Data-Driven Healthcare Comes with IT Hurdles

This article appears in the January/February 2013 issue of HealthLeaders magazine.

In healthcare, the IT group is in a pivotal position to enable its organization's response to reform and other industry changes by putting in place an infrastructure that can guide administrative and clinical leaders alike to deliver better outcomes at reduced cost.

But the hurdles to be overcome in reaching those goals can be considerable. First, healthcare IT groups strain under near-term reporting burdens. Second, as the industry moves away from a fee-for-service revenue foundation to a value-based purchasing model, many healthcare IT groups may find that they have to respond to a slew of internal demands for reporting and analysis. The investments required are many, and the return on investment often is unclear. Finally, for a long time, the IT needs of the industry, especially on the clinical side of the house, have been met with highly targeted software applications. The consequence is that many organizations find they have to accommodate a variety of software packages and data structures, which presents vexing problems now that both business and clinical analytics depend on using an integrated set of data. 

Near-term reporting burdens
More than half of respondents (52%) say that meeting regulatory reporting requirements is among the top three drivers of their organization's IT efforts. Indeed, even now, the October 1, 2014, deadline for implementing the CMS ICD-10 code sets is demanding significant resources.

"Inside our IT shop right now, the anticipation of the workload associated with ICD-10 is overwhelming," says Donna Abney, executive vice president of Methodist Le Bonheur Healthcare, a seven-hospital, not-for-profit healthcare delivery system with 1,709 licensed beds based in Memphis, Tenn.

ICD-10 tops the list of IT challenges for respondents, with nearly two-thirds (64%) of healthcare leaders saying that accommodating ICD-10 represents a major challenge. The second most frequently mentioned challenge was a tie, with 42% citing the requirements of the Patient Protection and Affordable Care Act overall, and the same percentage identifying physician documentation as a top challenge.

Internal analysis and reporting demands
Of course, IT teams have to respond to much more than regulatory and other public reporting requirements. More than one-third of respondents (39%) note that IT support for care coordination is among their top strategic drivers of their organization's IT efforts; that figure is even higher (51%) among those from health systems. Similarly, nearly one-third (32%) indicate that clinical decision support is a key strategic driver.

The ability to focus on forward-thinking and complex IT development activities such as care coordination at the same time as responding to pressing regulatory reporting requirements suggests that there may be haves and have-nots when it comes to making IT investments.

Indranil "Neal" Ganguly, CHCIO, FHIMSS, FCHIME, vice president and chief information officer for CentraState Medical Center, a not-for-profit health organization with a 284-bed medical facility and 450 board-certified physicians in Freehold, N.J., sees the need to separate oneself from the needs of the moment, no matter how compelling they may be: "Those who are always asking themselves which fire to put out might have trouble looking to the future and doing some visionary planning."

Overall, 80% of healthcare leaders expect their IT budgets to increase in the next three years; that's not surprising considering the increasing reporting requirements and the system development activities needed to support the shift to value-based purchasing.

There are indications that health systems are more supportive of forward-focused applications than hospitals or physician organizations. Two-thirds of leaders from health systems (67%) place business intelligence and analytics among their principal areas of IT investment over the next three years, compared to 39% of respondents from hospitals and 44% of respondents from physician organizations.

Higher percentages of health systems than hospitals and physician organizations will be investing in clinical decision support and the integration of clinical and financial data.

The irony of extending IT into clinical areas over the past several years is that, once clinical users get such access, they like what they see and ask for more. So a by-product of success in clinical areas is an increase in user requests, which adds to the competition for resources. As Ganguly observes, "IT departments are spending a lot of time now churning through requests, some of which may not be as valuable to the organization. We have to put prioritization models in place and get a strong sense of governance about how we run this piece of the business, because we have limited resources."

Challenges, rewards of data integration
Michael Ugwueke, MPH, DHA, FACHE, executive vice president and chief operating officer of the Methodist Le Bonheur Healthcare system, notes how information needs have changed: "In the past, CEOs were judged on how they ran a facility from a financial standpoint. We looked at metrics and ratios." Healthcare reform has added clinical performance and patient satisfaction to the performance measures that top administrators need to monitor, and Ugwueke will rely on IT to keep him up to date, based on what is more and more becoming an integrated set of data.

"Going forward, finance is only a piece of it," Ugwueke states. "You have to be good in all these areas. The only way you can become good at it is to have some type of dashboard or information system that is capable of helping you understand the data so that you can take action to address shortfall areas." He will also depend on IT to document the use of care paths. "I need to know how care paths are making a difference in improving the quality of care that we provide to patients. Ultimately, that's how we'll be judged."

Generally speaking, clinical IT is "younger" than financial IT. In many organizations, clinical areas have used special-purpose software packages designed for their disciplines. This heritage of using multiple software packages from a variety of vendors makes the integration task considerably more complicated.

Says Chris Snyder, DO, chief medical informatics officer for Peninsula Regional Medical Center, a 317-bed nonprofit hospital serving Maryland's Delmarva Peninsula: "Usually financial data is very robust and functional. Often clinical data typically is not; it can be very fragmented."

In addition to providing administrators with the information they need to guide the organization, integrated data can guide clinicians as they deliver care. "We are starting to merge clinical and financial data to spot variances in outcomes and care, and look for gaps in care that may benefit both the patient and the hospital," says Snyder.

Once such analysis demonstrates its value, the desire is to deliver the information faster. Snyder continues, "Now that we are documenting electronically, almost instantly the potential is there to provide information without IT analysts being involved." Next for Snyder and Peninsula: "We are working toward predicting the resources needed by a population of patients. Financially, that is where we as an industry are going to realize some cost savings."

Reprint HLR0213-4

This article appears in the January/February 2013 issue of HealthLeaders magazine.