When Considering Health IT, Think Like a Business

January 31, 2011

Whether we like it or not, healthcare is a business. In the past, practice was sufficiently remunerative and it was possible to be a bit sloppy with the business end of things. These days money is tight and, at the same time, practices are under pressure to spend on technology.

Whether we like it or not, healthcare is a business. In the past, practice was sufficiently remunerative and it was possible to be a bit sloppy with the business end of things. These days money is tight and, at the same time, practices are under pressure to spend on technology. 

The decisions about what to buy, and when, are complex and should not be made emotionally. It's important to stop and think like a business.

If you were FedEx or Amazon.com you would first envision a business animated by technology, plan the details of your new mode of operating and then buy whatever you needed to implement your plan. You would take whatever reasonable time was necessary. Why should a healthcare business behave any differently?

Business is about attracting customers and making a profit (or perhaps, for non-profits, losing as little as possible). That means things like customer satisfaction, quality, efficiency, and cost-effectiveness really matter. In many cases revenue is capped, and your profit depends on how little of it you spend. Any organization or independent practitioner that is ignoring what matters may believe that things are going well, but practice expenses can be like a patient that has had unrecognized hypovolemic shock for too long. Once the physiological disturbances have progressed past a critical point, no amount of last-minute intervention can reverse the irreversible; death is inevitable.

Some of the items that have appeared in my e-mail inbox over the past few days provide insights into how to approach the business of medicine.

IBM published a white paper entitled "Exceptional experiences: The key to customer engagement." The title makes the point, one also made 15 years ago by Stephen Covey in a seminar during which he identified an exceptional hotel chain whose mission statement was simply "To provide uncompromising personal service."

IBM suggests that "Context is key. The best experiences feel custom-fitted to users’ preferences..." Aim to use your EHR in a way that makes the patient feel a part of the process.Use the data you have gathered as the basis of two-way communication with patients. If your EHR interferes with this, maybe it's the wrong one.

Patient's today think in terms of social media. Consider offering group sessions, support groups, and Web discussion forums. Structured correctly these can create great word-of-mouth and maybe even be a source of revenue.

"Integration must be easy."IBM suggests leveraging existing data sources. The patient is an existing data source. How many different forms do you give a new patient that ask for the same information? Do you capture it electronically or do you then pay someone to enter items that the patient could have entered for you?

"Measurement is the key to advantages." If you can't measure or project the economic impact of what you are doing and what the government is pushing you to do, how will you make intelligent decisions? Modern Healthcare reports that a study in the Archives of Internal Medicine entitled "Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality," analyzed data from nearly 250,000 patients for evidence that computerized, clinical decision-support (CDS) tools improved the quality of care.

Researchers found "no consistent association between EHRs and CDS and better quality. These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality."

If others are concerned, perhaps you should also be concerned. EHR products vary widely in their ability to deliver their various touted benefits.

Anthony Guerra writes in Information Week: "The bottom line is that ONLY [emphasis mine] the most advanced hospitals -- in terms of their sophistication with advanced clinical technologies -- should attempt meeting meaningful use in the time periods required." Guerra then refers to Frank Poggio of the Kelzon Group in an article entitled "A Meaningful Ruse?"

His analysis that suggests that actual financial penalty of foregoing the EHR Incentive will most probably range between a 0.000957 increase to a 0.01914 decrease in Medicare payments.

The common thread in these recommendations is to:
• Focus on the patient;
• Provide service that's so good that the patients will value it and be willing pay for it;
• Don't blindly comply with every "mandate" unless it will improve some aspect of your practice;
•Take the time to do it right; and
•Only invest your time and money in activities that have a demonstrable and REAL return on investment.