Tuesday, January 3, 2023

"Exploring the Potential of Chat GPTs in Medicine: Benefits, Limitations, and Considerations"

GPT, or Generative Pre-training Transformer, is a type of artificial intelligence (AI) that has been used in a variety of applications, including in the field of medicine. In this article, we will explore how chat GPTs are being used in the medical industry and the potential benefits and limitations of this technology.

One way that chat GPTs are being used in medicine is by providing automated responses to patient inquiries. For example, a patient may ask a chat GPT about a particular symptom or treatment option, and the chat GPT can provide a response based on its knowledge of medical information. This can be especially useful for patients who may not have access to a healthcare provider or who may have questions outside of normal business hours.

Another use of chat GPTs in medicine is in providing information and support to healthcare providers. For example, a chat GPT could be used to provide physicians with information about a patient's medical history or to suggest treatment options based on the patient's symptoms. This could help to reduce the time that physicians spend on administrative tasks and allow them to focus on providing care to their patients.
There are several potential benefits to using chat GPTs in the medical field. For one, they can provide quick and accurate responses to patient inquiries, which can help to improve patient satisfaction and trust in the healthcare system.

Additionally, chat GPTs can be used to support healthcare providers by providing them with timely and relevant information, which can help to improve the quality of care that they are able to provide.

However, there are also limitations to using chat GPTs in medicine. One potential limitation is that the accuracy of the responses provided by the chat GPT may depend on the quality of the data it has been trained on. If the data used to train the chat GPT is incomplete or outdated, the responses it provides may not be accurate or relevant. Additionally, chat GPTs are not able to provide personalized care or make clinical decisions, so they should not be used as a replacement for human healthcare providers.In conclusion, chat GPTs have the potential to be a useful tool in the medical field, but they should be used with caution. They can provide quick and accurate responses to patient inquiries and support healthcare providers by providing them with relevant information. However, they are not able to provide personalized care or make clinical decisions, and the accuracy of their responses may depend on the quality of the data they have been trained on.

Don Lyons, FACHE
www.interoperant.com

don.lyons@interoperant.com

Personal Health Records - as Medical Devices?

