Overcoming the Top 3 Challenges in Health IT: Cost, Privacy and Adoption

Pathways to Leadership Series

May 15, 2014

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Agenda

• Housekeeping• Speaker Introductions• Presentation• Q&A• Conclusion

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Speakers

Jennifer Covich Bordenick

CEO

eHealth Initiative

Washington, D.C.

Russell Branzell

President & CEO

College of Healthcare Information

Management Executives (CHIME)

Geoffrey Brown

Chief Information Officer & Senior Vice

President

Inova Health System

Northern Virginia

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Serving as CEO of eHealth Initiative since 2009, Ms. Bordenick provides leadership for all the research, education and advocacy components of the eHealth Initiative and its foundation. Working closely with executives from across the spectrum of healthcare, she helped refine the organization's strategic focus to concentrate on the use of data and analytics; accountable care; data exchange; and technology tools for chronic care conditions. She has played an active role in educating the industry about the impact of healthcare reform on health IT, interoperability concerns and meaningful use regulations.

Jennifer Covich BordenickCEO, eHealth Initiative

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Russell Branzell is a Certified Healthcare CIO, a fellow of CHIME and HIMSS, and board certified through the American College of Healthcare Executives (ACHE). He has served as the president & CEO of CHIME since April 2013. Previously, he was the CEO of Colorado Health Medical Group, a division of University of Colorado Health. In 2010, he was honored with the CHIME State Advocacy Award for his work in bringing together stakeholders across Colorado to further the advancement of HIT.

Russell BranzellCEO, CHIME

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Mr. Brown has 35 consecutive years of progressive experience in information technology, management, consulting and strategic planning. Brown is in the unique position of having work experience as a CIO in public, for profit and not-for-profit healthcare organizations. He is known for delivering real results through improved utilization of technology and people. Inova Health System (IHS) is the largest not-for-profit healthcare system in the Washington D.C., metropolitan area with history dating to 1872.

Geoffrey BrownChief Information Officer & Senior Vice

President, Inova Health

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What are the Issues?

Cost :: Justifying the price tag of new

healthcare technology

Adoption :: Ensuring proper

implementation to ensure ROI is achieved

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Privacy :: Keeping pace with

emerging technologies, especially

mobile and telehealth

IT Challenge #1: COST

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Cost: The Challenges

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… while savings mostly go to insurers,

patients.

Providers pay

Health IT can

improve patient

safety, healthcare

quality, and

efficiency of data

collection while

restraining rising

costs. But …

… and the stakes are high.

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Full implementation of healthcare technology could

bring efficiency savings of $77 billion – but only after

the initial 15-year adoption period. (RAND Corp.)

A nationally interoperable system would

cost $150 billion over five years.

As reimbursements shrink, the need to

carefully analyze each purchasing decision has

never been more urgent.

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Strategies for Justifying the Cost of Health IT

Position as a clinical/business decision – not a

technology initiative or purchase

Treat technology as an agent for

change; a solution that drives clinical and operational

improvement

Don’t waste time justifying your

“plumbing” (network upgrades,

new PCs, etc.).Get that on a

schedule so you can spend time on true improvements.

1. Prioritize your financing. Not

enough IT departments do this.

2. Collect as much data as

possible. The more data you

collect, the more you can

document how you’re saving

money with technology – or how

much you’re losing without it.

Strategize, Prioritize, Quantify

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What’s the

priority?

ICD-10

Meaningful Use 2

Health Exchanges

Healthcare Reform

Patient Engagement

Revenue Cycle

EHRs

40% measure ROI on their EMR

implementations

only 36% of this smaller group is

convinced their ROI calculations are

accurate.

Source: 2013 Beacon

Partners survey of more

than 200 hospital CIOs:

Making the Business Case

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Step 1:

Capture Your Current State

• Financials, Revenue, Quality, Process, Workflow

Step 2:

Show Where Changes Would Bring Value or Improvement

Step 3:

Understand the Full Impact on Your Organization

• Deployment, Equipment, Licensing,

It is difficult to

make a

business case

for disruptive

technologies

But it can be

done …

CASE STUDY: Lakeland HealthCare

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Provider: Lakeland HealthCare, 4-hospital system in

Western Michigan

Technology: $50 million EHR implementation over 5 years

The board at Lakeland wanted to see the value of investment beyond the fact that

EHRs are mandated by Meaningful Use.

Plan of Action

1. Hired a consultant.

2. Consulted with peers, developed a governance structure and identified KPIs approved by

leadership team

3. Created a team to measure financial and clinical returns

• Teams meet regularly, report to board quarterly

• To measure, established baseline and tracked over time.

“If you don’t want to be

seen as just another

cost center, you must

evaluate and report on

investments in IT.”

Results

• CPOE had immediate cost impact - $1 million savings in the

first year – due to reduced need for transcriptionists

• Improvements in sepsis care as a result of barcode scanning

saved 32 lives

IT Challenge #2: Privacy

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• What is your organization’s biggest privacy challenge?

• mHealth applications

• Sharing data with third parties

• Regulatory compliance

• Organizational culture

• Other

POLL

Privacy: The Challenges

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Current policies were developed

for a paper-based world.

Consumers are more aware of

data breaches, and the cost is

huge: Last week New York

Presbyterian and Columbia were

hit with the largest HIPAA

settlement at $4.8 million after

6,800 patient records were

released on the Internet.

PrivacyChallenges

Data breaches

Policy not keeping

pace

HIPAAMobile Use

BYOD

Privacy: Whose Information?

