In late 2002 having been newly recruited from Seattle, and upon entering the halls of one of the top cancer centers in the world, I was presented with enormous challenges. The central IT division was almost equal in size to it's "federated components." These "islands of automation" in most cases were highly effective - but perhaps were not the most efficient from a data integration and cost perspective. They were in many cases highly independent. Although I functioned in the Deputy CIO role, our organization had at least 20 or so "other CIO's." I can attest to the fact that most all of them had the next great idea! In fact, the division of Radiology under physician leadership had built an absolute world-class clinician portal called "Clinic Station." Having spent a number of years with this team, and having had a long career as a leader and a technologist - I would say Clinic Station today has few, if any, equals...it was and is a smashing success (thanks to Kevin, and Chuck)! Clinic Station through leveraging the SOA (.xml) environment continues to improve with new releases. Stay tuned for new developments as "Research Station" rolls out in the near future...
The challenge - the costs of managing this portfolio in a distributed manner were and are absolutely staggering. Also, not all functions could be efficiently integrated such as CPOE, Medication Management, etc. And what about using the data for clinical research? Data was everywhere - it was the land of databases...
Structured decision making, or the lack thereof often led to poor technology choices - the result of which became a very (massively) expensive "de-installation" project for other clinical applications. What the scenario lacked was effective decision making rooted in the technical and user community, managed by a collaborative governance team.
Extraordinary expense levels could not continue, and data integration became the new mantra. So how did we go about managing for results, and leading for transformation in this scenario?
As the Deputy CIO and in conjunction with our team of operational executives and physicians; we formed the Information Services Executive Team (a few consultants were added to the mix). The team began to define the need for:
1. Effective IS Governance.
2. A clear and credible organizational IS Strategy.
3, Well coordinated IS projects.
4. The need to provide substantial value through those projects.
5. Building relationships between central and distributed IS organizations.
From there we laid out the charge, the guidelines, the committee's, participation, etc. Today, and according to Gartner Research, the organization has reached a pinnacle in governing itself around IS technology, people, and related process issues. We were pioneers in tackling these problems with all it's political implications - I was proud to be part of the solution.
One size does not fit all, and we at InterOPERANT can help you design, build and implement the proper solution for your organization. Much of our research comes from Gartner, the CISR at MIT, Sloan School of Management, http://mitsloan.mit.edu/cisr/. Also, see our blog post, "Governance - Verse1." As well, InterOPERANT relies on the work from HITSP, and are commenting members of ANSI, HITSP, http://www.hitsp.org/.
Today, health care organizations are just beginning to understand how to manage the expense and complexities of it's information technology functions. As I have mentioned in prior posts, IT is both a value creation, and service delivery center all tied to core functions and processes at every level of the organization. It is a concept which must be embraced by everyone - and effective, and participative (read collaborative) governance will help create, and deliver real value across perceived organizational boundaries.
Some of you may have friends at Stanford Hospital and Clinics - we do. They have a huge appetite for advanced clinical systems, and an annual capital budget of $40 to $60 million allocated to information systems. Not only are they huge and wonderfully complex, but in 2004 they established a seven year system-wide information technology out-source contract with Perot Systems Corporation. As well, a few large scale consulting firms got involved...2007 found trouble in paradise.
Today, they are well on there way toward implementing an elegant and strong governance solution to manage their commitment to information technology out-sourcing. This is one of the most difficult of all challenges. If they can do it, so can you. We at InterOPERANT will help you achieve your climb to the summit!
Best,
Don Lyons
InerOPERANT
CEO and Managing Partner
Thursday, August 28, 2008
Tuesday, August 5, 2008
Acute Care, Really?
In performing research for Quantum Leadership (American College of Healthcare Executives) on Acute Care, Managed Care, and Ambulatory Care - we found large variations in what was described, world-wide. InterOPERANT continues it's quest to provide a benchmark understanding of the key terms describing the people, process and technology. These are the systems that encompass the delivery of our national healthcare model. We will start with Acute Care, and continue additional posts on other forms of care delivery most prevalent in the US.
Knowledge of Acute Care Sector
Acute Care defined:
A commonly accepted definition is difficult to find in the literature and changes are by author, or organization, or political administration. However, it conforms generally to the following:
· Acute care refers to necessary treatment of a disease for only a short period of time in which a patient is treated for a brief but severe episode of illness. Many hospitals are acute care facilities with the goal of discharging the patient as soon as the patient is deemed healthy and stable, with appropriate discharge instructions.