"Personal Health Records are Durable Medical Equipment By Manfred Sternberg, J.D. Presiding Officer, Board of Directors, Texas Health Services Authority
There is little debate that knowledge and information have always been among a physician’s best clinical tools. Consistent with this fact, information technology (IT) should be viewed by the healthcare industry as a medical device. With the advent of evidence-based medicine coupled with advances of IT, we are in many ways on the brink of a golden age of medicine. In the relatively near future, information supporting evidence based medicine will translate from bench to bedside at speeds never before witnessed. We will have more accurate information to treat health issues more appropriately, based on the data, than ever before. Admittedly, IT is in many ways a crude medical device, but that is today. Many of the now traditional medical devices that were introduced into the healthcare market throughout history started off as crude devices; think about surgical tools.
Like other medical devices, this device is certain to evolve with use, experience, and continued development and innovation. Many predict that the use of this IT device by healthcare professionals will become the standard of practice, like scrubbing in before surgery. The legitimate debate generally centers on how and when. As with other changes in medicine, the adoption of this new tool will be an evolution. It will not happen by just flipping a switch at the end of any given year, it will evolve. Consumers and their physicians must participate in this evolution for it to ultimately be successful. The consumer’s best platform to effectively and economically engage with the industry is a standardized personal heath record (PHR).
What is a PHR?
A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual. PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information.
The Benefits of using a PHR
There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective healthcare. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs. Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and consumers and doctors can share that information to make the best decisions concerning their healthcare. Better data (e.g. timely, personalized clinical and billing data) provides better results whether in the hands of a physician, patient, health coach, or measurement program Additionally, care coordination from a process management perspective is critical to improved results
Consumer Empowerment
Consumers have great interest in the subject of healthcare. It is the most searched subject on the Internet, yet the long predicted wave of consumer empowerment in healthcare has yet to arrive. Consumers, as well as the business community, are generally unaware of the healthcare cost and quality issues and interoperability issues. Nor do they recognize that they have a new, long anticipated, role as purchasers seeking value in the healthcare delivery system. They tolerate the existence of numerous inefficiencies and cost in the healthcare sector far more than in any other market, because of and in spite of its relative importance and their inability to judge value.
Today, the consumer is unable to identify value without information on cost and quality. Quality cannot be identified without measurement and it cannot be compared without standardization. Since the mass adoption of the Internet, the benefits of IT have embedded themselves into society as one of the most powerful tools that consumers have ever had. Endless information is now available in everyone’s home. Society has embraced this new found consumer tool, but comprehensive personal clinical information has not digitally made its way into the consumer’s hands. To some degree it is not readily recommended or available, yet. How does a consumer get educated about their new role in their own health and their interaction with the healthcare delivery system? Who do they trust to guide them? Consumers trust their physicians far more than any other group in the Healthcare system. They certainly value their doctor’s advice, even if they don’t follow it all of the time.
Today, the consumer is effectively, unwittingly waiting on their physicians to recommend this new medical device for their health. Therefore, engagement of the physician is the key to fostering consumer empowerment.
What is Durable Medical Equipment (DME)?
There is no single authority, such as a federal agency that confers the official status of DME on any device or product. A fairly comprehensive definition of Durable Medical Equipment as contained in a Texas Group Policy is as follows:
Durable Medical Equipment is defined as being equipment that:
can withstand repeated use; and is primarily and customarily used to serve a medical purpose; and is generally not useful to a person who is not sick or injured, or used by other family members; and is appropriate for home use; and improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition; and is prescribed by a physician.
A consumer’s PHR fits the definition as follows:
Durable Medical Equipment means equipment : Noun. An instrumentality needed for an undertaking or to perform a service. that: can withstand repeated use. A PHR easily withstands repeated use. is primarily and customarily used to serve a medical purpose. A PHR contains a consumer’s relevant medical information so many medical decisions can be made based on the contents of the record.
is generally not useful to a person who is not sick or injured, or used by other family members. A PHR is not useful to anyone in the consumer’s family but the consumer and only the consumer can use it to track and support her health or coordinate her care when she is ill is appropriate for home use. A PHR is appropriate for home use or anyplace a consumer has a connection to the Internet. improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition. According to the trade association that represents insurance plans and the executives of most plans, there is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs. and is prescribed by a Physician; Can physicians professionally make this recommendation to their patients? It depends on whether they can professionally agree with the statement that “a PHR is a medical device that in certain cases can benefit their patient’s ongoing health or illness.” If physicians prescribe a PHR for their patients, and the Payers collectively agree to pay the costs, the standard of practice in a community will change. Physicians will create a new business model in order to pay for their EMR system, and the power of a new medical device can be leveraged for the benefit of the consumer. The PHR information must be stored in a secure way with patient privacy a cornerstone of the repository. Physicians must play a role in the central repository of this clinical information in terms of governance and oversight with appropriate financial compensation for their participation. If every physician in Harris County, Texas prescribes a PHR for every patient that could benefit from such a device, it will be a catalyst for the creation of a clinical information database that would be owned and controlled by doctors and their patients.
The opportunity for today’s leaders is to take steps to enable our community to appropriately leverage the power and value of the data. To be sure, this is not as much a technology problem as it is a sociology issue. The first step is for the Industry is to acknowledge IT for what it is, a medical device."

Thursday, October 18, 2018

InterOPERANT LLC develops Radiant Health.today for Consumer Health, Wellness and Prevention.

News Release 10.18.2018
3:55 CST


InterOPERANT LLC is developing a Block Chain powered Consumer platform to support Health, Wellness and Prevention of Disease - Radiant Health.today

The Problem: 

It is commonly known that insured American healthcare consumers (65% of population) pay twice per capita what Europeans do for healthcare and we are less healthy. The extraordinary total cost of the US healthcare system around 23% of GNP or $4.1 trillion has made American based businesses non-competitive. It is also bankrupting the middle class. Obamacare was not the answer and neither will other incremental reforms to the current system. A new streamlined, consumer centric approach to healthcare needs to be designed from scratch.

