utilities and administrative services (HR, finance, and procurement) are reasonable. However, using revenue, patient days, or admissions for allocating capital depreciation, pharmacy costs, and radiology utilization are inequitable. Often the drivers from budgeting and capacity planning are divorced from the costing process where assumptions are independent from the costing methodology. This makes it impossible to arrive at informed decisions that will improve financial results.
To stay competitive, healthcare organizations need to streamline inefficient processes and understand the types and the amount of resources they need to deliver care across the enterprise. This can only be achieved through cost transparency and micro-costing. To learn more download our white paper
In this video, my colleague, Lesli Adams discusses the intersection of cost, quality and the patient.
The Intersection of Cost, Quality and the Patient in Healthcare
Lesli and William Bercik, Oracle Director for Healthcare and former CFO, will be presenting a webinar, Align Patient Outcomes with Financial Data: A Formula for Correlating Cost and Quality on August 13, 2014 at 1:00 CT.
Taking our “What the market says you need in your patient portal” series a step further, today we are going to address the market demand for dynamic scheduling. When it comes to the marketing work of drawing patients into the brick and mortar, I often tell clients that, where their website and patient portal are concerned, if they get the Find a Provider tool wrong, then they have gotten everything wrong. It’s an extreme statement, but it is meant to highlight a few key market dynamics:
Enter the new world of scheduling embedded into a market driven patient portal. In this world we allow patients to schedule appointments online by providing them with calendar capabilities. Yes, this is very different from the way that business is currently done. Why? Clinicians work in a very dynamic environment that makes it challenging to manage schedules. Even though it is dramatically different from the way business is currently done, the market is making existing scheduling systems obsolete. Why? It’s surprisingly due to that very same dynamic nature of clinician schedules. The healthcare environment provides a seemingly endless supply of tasks for the clinician. Trying to overlay that dynamic environment over the traditional scheduling system is fraught with the well known long wait times, and poor consumer experience, that patients currently experience. Dynamic scheduling makes appointments easier for both the provider and the patient. Here’s how:
What do you think of the market drive towards dynamic scheduling?
Oracle’s decision to sunset the eGate HL7 integration engine has been a little bit of a headache for healthcare organizations. In reality, it has been an ongoing migraine for those who have not replaced it. eGate customer support is virtually unheard of, and if you are lucky enough to find skilled developers with specific Java and Monk experience you better have a big checkbook.
Additionally, depending on contractors to build, implement and maintain the multiple eGate interfaces results in increased costs, lack of control of interfacing projects and delayed access to important clinical data.
Making the decision to migrate from eGate is only the first step in the process, a process that can seem overwhelming when you consider the hundreds or thousands of application to application healthcare interfaces that need to be streamlined. There are many interface engines available today but when evaluating interface engines it is important to select one that is easy to use, robust, fits in the organizations work environment and aligns with the long-term IT goals.
Your vehicle. Many interface engines are very powerful and require individuals with specific programming skills to design and execute an efficient healthcare integration platform. Typically, these integration solutions are pricey and development time is lengthy. Other interface engines on the market are robust, designed with a simpler approach and require personnel to have basic programming or analyst-level skills. These solutions are usually competitive in price and development time is much shorter.
With many different integration solutions, it is essential for healthcare organizations to take the time to research and identify the one that best fits their environment. Organizations should consider many things including business model, location, size, areas of expertise, services offered and personnel needs. Failure to take these things into consideration can result in a solution that is very costly in time, price, personnel and productivity.
When determining the integration engine that will work best for your organization a thorough analysis should be completed. Below are some key attributes you may want your integration engine to include:
Now that you have identified where you want to go and the vehicle you are going to use, it is time to take a look at the map that will get you to your destination. Read the rest of this post »