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Consumers

trust health

providers the

most with their

information:

Who do you trust to store or

access your healthcare

information?

27% federal agency

27% private firm like Google or Microsoft

71% hospitals

99% primary care

doctorSource: Ponemon Institute

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Strategies for Addressing Privacy Issues

Convince leadership to

invest in technology that

protects privacy,

associate with the bottom line

Conduct a solid risk

assessment, many privacy programs at

early stage of development

Consider your organization’s

existing culture, determine

weaknesses and integrate efforts within

existing privacy policies

New privacy policies should

reflect your organization’s

priorities

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Provider: Sutter Care at Home, a California-based home care and

hospice agency whose 1,300 caregivers service nearly 100,000

patients in 23 counties

Technology: Android 4G 7-inch tablets for at-home caregivers

SOLUTION: Mobile device management (MDM): Sutter installed MDM

software on their tablet devices that allowed them to apply security policies

and controls; to track device inventory and usage; to manage software

distribution; and to remotely wipe a lost/stolen device.

1. IT department has greater level of control over the tablets versus laptops.

Tablets are password protected and encrypted; if a tablet is lost or stolen,

Sutter Care at Home can wipe the device clean of information remotely, in

a matter of seconds.

2. The system also alerts the IT department if any unauthorized app is

downloaded by a user, and the device repeatedly prompts the user to

delete the app until it is removed.

“There are

always issues

with security

compliance with

any device.

When our

security office

wants to know

whether a device

was encrypted,

we can tell them

exactly when,

and we can issue

a wipe command

and erase the

device

immediately. We

have a level of

security that we

never had with

laptops.”

CASE STUDY: Sutter Care at Home

Addressing BYOD

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Nearly everyone owns smart technology now – and they want to

use applications on their own device to provide care OR

receive care (in the patient’s case).

This, however, creates privacy concerns as our devices are

used for multiple functions, for lots of sharing, and are not

encrypted or protected properly.

Your job:

1. Help hospital leadership understand there needs to be a

policy – sooner rather than later. BYOD is not something that

can be ignored.

2. Define your risk tolerance level, and build a policy around

that level. If the banking industry can do it, healthcare can do it.

Addressing BYOD at Inova

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BYOD is like mobile with new policy and control issues.

Technologies are the same (devices, security controls)

Employee ownership of device raises issues of control & management

How should it Easy answer is to treat employee devices as another external Internet connection

Problem: Mobile apps provide better user experience but require internal connections to your production environment

Where do the risks come from? Sensitivity of data on the device (e.g. Patient Records)

Impact of loss or misuse (e.g. data breach reporting reqs.)

Inova Health:

5 hospitals

1,700 beds

16,000 employees

IT Challenge #3: Adoption

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Barriers to Technology Adoption

Barriers

Physician Preference

Staff Resistance

Unqualified Workforce

Lack of Time

Interoper-ability

Fear of change

“Technology cannot do anything

alone. When the patterns of its use

are not tailored to the workers and

their environment to yield high

quality care, the technological

interventions will not be productive.

Any IT acquisition or

implementation should, first and

foremost, be an organization

change.

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• Find physician champions.

• Highlight benefits for different groups.

• Maintain realistic expectations.

• Make tools user-friendly.

• Recruit Subject Matter Experts.

• Use a Communications Plan.

Implementation Best Practices

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• Does your organization use a formal communications plan when rolling out new technology?

• Yes, always

• Yes, sometimes

• No, but we are considering it

• No, never

POLL

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Why do I need one?

This is a huge change management exercise – not an IT “project” or

simple technology switchover.

What should your Communications Plan look like?

Robust enough to cover the necessary information,

but not so dense that no one will actually read it.

How will my Communication Plan succeed?

By involving everyone upfront. Most training plans end up being reactive

to complaints and issues – adoption is more successful when your

communications plan anticipates obstacles.

How will I communicate my Communications Plan?

In multiple formats and several places. In person. Via newsletter. Emails.

Everyone adapts differently, so providing multiple avenues helps ensure

more people will grow comfortable with the technology.

Your Communications Plan

Measuring Results & Impact

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Measuring results and impact is

important because …

• You need to understand your

organization’s level of adoption to realize

further improvements

• You will be reporting back to the C suite

on the value of the investment

• You can leverage the information to

justify future technology investments

TIPS:

Take a “before” picture

so the “after” picture is

an accurate measure of

improvement.

Define: What does

success look like? All

measurements should

relate back to this model

.

A project doesn’t end the

day you go live – it’s just

the beginning.

CASE STUDY

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Step 1 :: Implementation team was formed across departments

Step 2 :: Phased implementation and strategy to encourage use

Obstacle: Nurses were recording medication information hours after it was

given; this practice would have to change with the safety system

Reasons for Success: Made it easy for the nurse to “make the better choice” by understanding

medication recording process and reforming it through the nurses’ eyes

Units and users that achieve 100% scan rate are honored

Units and users that achieve low scan rates are given extra training

Project was billed as a Patient Safety Initiative made possible by the IT department

– not an “IT project” – and was driven by clinicians

Provider – Cook Children’s Medical Center, Ft. Worth, Texas

Investment – Barcode bedside medication verification system

Goal – Provide another layer of safety to augment the experienced staff

Q&A

Jennifer Covich Bordenick

CEO

eHealth Initiative

Washington, D.C.

Russell Branzell

President & CEO

College of Healthcare Information

Management Executives (CHIME)

Geoffrey Brown

Chief Information Officer & Senior Vice

President

Inova Health System

Northern Virginia

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