The Solution: 


Enter Radiant Health.today and the Radiant Health Outcome Composer. This product/service is a smartphone App that confidentially and securely presets and tracks user biometric, preventative, integrative and lifestyle data to guide the user to Radiant Health Outcomes over time. The Radiant Health Outcome Composer™ (RHOC) is a buttery smooth health and wellness UI which addresses total health and wellness obstacles, treatments and challenges. RHOC allows a user to map a wellness lifestyle path that incorporates all the key variables that affect wellness. . With RHOC™ anyone can learn how to create their own Radiant Health map and plan in less than 20 minutes. While the RHOC UI is intuitive an easy to use and interpret, it can accommodate the unique circumstances of individuals and be customized to meet their specific health and wellness needs. As well it runs within the Block Chain full Asset Trust model. The net effect for younger cohort groups getting into the RHOC program is expected to be far less chronic age related degenerative disease, lower long-term health care costs, more active monitoring of health between doctors or CAM providers and patients and healthier, happier, higher energy consumers.

The Harvard Business Review says it best:


"Finally, health care, which has been largely immune to the forces of disruptive innovation, is beginning to change. Seeing the potential to improve health with simple primary-care strategies, some of the biggest incumbent players are inviting new entrants focused on empowering consumers into their highly regulated ecosystems, bringing down costs."This shift is long overdue. Whereas new technologies, competitors, and business models have made products and services more affordable and accessible in media, finance, retail, and other sectors, U.S. health care keeps getting costlier. It is now by far the world’s most expensive system per capita, about twice that of the UK, Canada, and Australia, with chronic conditions such as diabetes and heart disease now accounting for more than 80% of total spending.These astronomical costs are largely due to the way competition works in American health care. Employers and insurance companies — not end consumers — call the shots on what kind of care they will pay for. Large hospitals and physician practices, in turn, compete as if they’re in an arms race to attract payers, adding advanced diagnostic gear or new surgical wings to differentiate, driving up costs.



In most industries, disruption comes from startups. Yet almost all health care innovation funded since 2000 has been for sustaining the industry’s business model rather than disrupting it. Our analysis of Pitchbook Data shows that more than $200 billion has been poured into health care venture capital, mostly in biotech, pharma, and devices where advances typically make health care more sophisticated — and expensive. Less than 1% of those investments have focused on helping consumers to play a more active role in managing their own health, an area ripe for disruptive approaches." Jennifer Maravillas, HBR.




For more information, or an investor executive briefing contact:

Don Lyons, CEO InterOPERANT LLC/Radiant Health.today
Email: don@radianthealth.today 





Monday, November 21, 2016

"The Big Dig" - the coming evolution of AI in Healthcare


"As the EMR “space race” peaks, clinical and health leaders are coming to understand that digitizing data does not, on its own, drive innovation or transformation
.
Many are wondering what’s next. Looking ahead, the next wave in our journey towards digital transformation is Artificial Intelligence (AI).Simply put, Artificial Intelligence is a collection of systems that sense, comprehend, act and learn.

The goal of AI in health is to drive greater “data dividends” than what we are getting from investments already made in EMRs and other systems. This dividend will be measured two ways: First, improved quality and efficiencies of systems that care for people when they are sick. Second, AI will enable a new style of “health systems” that empower consumers to better shape and manage their own health.


AI is not about auto-robots creating assembly-line healthcare. It is about systems that assist and support the wisdom and experience of well-trained clinicians in making better data-driven decisions and taking actions that best support the needs of those they serve. It does this by gathering and crunching massive amounts of data quickly and intelligently to identify patterns often overlooked or undiscovered in the traditional practice of care."

There are many global companies pursuing this trillion dollar business. Those who will own this in the Z-economy(c) and can push the culture toward the evolution of change - understand the human healthcare interface and the clinicans and caregivers intimately...

More to come.