· The term is generally associated with care rendered in an emergency department, ambulatory care clinic, or other short term stay facility. An important aspect of the current health care crisis in the US is the result of the growing need for acute care despite a decrease in the number of facilities which provide that care. This mismatch has resulted from the dramatic increase in the number of patients who are uninsured or underinsured, and therefore unable to pay for services rendered. Those patients often turn to emergency departments for their acute care needs. That has resulted in overcrowding and made it increasingly difficult to focus adequate resources on those patients who present with true emergencies.
From the “Wikipedia 2008”...simple, and powerful, another more simplistic notion is the following:
acute care
n.
Short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery.
DEFINITION AND DESCRIPTION OF ACUTE CARE HOSPITALS:
Acute care is a level of health care in which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma, and during recovery from surgery. Acute care is generally provided in a hospital by a variety of clinical personnel using technical equipment, pharmaceuticals, and medical supplies.
Hospitals – the essential partner to the physician a hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays. Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), health insurances or charities, including direct charitable donations. In history, however, they were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers
Financial and Operational Classes:
· For profit
· Not for Profit
· Community Hospitals
· Academic and Teaching Hospitals
· Government Hospitals
Hospitals may have any of the following departments or units:
Behavioral Health Services
Burn unit
Cancer Center
Coronary care unit
Dispensary
Emergency department
Intensive Care Unit
Labor and Delivery and Neonatal
Laboratory Services
Nursing unit
Orthopedic Services
Outpatient Department
Pharmacy
Psychiatric ward
Rehabilitation Services
Physical Therapy
Post anesthesia care unit
Radiology
Respiratory Therapy
Surgery
Urgent care
Non-medical departments include:
Medical records department
Release of Information department
Other such as Legal, Compliance, etc.
Physicians
· Primary Care – primary contact with the patient
· Medicine – referral
· Surgery - referral
· Diagnosis – referral
· Multispecialty Practices
§ Open to fee for service, and managed care financing
· Group Practices
§ HMO financing
· Independent Physician Associations
· Physician Hospital Organizations
§ Fee for service and managed care.
· Government Physicians
· US Army, VA, etc.
· Academic Medical School Faculties
· Government and Private
Other providers and integrators to the system
· Over 50 professional specialties that support the model.
· Hospice
· LTC
· Vendors and suppliers, equipment, Pharma, Bio-Pharma, etc.
Healthcare Networks and Systems, and Alliances – Consolidations
· An Integrated Delivery Network (IDN) is a network of facilities and providers working together to offer a continuum of care to a specific market or geographic area. Developed in the early 1980s, IDNs emerged to address common concerns like capitation, excess capacity, decreased margins, and complaints from patients regarding access.
· IDNs include many types of associations across the continuum of care and one network may include a short- and long-term hospital, HMO, PHO, PPO, Home Health agency, and hospice services, for example. Multi-hospital systems and mergers may be considered limited IDNs in that different entities join forces to provide care.
· Some members of a network provide identical or complementary services to patients. Such associations in which a similar level of care is provided by members of a network is sometimes called horizontal integration or, as opposed to different levels of care, or vertical integration, generally seen in the more traditional IDN model.
During the 1990s and into the next decade many hospitals pursued twin strategies of vertical and horizontal integration. Each type of integration assumed multiple forms:
· Vertical integration. Proponents of vertical integration between hospitals and other health care providers and payers mentioned several goals underlying these efforts. These objectives reflected a range of efficiency goals (manage global capitation, form large patient and provider pools to diversify risk, reduce cost of payer contracting), access goals (offer a seamless continuum of care, respond to state legislation), and quality goals (assume responsibility for health status of local population).
· Horizontal integration. Hospitals’ rationales for horizontal combinations likewise reflected a mixture of efficiency goals (prepare for capitation, reduce excess capacity, strengthen financial position) and access goals (expand the delivery network). In fact, their objective functions for the two broad strategies often overlapped, which suggests that hospitals did not really understand the difference between the two. A major stated objective in horizontal integration was achieving economies of scale. Such economies were believed to flow from several sources, including large patient volumes, sharing of equipment and services, and group purchasing.
· All of these alternatives give the hospital-based enterprise a role, but by no means the leading role, in linking the services that patients receive. What entity will actually control the process of coordination is still up for grabs. Given the strong trends toward outpatient care, even within a hospital structure, we can probably rule out an inpatient-oriented firm as a contender. The hospital will have to be more than a hospital alone. Economic theory implies that organizational structure and control depend on transaction cost, or its mirror image, transaction productivity. It remains to be seen whether any of the current players, or possibly some wholly new entity, will perform best in that role.
