What I learned at HFMA’s Revenue Cycle Conference at Gillette Stadium

(…while the Patriots prepared to get their butts kicked)

Right from Jonathan Bush, the co- founder and CEO of athenahealth [the keynote speaker]: “Make Hospitals Focus on What They’re Good At – Everything Else, “Seek Help!” I can help define “everything else”. For now, I will keep it generally confined to the world of healthcare data – because I would argue more time, money, and effort is wasted on getting good data than almost any other activity in a hospital.

If you are a Chief Quality Officer, or Chief Medical Informatics Officer, or Chief Information Officer – what would you rather spend your budget on?

data analysisYour analysts collecting data – plugging away, constantly, all-day into a spreadsheet?

Outcomes: Stale data in a static spreadsheet…that probably needs to be double/triple-checked…that probably is different than what the other department/analyst from down the hall gave you…that you probably wouldn’t bet your house on is accurate.

Or your analysts analyzing data and catalyzing improvement with front line leaders?

Outcomes: Real time data in a dynamic, flexible multi-dimensional reporting environment…that can roll up to the enterprise level…and drill down to the hospital → unit → provider → patient level.

Here’s a hint – this isn’t a trick question. Yet, for some reason, as you read this, you’re still spending more money on analysts reporting stale, static, inaccurate data than you are on analysts armed with real time data to improve the likelihood of higher quality and patient satisfaction scores and improved operational efficiency.

The majority of the speakers at this year’s HFMA Revenue Cycle conference seemed to accept that providers are NOT good at collecting and analyzing data, or using it as an asset to their advantage. They also seemed to align well with other speakers I’ve heard recently at HIT conferences. If you’re like 99% of your colleagues in this industry, you probably don’t understand your data either. So do what Jonathan Bush said and GET HELP!

What I Learned at Health Connect Partners Surgery Conference 2012: Most Hospitals Still Can’t Tell What Surgeries Turn a Profit

What I Learned at Health Connect Partners Surgery Conference 2012: Most Hospitals Still Can’t Tell what Surgeries Turn a Profit

As I strolled around the Hyatt Regency at the Arch in downtown St. Louis amongst many of my colleagues in surgery and hospital administration, I realized I was experiencing déjà vu. Not the kind where you know you’ve been somewhere before. The kind where you know you’ve said the same thing before. Except, it wasn’t déjà vu. I really was having many of the same conversations I had a year ago at the same conference, except this time there was a bit more urgency in the voices of the attendees. It’s discouraging to hear that most large hospitals STILL can’t tell you what surgeries make or lose money! What surgeons have high utilization linked to high quality? What the impact of SSI’s are on ALOS? Why there are eight orthopedic surgeons, nine different implant vendors and 10 different total hip implant options on the shelves? It’s encouraging, though, to hear people FINALLY admit that their current information systems DO NOT provide the integrated data they need to analyze these problems and address them with consistency, confidence, and in real time.

Let’s start with the discouraging part. When asked if their current reporting and analytic needs were being met I got a lot of the same uninformed, disconnected responses, “yeah we have a decision support department”; “yeah we have Epic so we’re using Clarity”; “oh we just <insert limited, niche data reporting tool here>”. I don’t get too upset because I understand in the world of surgery, there are very few organizations that have truly integrated data. Therefore, they don’t know what they don’t know. They’ve never seen materials, reimbursement, billing, staffing, quality, and operational data all in one place. They’ve never been given consistent answers to their data questions. Let’s be honest, though – the priorities are utilization, turnover, and volume. Very little time is left to  consider the opportunities to drastically lower costs, improve quality, and increase growth by integrating data. It’s just not in their vernacular. I’m confident, though, that these same people are currently, more than ever, being tasked with finding ways to lower costs and improve quality – not just because of healthcare reform, but because of tightening budgets, stringent payers, stressed staff, and more demanding patients. Sooner or later they’ll start asking for the data needed to make these decisions – and when they don’t get the answers they want, the light will quickly flip on.