Best,

Don

Friday, August 28, 2015

Value-Based Health Care - Our Solutions for You


The reformation of our healthcare system to one that is value-based, rather than volume-based, is still an ongoing process with quite a way to go. Getting to value is not an easy, or straightforward road.  Healthcare organizations, including providers, payers, and the government have all encountered numerous starts and stops, dead-ends, and flat-out blockades.  Some pioneering organizations have made great progress, but navigating the journey to value-based care is no small feat for any organization and requires a thoughtful plan of action matched to exceptional leadership. 


A well-thought out roadmap to value-based care for a healthcare delivery system includes considerations of organizational structure, integration of facilities, geographic expansion of services, measurement of outcomes and costs of care, reimbursement reforms, and integrated information technology (Porter and Lee, HBR). All components of the roadmap are important and each component presents its own unique challenges.

For instance, take the measurement of outcomes of care and the costs to achieve that care.  To determine either one, you must first determine perspective. Clinicians, patients, and other caregivers can each have their own set of criteria by which they measure a successful outcome of care. The key for an organization is to align those criteria to form a set of metrics which provide sufficient clinical, but patient-focused information about the care being delivered and the process through which it was delivered.  When measuring costs, perspective is again paramount.  Is the organization interested in measuring the costs associated with the delivery and provision of care only? Are they also interested in measuring the cost to the patient of consuming that care? Perhaps, they are interested in the costs to employers of care? Perhaps, to the healthcare system as a whole?   All are valid questions and measurements that determine how organizations will report their unique value proposition.

With unique experience in designing and implementing value-based programs at leading healthcare organizations InterOPERANT provides guidance and leadership to assist our clients in determining their unique roadmap to value-based care.

For more information about our solutions, please contact me:


Heidi Wied Bunyan, MPH, MHA, FHFMA
Don Lyons, FACHE, Managing Partner


1 713.705.3544

Monday, February 16, 2015

The future of Medical School is — almost — here.


The future of Medical School is — almost — here.

Over my career in healthcare I have realized that as much as my clinical work had an evidence basis, how about my management practice? Do we in the healthcare "practice of management" approach our work through a basis in evidence?

Thus began my interest in teaching in both healthcare management and work within the context of learning. Technology is having a dramatic effect on healthcare teaching and service delivery...

More and more, technology is shaping what medical schools teach, how professors teach it and how students learn.  
"There are not a lot of microscopes anymore," laughed Morgan Passiment, director of healthcare affairs for the Association of American Medical Colleges. Cadavers could soon be on their way out too, in favor of virtual anatomy. Instead, schools are beginning to incorporate EHRs, simulation, data analytics and new instructional approaches inspired by mHealth and telemedicine.

Medical school students now need to learn more technology-based skills, which require new settings and strategies that break from the traditional lecture hall environment. The challenge medical schools face is in preparing students for roles that continue to shift as care models and technologies change.
"This is a new era for medical education and it parallels the changes that are happening in our healthcare delivery system," says Marc Triola, MD, associate dean of educational informatics and the director of the Institute for Innovations in Medical Education at NYU School of Medicine.

But curriculum evolves slowly, Ms. Passiment says. Changes are typically reviewed and formalized every eight to 10 years.
"We knew there was a consensus out there for what had to change, but it wasn't happening," says Susan Skochelak, MD, AMA vice president of medical education and director of the AMA Center for Transforming Medical Education.
That's why the AMA decided in 2013 to launch its Accelerating Change in Medical Education Program, which awarded $11 million in grant funding to 11 medical schools. When the AMA put out a request for applications, nearly 85 percent of American medical schools responded, according to Dr. Skochelak.

"People want to teach IT, but they don't have the resources or don't know how to teach it," she says.
The 11 chosen schools were tasked to form a consortium and develop new curricula and learning strategies to share with other institutions around the country. Through 2018, the 11 selected universities, including Indiana University School of Medicine, NYU School of Medicine and Vanderbilt University School of Medicine, will be in the implementation stages of their individual curriculum projects.

The AMA's program isn't the only initiative focused on updating medical school curriculum. The ONC sponsors a Curriculum Development Centers Program, for example, which has awarded schools like Oregon Health and Science University with $2.7 million to overhaul curriculum and include new emphases, like EHRs.
While there is still not consistent integration of health IT across medical schools, pockets are diving into technology-based curricula, according to Ms. Passiment.

