The stimulus plan has definitely lived up to its name. Like many CIOs, I'm hyperstimulated. So are our physicians, staff, trustees, vendors and even our patients. They're all asking detailed questions and using a wide range of abbreviations, including MU, EPs, EHs, EHR, PHRs, HIEs, CCRs and CCDs. Answering questions about this alphabet soup is actually fun. Increasingly, however, I'm asked to address the really tough questions, such as "You want how much?" and "Why can't I have it now?" I understand these questions, but the answers are more complex.
CHIME Time: With health IT, sell the sizzle and the steak
People don't always see these questions as complex; rather, they expect that their own personal experiences can be translated into the business environment. For example, at home, plain old telephone service (or POTS, which really is the industry acronym) delivered via land lines has been replaced by powerful technologies that have upgraded POTS to include voicemail, caller ID and a host of other capabilities, including access to the Internet.
But having POTS via land line is old-fashioned. My daughters don't even have POTS. All of their telecommunications service, including Internet acces, is delivered by cable modem or wirelessly via their phones. And those phones have replaced their cameras and boom boxes (you may remember those as the short transition technology between records and downloads).
Smart phones are everywhere. If you don't have one, you soon will. To quote the fictitious Borg, "Resistance is futile." If you can't figure out how to use the new gadgets, ask a teenager or even a toddler. And more astonishing is the term "app" and the technology of applications. Most of the really good apps are free or cost less than $5. So why does everything in the healthcare IT environment cost millions of dollars and take years to install?
In our personal lives, we've done a very good job of making a value determination. For instance, costs for phone services have increased, but most people are willing to pay extra for premium services, even if the quality of the call isn't so wonderful. The cost of service, flexibility and safety far outweigh the negatives, yet we have justified the cost in relation to the value.
So how are we measuring value at work? Certainly not the way we measure it on a personal scale. It's very difficult to provide specific metrics to quantify the value of the investment, or VOI, in the electronic health record. There's no question it should be done—the challenge is how. There are many factors that yield a benefit and have an associated cost.
In calculating the VOI, do you include pre-implementation activities, such as order set standardization? In the effort to develop standardized order sets before other project-specific activities, we saw statistically significant improvements in outcomes. Should that count?
We saw considerable improvements in satisfaction and financial metrics associated with the re-engineering of patient-flow processes, but some of the improvements are the result of changes in practice not directly attributable to the EHR. What portion of those improvements should be recorded as a VOI? For each of our implementations, we try to encourage post-implementation optimization by increased training and a review of the new processes. Do these activities count? How long should we track VOI after implementation?
Even with these challenges, it's crucial that hospital and information system leaders have these dialogues. To deal with these questions, Baylor Health Care System in Dallas established a value model realization program. For each project deemed appropriate by our information management governance council, we create an associated value model realization project. Three recent examples included implementations of the EHR, a lab information system and a radiology information system.
The goals of value model realization are relatively easy to understand. Our discussions of value helped us and our users understand how the implementation or upgrade impacts or produces value in such a way that value can be designed into the project. Discussions about value help users become owners of what would otherwise be interpreted as a technical implementation.
If this is done successfully, an organization will be able to establish guideposts that enable all participating and affected parties to assess progress from pre- through post-implementation. These guideposts—and hopefully there are many along the way—can help motivate users during a sometimes very difficult transition process. Most importantly, each time that an organization reaches a guidepost and realizes value, a sense of achievement is created.
So far, the focus has implied that there is a need to measure costs as a way to determine value. However, some attention must be paid to intangibles. "It's the right thing to do" is an example of an immeasurable outcome; patient satisfaction, however, is a measurable intangible.
Oddly enough, intangibles are probably the primary reasons that information technology requests are honored. When developing the value model, be sure to include intangibles in your predictions. Use measurements where you're able and anecdotes when you cannot. The story of a single patient and their family can have more impact than all the statistics associated with a population study. Although you may not be able to touch an intangible, the intangibles are sure to touch your stakeholders.
And finally, there's the matter of time. Traditionally, plans for information systems could be divided into short-term, mid-term and long-term horizons. Now, because of the speed of innovation in our personal lives, even the short-term time frame is too long, and "immediate" is now required. Marketing classes used to teach students about selling the "sizzle instead of the steak." Now, we must deliver a sizzling steak immediately.
But you can't build an EHR, populate a PHR, meet meaningful-use requirements—and, of more importance, meaningfully use health information technology—by focusing only on the immediate. The complexities of human and organizational change management require the traditional time frames for people to adjust and accept changes, but you must create some sizzle along the way.
The implementation of an EHR affects virtually all work flows in a facility. Plan and execute on each horizon. Small wins build trust and help sustain enthusiasm, and so it's crucial for the information systems department to share small wins with its constituents.
It's no surprise that the expectations associated with EHRs are moving at an incredible pace. We cannot just be prepared to move with them; we as CIOs must lead these changes. I wonder, "Is there an app for that?"
David Muntz is senior vice president and chief information officer of Baylor Health Care System, Dallas.
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