Health Insurance Organizations – primary method to finance healthcare in America
· Healthcare Insurance over 2,000 private payors and commercial companies, BlueCross/BlueShield
· Medicare
· Medicaid
· HMO Act 1973
§ Limits on premium covered – employee premium sharing
§ Limits on payments – deductibles, co-payments
§ Limits of provider selection – PPO’s, POS
§ Provider risk sharing – DRG’s, and capitation
§ Pay for performance – behavior change among physicals
So how about a question for our readership:
The best strategic approach for hospitals to pursue most efficient operations:
1. Pursue vertical integration strategies
2. Pursue horizontal integration strategies
3. Monitor the environment and be aware of emerging strategies to best position for short-term and long term viability focused on the needs of patients.
4. Continue every day with business as usual. Healthcare delivery processes will not evolve.
Correct answer: 3. The environment should be closely monitored for a combination of vertical and horizontal integration strategies and projects on an individual basis of merit with a focus on economic returns, patient, physician and employee satisfaction, and operational re-trenchment, stability and growth.
References:
The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2003. Published by Houghton Mifflin Company.
Center for Medicaid and Medicare Services, 2005
Griffith, J.R., and K.R. White, The Revolution in Hospital Management, 2005.
Griffith, and White, The Well Managed Health Care Organization, 6th Edition, 2006.
Rosenberg, C.E., The Care of Strangers, The Rise of Americas Hospital System, 1989.
Glen McDaniel, MS, MBA, The Gerhson, Lehrman Group, Expert Healthcare, 2008.
Lastly, why might a technology executive have a specific interest in what I have written today? Strategic thinking CIO's, and Technology Director's, Manager's, and Staff must understand these components, and follow the genesis of new delivery structures. You are the enablers, and manage potentially the largest "Value Creation and Delivery Center" in Modern Healthcare...
We at InterOPERANT would like to help you climb to your Summit in creating greater value for your organizations.
Best,
Don Lyons
InterOPERANT
CEO, and Managing Partner
Knowledge of Acute Care Sector
Acute Care defined:
A commonly accepted definition is difficult to find in the literature and changes are by author, or organization, or political administration. However, it conforms generally to the following:
· Acute care refers to necessary treatment of a disease for only a short period of time in which a patient is treated for a brief but severe episode of illness. Many hospitals are acute care facilities with the goal of discharging the patient as soon as the patient is deemed healthy and stable, with appropriate discharge instructions.
· The term is generally associated with care rendered in an emergency department, ambulatory care clinic, or other short term stay facility. An important aspect of the current health care crisis in the US is the result of the growing need for acute care despite a decrease in the number of facilities which provide that care. This mismatch has resulted from the dramatic increase in the number of patients who are uninsured or underinsured, and therefore unable to pay for services rendered. Those patients often turn to emergency departments for their acute care needs. That has resulted in overcrowding and made it increasingly difficult to focus adequate resources on those patients who present with true emergencies.
From the “Wikipedia 2008”...simple, and powerful, another more simplistic notion is the following:
acute care
n.
Short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery.
DEFINITION AND DESCRIPTION OF ACUTE CARE HOSPITALS:
Acute care is a level of health care in which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma, and during recovery from surgery. Acute care is generally provided in a hospital by a variety of clinical personnel using technical equipment, pharmaceuticals, and medical supplies.
Hospitals – the essential partner to the physician a hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays. Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), health insurances or charities, including direct charitable donations. In history, however, they were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers
Financial and Operational Classes:
· For profit
· Not for Profit
· Community Hospitals
· Academic and Teaching Hospitals
· Government Hospitals
Hospitals may have any of the following departments or units:
Behavioral Health Services
Burn unit
Cancer Center
Coronary care unit
Dispensary
Emergency department
Intensive Care Unit
Labor and Delivery and Neonatal
Laboratory Services
Nursing unit
Orthopedic Services
Outpatient Department
Pharmacy
Psychiatric ward
Rehabilitation Services
Physical Therapy
Post anesthesia care unit
Radiology
Respiratory Therapy
Surgery
Urgent care
Non-medical departments include:
Medical records department
Release of Information department
Other such as Legal, Compliance, etc.
Physicians
· Primary Care – primary contact with the patient
· Medicine – referral
· Surgery - referral
· Diagnosis – referral
· Multispecialty Practices
§ Open to fee for service, and managed care financing
· Group Practices
§ HMO financing
· Independent Physician Associations
· Physician Hospital Organizations
§ Fee for service and managed care.