"The challenge we have right now is helping our learners understand the role technology can play in healthcare, and focusing on care outcomes, not on technology. Technology is a tool," says Ms. Passiment.

The disappearing paper trail

Just as hospitals strive to integrate EHRs as a tool for improved patient care, many medical schools still grapple with how to best integrate EHRs into curriculum, Dr. Skochelak says. Some universities continue to teach old-school paper record-keeping first, while others debate the use of templates. Meanwhile, at the residency level, students are missing the opportunity to use EHRs due to lack of training or HIPAA restrictions, she says.

"The challenge for educators at the beginning level and at the medical school level is we don't know the methods or the pedagogy that work best," says Dr. Skochelak.

IU School of Medicine, based in Indianapolis, is working to develop better methods and pedagogy to incorporate the EHR in a learning environment. It received a $1 million Accelerating Change in Medical Education grant from the AMA for its proposal to develop a virtual health system and teaching EHR, which would let future physicians practice clinical decision making in a realistic environment.

"I want our medical students to understand this. If I just put them in a lecture hall and talk at them, they won't get it," says Sara Jo Grethlein, MD, associate dean for undergraduate medical education and professor of clinical medicine in the division of hematology and oncology at IU School of Medicine.

"It's not just about [the students]; they have a place in a big, complex system, and they need to learn how to function and how they are assessed in that system, so they can thrive in that system," she says.
IU worked with the Indianapolis-based Regenstrief Insitute, an informatics research organization, and with the support of Eskenazi Hospital in Indianapolis it launched a fully functional teaching version of its EHR a year into the implementation stages of the grant. The tEHR uses real, carefully de-identified patient data from roughly 10,000 patient charts, down to the written notes.

The tEHR stands alone, unconnected to the hospital system, so students are free to write in orders and notes in a simulated environment where it can't hurt anybody, Dr. Grethlein says.
Second-year students at IU will soon start using the tEHR. They will receive 12 sessions across the year learning about systems-based practice and big data, according to Dr. Grethlein.

Now officials are developing activity-based assignments for third-year students to incorporate into their rotation schedules. For example, students could be assigned a hypothetical patient in the tEHR with cholecystitis, or a "hot gallbladder", who received gallbladder surgery. The student will then be asked to go into the tEHR, look at the labs and imaging tests performed during the patient stay and justify each of them, Dr. Grethlein says. If they cannot do so, she says, they must find out how much money was wasted on unnecessary tests.
The ideas behind the tEHR are not entirely new — Dr. Grethlein says she used to have students write down tests that weren't justified on index cards — but, "it's just a slicker, higher-tech way of doing the same thing."
The most important part is showing students how to use the EHR as a tool to better understand their role in providing care.

"It's not just how you put in notes or orders, it's how you use it as a tool to answer clinical questions and design intervention," says Dr. Skochelak.

Getting a hold of big data

To use EHRs as a tool, it is increasingly important for physicians to understand how to make data from EHRs and other sources actionable at the point of care.

"The analytics piece, just like the EHR, becomes the tool and mechanism to provide care. Many schools are headed in this direction, however, I don't believe it is consistent across medical education," says Ms. Passiment with the AAMC.

Clinical informatics became a certified subspecialty only a few years ago, in September 2011. It emphasizes data management to help improve how providers, patients and trainees use the information to improve overall health.

"There is a real challenge in getting people to fill the applied analytics positions in healthcare because you have to have some understanding and background in healthcare as well as analytics," says Ms. Passiment. Giving all future physicians some training in the data analytics portion of informatics could help address this challenge.

NYU School of Medicine, which also received Accelerating Change in Medical Education funding, is working to add data analytics into its traditional doctoring course, called "Practice of Medicine."
"NYU is using big data," says Dr. Skochelak with the AMA. "And I mean big data."

