While I agree with the author's points in respect to possible lost business because of a potential reduction in the number of patients seen, the lessons to be learned from the analogy with other businesses are not obvious. All of the businesses referenced in the analogy collect data at the core business process sourceat the primary purpose of their business.
It just happens the personnel who perform the work at the core source of the business are sales associates, clerks, tellers and deliverymen and women. In healthcare the core business process is the patient experience and the technicians in the care process are the clinicians. As in other businesses this is where the information needs to be collected to benefit the service organization, its customer and the industry. As the care provider, the physician at this point in the business process is not acting as the executive but as the person providing the service of the core processes of the business, as in the other organizations presented in the analogy. Yes there is a wide gap in salaries, and the salaries of the providers do approach or often times even exceed executives' salaries. Providers in the care process are performing the work of the core business processes and the expertise and knowledge needed at this service level demand an obvious difference in salary ranges compared with the service providers presented in the other industries. It is not expected that executives enter data nor is it expected that the clinicians who are performing executive-level functions for their practice enter data in the organization, but should be expected to when performing in the provider role. Executive information for the evaluation of the practice should be a byproduct of the actual work being performed in the care process. If you investigate the reasons for capturing the information at the point of care you will find it is the same as the business processes of UPS, FedEx, McDonald's, Gap and Wal-Mart.
These are to increase:
- And retain the business transaction information.
- Efficiencies in the overall business operations through reduced staff, space and expenses.
- Customer satisfaction.
- Revenue by capturing the chargeable items.
- Quality in the service provided.
- Compliance to regulatory and business reporting needs.
- Understanding and knowledge of the customers.
- Understanding of the business operations and safety concerns.
- The knowledge of the overall organization and make comparisons.
What healthcare needs is the investment in systems that do capture the information at the point of care by clinicians to realize the same benefits we have come to appreciate from other service industries. What is at issue is the complexity of the care process and the need for healthcare information systems to simplify and reduce the front-end investment by healthcare providers. Healthcare is not simply dealing with boxes, addresses, hamburgers, clothes or other items that can be easily identified through a standardized coding system. The complexity of the human body systems, the number of diseases, the number of possible approaches to caring for the diseases and the interaction between multiple diseases and human genetics makes it very difficult to create a system that takes all these factors into consideration to aid in decisionmaking.
Healthcare is fragmented with many vendors only producing a partial solution to the data-capturing and decisionmaking needs. A number of these vendors potentially will not be here tomorrow creating an investment risk to the executive portion of the provider's role. Healthcare, because of the lack of a free-enterprise market as seen in the other industries, does not allow for open competitiveness and price adjustments for recapturing the expense of healthcare information systems investment costs.
Reimbursement reductions have created a market where healthcare providers must increase the volume of patients seen to maintain their income level, making investments that potentially reduce the number of patients a quagmire.
What is needed is truly a transformation in the healthcare industry; this transformation is a journey that will need to take place over several years, because of needed changes in technology, practice patterns, reimbursement methods and the development of standards. To make this journey occur more quickly will require making some politically unfavorable decisions that will affect vendors, payers and providers.
James BahenskyAssociate professor of health management and policyUniversity of IowaIowa City To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.