Now for the encouraging part – some people have already started asking for the data. These folks can finally admit they don’t have the information systems needed to bring operational, financial, clinical and quality data together. They have siloed systems – they know it, I know it, and they’re starting to learn that there isn’t some panacea off-the-shelf product that they can buy that will give this to them. They know that they spend way too much time and money on people who simply run around collecting data and doing very little in the way of analyzing or acting on it.

So – what now?! For most of the attendees, it’s back to the same ol’ manual reporting, paper chasing, data crunching, spreadsheet hell. Stale data, static reports, yawn, boring, seen this movie a thousand times. For others, they’re just starting to crack the door open on the possibility of getting help with their disconnected data. And for a very few, they’re out ahead of everyone else because they already are building integrated data solutions that provide significant ROI’s. For these folks, gone are the days of asking for static, snapshot-in-time reports – they have a self-service approach to data consumption in real time and are “data driven” in all facets of their organization. These are the providers that have everyone from the CEO down screaming, “SHOW ME THE DATA!”; and are the ones I want to partner with in the journey to lower cost, higher quality healthcare. I just hope the others find a way to catch up, and soon!

Why EMR’s Are Not Panacea’s for Healthcare’s Data Problems

So, you’ve decided to go with Epic or Centricity or Cerner for your organization’s EMR.

Think your EMR is Hamlin’s Wizard Oil?

Good, the first tough decision is out of the way. If you’re a medium to large size healthcare organization, you likely allocated a few million to a few hundred million dollars on your implementation over five to ten years. I will acknowledge that this is a significant investment, probably one of the largest in your organizations history (aside from a new expansion, but these implementations can easily surpass the cost of building a new hospital).  But I will argue: “Does that really mean the other initiatives you’ve been working should suddenly be put on hold, take a back seat, or even cease to exist?”Absolutely not. The significant majority of healthcare organizations (save a few top performers) are already years and almost a decade behind the rest of the world in adapting technology for improving the way the healthcare is delivered. How do I know this? Well, you tell me, “What other industry continues to publicly have 100,000 mistakes a year?” Okay, glad we now agree. So, are you really going to argue with me that being single-threaded, with a narrow focus on a new system implementation, is the only thing your organization can be committed to? If you’re answer is yes, I have some Cher cassette tapes, a transistor radio, a mullet, and some knee highs that should suit you well in your outdated mentality.

An EMR implementation is a game-changer. Every single one of your clinical workflows will be adjusted, electronic documentation will become the standard, and clinicians will be held accountable like never before for their interaction with the new system. Yes, it depends on what modules you buy – Surgery, IP, OP, scheduling, billing, and the list goes on. But for those of us in the data integration world, trying every day to convince healthcare leaders that turning data into information should be top of mind, this boils down to one basic principle – you have added yet another source of data to your already complex, disparate application landscape. Is it a larger data source than most? Yes. But does this mean you treat it any differently when considering its impact on the larger need for real time, accurate integrated enterprise data analysis? No. Very much no. Does it also mean that your people are suddenly ready to embrace this new technology and leverage all of its benefits? Probably not. Why? Because an EMR, contrary to popular belief, is not a panacea for the personal accountability and data problems in healthcare:

  • If you want to analyze any of the data from your EMR you still need to pull it into an enterprise data model with a solid master data foundation and structure to accommodate a lot more data than will just come from the system (how about materials management, imaging, research, quality, risk?)
    • And please don’t tell me your EMR is also your data warehouse because then you’re in much worse shape than I thought…
    • You’re not all of a sudden reporting real time. It will still take you way too long to produce those quality reports, service line dashboards, or <insert report name here>. Yes there is a real time feed available from the EMR back end database, but that doesn’t change the fact that there are still manual processes required for transforming some of this information, so a sound data quality and data governance strategy is critical BEFORE deploying such a huge, new system.

The list goes on. If you want to hear more, I’m armed to the teeth with examples of why an EMR implementation should be just that, a focused implementation. Yes it will require more resources, time and commitment, but don’t lose sight of the fact that there are plenty more things you needed to do with your data before the EMR came, and the same will be the case once your frenzied EMR-centric mentality is gone.