Big as in 5 million de-identified patient records. NYU students are learning to approach big clinical data sets and analyze them to measure providers' performance. They're challenged to think critically about healthcare and ask their own questions of the data, which is compiled from a publically available database called SPARCS, or the Statewide Planning and Research Cooperative System. Launched in 1979, the New York State database houses hospital admission and discharge information, patient diagnoses, treatments and charges, and outpatient services information. NYU combined this with CDC nutrition surveys and NYU Langone Medical Center's own patient data, providing students with access to millions of de-identified records.

The big data then becomes a learning tool. For example, in a pilot class NYU launched last summer, students were asked, "What do you think is the most likely reason a person is hospitalized in the state of New York?"
Most guessed chest pain or pneumonia, Dr. Skochelak says. They were surprised to learn the number one reason for hospitalization in New York is actually childbirth. They were even more surprised when they saw the fluctuation in cost for this service across the state. Delivering a baby costs $2,000 to $3,000 in rural areas, but up to $22,000 in Manhattan, Dr. Skochelak says. Students are challenged to think about why this discrepancy exists and track their own patient and population management activities and queries.
"What our students love most about this is the fact that it's real," says Dr. Triola. "It's not a textbook exercise; it's real clinical data. It's the environment students will be training in and potentially working in."
By October 2014, administrators were so impressed by the pilot they wanted the whole class to have the lesson, Dr. Skochelak says. It is now a core part of the medical curriculum and the entire first year class has taken the course, entitled "Healthcare by the Numbers."

Adding data analytics to the curriculum helps move NYU toward competency-based education, Dr. Triola says. It helps students acquire the tools they need to continue to learn throughout their careers. So, even though medical students are now tackling data analytics and other IT skills in addition to anatomy and biochemistry, Dr. Triola doesn't believe medical school needs to be longer.

"What I do think we need to do is begin using some of these technologies to make medical education more of a continuum," he says.

Applying IT to learning processes

Nashville-based Vanderbilt University School of Medicine did just that, by not only incorporating technology into what professors teach, but also into how students learn.
Vanderbilt calls it Curriculum 2.0.

The new curriculum applies not only to clinical outcomes or patient records, but to students and their learning trajectories. It documents achievements, competencies, faculty ratings and assessments in a portfolio for each student. It is also populated with hospital notes students enter in the EMR during their clerkships, automatically capturing their panel of patients, so they can use it as a teaching space.

Vanderbilt provides each student with a portfolio coach, who they keep throughout their time in school. Students are scheduled to periodically meet with their coaches to talk about their progress and performance.
"It allows us to ask students, 'How can we help you be the very best that you can be?' For high performers, we can ask, 'Given where you are, what else can you do?'" says Kim Lomis, MD, associate dean of undergraduate medical education and associate professor of surgery at Vanderbilt.

The advantage of this system is that it allows students to progress through medical school in a flexible way, Dr. Skochelak notes. Students advance through competencies based on performance, rather than time. This works well for some students who may need more — or less — time in medical school. Physical therapists who decide to go back to medical school, for example, could potentially acquire all the necessary competencies in a time frame shorter than the traditional four-year period, she says.

More importantly, it helps ensure students are building skills like communication, skills that could potentially fall through the cracks in a lecture hall-structured, knowledge-based curriculum, according to Dr. Lomis.  
"It's very much in the spirit of patient safety. It's making sure people are prepared for the roles they're going into," she says.

Vanderbilt's Curriculum 2.0 is more focused on team-based, active learning and puts students into the workplace sooner, Dr. Lomis says. Instead of the traditional two years of basic science, students go into clinics in their second year and the school weaves the remaining science courses through all four years.
"The new curriculum is not only focusing on content, but also on teaching students how they will learn throughout their whole career," she says.
* * *
Technology and technology-based learning strategies are helping medical schools like IU, NYU and Vanderbilt shift into collaborative, interactive learning environments, which may be better suited for a new generation of physicians.

"Students are used to a much more networked, engaged sharing environment and healthcare is not yet like that," says Ms. Passiment. "It's a much more structured tech environment. It's clunky for a lot of learners. It's challenged them to create their own workaround, which allows us to see what the next generation of care will look like."

