The Pivot: From Compliance to Strategy

HIMSS16 – billed as the largest and most important healthcare IT conference in the United States occurred last week in Las Vegas.  The message was loud and clear – something is different; the government mandate is over.  Strategy is the new, new.

For years the HIT world has encouraged alignment of enterprise strategy and the IT plan.  Alignment suggests two distinctly different things creating a linkage or connection.  Healthcare enterprise strategy decisions such as which markets do we enter, who do we acquire, which service lines do we emphasize, and what capital investments do we make are explored at executive and board levels.  Operations and financial decisions to support our hospitals and physician practices are made within organizational silos.  Sometimes IT is at the table, but more often than not information systems professionals are called in after the fact to “implement” selected systems and tools.  Sophisticated IT organizations have created IT Strategic Plans, IT Governance structures, IT Road Maps, and IT Champions/Customer Relationship Managers.  Our challenge – separate, sometimes aligned but rarely one.

Uncertainty is the new normal.  Strategies that take years to implement, vendor partners who are all vying for the same space and the challenges of mergers and acquisitions are driving us from 1.0 healthcare – where business as usual no longer is sustainable.  We are at a cross roads.  Those of us in transition must “pivot” our viewpoint from 1.0 volume based thinking to 2.0 and beyond.

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We need fresh, new perspectives regarding the relationship between enterprise direction and the digital strategies required for the future.  New harmonized strategies will:

  • Vary by geographic market and depend on community progress toward clinical integration
  • Necessitate partnerships, alliances and consolidations – no one can fund the investment alone and no one vendor will have all the solutions
  • Require governance models that address horizontal, vertical and virtual decisions making and integrate change across multiple systems of care
  • Move from an applications focus which emphasizes feature, functionaliy to a platform focus, producing highly configurable systems which will drive standardization and enable business strategies simultaneously
  • Redesign our organization structures, leadership competencies and operating models in IT, Informatics, Analytics and Quality
  • Acknowledge our work to create systems of documentation was foundational but not the end goal; systems of insight and behavorial change are the next stages in the evolution
  • Result in convergence of people, process, information, change and technology to rationalize costs, manage risks, realize value and activate patients to become involved in their care

 

Organization Design – Emerging Models for IT, Informatics, Analytics & Quality

“IT in healthcare is no longer a hero’s game” indicates one executive. CIO in healthcare stands for “Chief Infrastructure Officer” and in the future it must stand for “Information, Integration and Innovation” says a CIO who comes from outside the healthcare industry. Our “clinical informatics leaders must think more strategically” indicates a CEO. All quotes from recent interviews of executives from 60 leading health systems conducted by Maestro Strategies CEO Pam Arlotto. CEOs, CMOs, CIOs and CMIOs all indicate new leadership and organizational models are needed as the industry transitions from volume to value. As senior leadership teams tackle consolidation, clinical integration, population health management and a variety of new strategies. Traditional silo based organization structures will not drive value in tomorrow’s health and healthcare enterprise. Emerging themes include:

  • The ability to work across entities, geographies, points in the continuum, service lines, etc
  • Clinical integration is driving new organizations structures and operating models
  • Informatics is being formalized and is pivoting from a focus on technology adoption to information, people, process and change
  • Analytics skills and competencies while not new to healthcare, must evolve to meet the demands of today’s enterprise
  • Convergence of informatics, analytics and quality is needed to manage the health of populations

See a short video (~15 minute) Research Summary of the emerging organization design trends for IT, Informatics, Analytics and Quality. A more in-depth virtual or in person briefing is available for leadership teams.

 

 

Two Canoes … and Four ‘I’s

Change: No two healthcare provider organizations experience it the same way. Some actively pursue development of clinically integrated networks and accountable care organizations, others double down on traditional healthcare practices. Many are paralyzed, not knowing what to do or how. The transition from volume to value has been described as “stepping from one canoe to another midstream.” Although the analogy clearly depicts the challenge, it doesn’t instruct healthcare executives how to successfully execute the step without falling in. The American Hospital Association has tackled this task by publishing a series of white papers describing the journey as moving from “first curve” to “second curve” healthcare. The most recent, Your Hospital’s Path to the Second Curve: Integration and Transformation (January 2014), provides 10 strategies, necessary organizational capabilities and potential paths for hospitals. It depicts a number of case study organizations that are actively “living in the gap” between volume and value, and describes various integrated delivery programs to improve care coordination, physician alignment, performance measures and patient outcomes. While most volume to value publications rarely address healthcare information technology, except to say “implement EHRs” as part of clinically integrated care, this white paper takes it a step further. It encourages health systems to “conduct information exchange” and use information systems to:

  • Implement electronic health records
  • Enhance health information system interoperability across sites of care
  • Use existing data to facilitate analysis and reporting for process improvement and behavioral change
  • Use predictive modeling for population health management
  • Use data analytics for care management and operational management

Yet, many health systems and providers are challenged to successfully execute these recommendations. In fact, we find the operational, clinical, financial, technological and legal unintended consequences of HITECH often undermine the potential benefit. Many clinicians still ask “why” and have not incorporated needed workflow changes.   Healthcare executives question what value they have received for their multimillion-dollar investments. To a certain degree, the focus on Meaningful Use and its incentives has been the “technology tail wagging the dog.” Rather than leading with the business strategy we wanted these systems to enable, the healthcare industry focused on the technology. So while healthcare strategists are actively living in the gap and planning the next step on the journey to value, clinicians and other users of information technology are struggling with the day-to-day impact these systems have left on care delivery. Rather than rushing to select health information exchange applications, layer on business intelligence systems and purchase care management systems, we suggest an alternative approach focused on value creation and realization. It starts with one letter – “i.” My friend Praveen Chopra, Executive Vice President and Chief Information Officer at Thomas Jefferson University and the TJU Hospital System, started his career outside healthcare in retail and supply chain. “Rather than focusing on technology, the healthcare industry should focus on three “i’s” – information, integration and innovation,” Chopra says. At Maestro Strategies, we also want to focus on one more “i” – insight. We believe that a focus on these four words will help drive more value as we take the next steps on our joint transformation journey. Our “i-men” characters help us tell the “why,” and with this new website, we plan to bring our clients and friends specific strategies and tactics to help execute on the change and close the gap between the two canoes.