· Government Physicians
· US Army, VA, etc.
· Academic Medical School Faculties
· Government and Private
Other providers and integrators to the system
· Over 50 professional specialties that support the model.
· Hospice
· LTC
· Vendors and suppliers, equipment, Pharma, Bio-Pharma, etc.
Healthcare Networks and Systems, and Alliances – Consolidations
· An Integrated Delivery Network (IDN) is a network of facilities and providers working together to offer a continuum of care to a specific market or geographic area. Developed in the early 1980s, IDNs emerged to address common concerns like capitation, excess capacity, decreased margins, and complaints from patients regarding access.
· IDNs include many types of associations across the continuum of care and one network may include a short- and long-term hospital, HMO, PHO, PPO, Home Health agency, and hospice services, for example. Multi-hospital systems and mergers may be considered limited IDNs in that different entities join forces to provide care.
· Some members of a network provide identical or complementary services to patients. Such associations in which a similar level of care is provided by members of a network is sometimes called horizontal integration or, as opposed to different levels of care, or vertical integration, generally seen in the more traditional IDN model.
During the 1990s and into the next decade many hospitals pursued twin strategies of vertical and horizontal integration. Each type of integration assumed multiple forms:
· Vertical integration. Proponents of vertical integration between hospitals and other health care providers and payers mentioned several goals underlying these efforts. These objectives reflected a range of efficiency goals (manage global capitation, form large patient and provider pools to diversify risk, reduce cost of payer contracting), access goals (offer a seamless continuum of care, respond to state legislation), and quality goals (assume responsibility for health status of local population).
· Horizontal integration. Hospitals’ rationales for horizontal combinations likewise reflected a mixture of efficiency goals (prepare for capitation, reduce excess capacity, strengthen financial position) and access goals (expand the delivery network). In fact, their objective functions for the two broad strategies often overlapped, which suggests that hospitals did not really understand the difference between the two. A major stated objective in horizontal integration was achieving economies of scale. Such economies were believed to flow from several sources, including large patient volumes, sharing of equipment and services, and group purchasing.
· All of these alternatives give the hospital-based enterprise a role, but by no means the leading role, in linking the services that patients receive. What entity will actually control the process of coordination is still up for grabs. Given the strong trends toward outpatient care, even within a hospital structure, we can probably rule out an inpatient-oriented firm as a contender. The hospital will have to be more than a hospital alone. Economic theory implies that organizational structure and control depend on transaction cost, or its mirror image, transaction productivity. It remains to be seen whether any of the current players, or possibly some wholly new entity, will perform best in that role.
Health Insurance Organizations – primary method to finance healthcare in America
· Healthcare Insurance over 2,000 private payors and commercial companies, BlueCross/BlueShield
· Medicare
· Medicaid
· HMO Act 1973
§ Limits on premium covered – employee premium sharing
§ Limits on payments – deductibles, co-payments
§ Limits of provider selection – PPO’s, POS
§ Provider risk sharing – DRG’s, and capitation
§ Pay for performance – behavior change among physicals
So how about a question for our readership:
The best strategic approach for hospitals to pursue most efficient operations:
1. Pursue vertical integration strategies
2. Pursue horizontal integration strategies
3. Monitor the environment and be aware of emerging strategies to best position for short-term and long term viability focused on the needs of patients.
4. Continue every day with business as usual. Healthcare delivery processes will not evolve.
Correct answer: 3. The environment should be closely monitored for a combination of vertical and horizontal integration strategies and projects on an individual basis of merit with a focus on economic returns, patient, physician and employee satisfaction, and operational re-trenchment, stability and growth.
References:
The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2003. Published by Houghton Mifflin Company.
Center for Medicaid and Medicare Services, 2005
Griffith, J.R., and K.R. White, The Revolution in Hospital Management, 2005.
Griffith, and White, The Well Managed Health Care Organization, 6th Edition, 2006.
Rosenberg, C.E., The Care of Strangers, The Rise of Americas Hospital System, 1989.
Glen McDaniel, MS, MBA, The Gerhson, Lehrman Group, Expert Healthcare, 2008.
Lastly, why might a technology executive have a specific interest in what I have written today? Strategic thinking CIO's, and Technology Director's, Manager's, and Staff must understand these components, and follow the genesis of new delivery structures. You are the enablers, and manage potentially the largest "Value Creation and Delivery Center" in Modern Healthcare...
We at InterOPERANT would like to help you climb to your Summit in creating greater value for your organizations.
Best,
Don Lyons
InterOPERANT
CEO, and Managing Partner
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