Written by Emily Rappleye (Twitter | Google+)  | February 10, 2015

Best,

Don 


Tuesday, August 12, 2014

Healthcare Mergers, Joint Ventures and Governance

"The healthcare industry has experienced increased consolidation in recent years, and there are significant challenges in healthcare mergers that should be addressed both before and after integration. Specifically, there must be common goals, shared values, and one aligned culture within an established governance structure to create efficiencies and best practices with the combined best features of each of the consolidated entities.
As one example of the manifest need for cultural alignment, earlier this year, the HCA Midwest Health System purchased two Catholic hospitals in Kansas City (St. Joseph and St. Mary’s Medical Centers) as part of a transaction that resulted in a total of 12 hospitals, seven surgery centers and over 10,000 employees. In connection with this transaction, the HCA Midwest Health System has agreed to work with the local Catholic Dioceses of Kansas City to preserve the hospitals’ religious heritage. This is one of many examples illustrating the importance of culture and strategy as essential pieces of governance and successful integration.
For healthcare board members contemplating or engaging in mergers or acquisitions, the need for proper governance practices is magnified in the pre- and post-integration environment. If there is not sufficient discussion and alignment on cultural norms and values pre-merger, the consolidated entity will likely encounter costly challenges that could have been proactively addressed and resolved.
To execute their duties effectively, healthcare boards must engage in proper oversight of critical areas. The primary oversight responsibilities for healthcare boards can be grouped into six functional categories:
Culture – Culture is the term that describes the values, attitudes, norms, and behaviors of the entity – who they are and how they interact with one another. When two or more healthcare entities with different backgrounds merge, it is critical for them to (a) reach alignment on culture and (b) have an assured commitment for the going-forward culture before merging. Developing and maintaining the right culture maximizes the benefits of integration, allowing the consolidated healthcare system to achieve synergies and efficiencies that are possible through combined efforts that are greater than the sum of the individual capacities. Boards should devote time and attention to proactively defining, communicating and reinforcing the culture.
Talent – Emerging best practices are to have a more interactive, full-board discussion around robust succession and talent development planning for the CEO and senior management. Boards must demonstrate independence in undertaking executive compensation and evaluation decisions.
Strategy – As the oversight duties for boards increase, trustees are taking a more active role in assuring that their entity has a strategic plan that the trustees fully understand and jointly own with management. Involvement in the strategic process is best achieved through a meeting or retreats after integration devoted to strategy that not only educates on strategic issues, but also permits the trustees to have informal time together to promote collaboration through socialization and trust building. Such meetings allow boards and management to mutually develop their respective macro and micro roles – an invaluable asset for the consolidated system. Effective strategic plans for healthcare entities will take into account compliance and the changes on the horizon for the industry that will result from the Affordable Care Act.
Compliance – Complying with laws and regulations, while simultaneously assuring the highest ethical conduct, is largely dependent on a board’s commitment to best practices in compliance.  The government places additional compliance requirements on healthcare entities and expects healthcare boards to be aware of the applicable complex regulatory structures. The board must continually monitor the entity’s compliance risk assessments, education/prevention, and detection to ensure that all are working well on an integrated basis.
Risk – As board and trustee responsibilities increase, boards are expanding their oversight of risk management. Specific to healthcare entities, the Office of Inspector General requires an ongoing process of risk assessment. Best practice is to establish and maintain an Enterprise Risk Management program with clear allocation of accountability. The board should (a) oversee ERM and assure that it receives sufficient attention at all levels of the entity and (b) ensure that remedying of major risks is discussed by the full board and addressed in the entity’s strategic plan.
Governance – Boards should be large enough to accommodate the need for diverse skill sets, resources and experience and small enough to promote collegiality, flexibility and effective participation. Some healthcare boards are decreasing the size of the board and creating a board of visitors or board of advisors. Thus, the board operates more effectively while still involving well-respected advisors who provide access to experience, resources and networking. To this end, best practices today are for a nominating and governance committee to create a template of needed skills and character attributes for full board input and approval. The approved template is then used to ensure board searches are based on needed skills and required attributes."

Bill Ide is a partner at McKenna Long & Aldridge LLP.