31 May IT guru Melissa Chapman: how to make health IT work for the bottom line
Former aerospace engineer Melissa Chapman knows a thing or two about how to make things fly, especially when it comes to health information technology (HIT).
After serving as CIO at two wide-berth government agencies, the Food and Drug Administration and Department of Health and Human Services, Chapman has led her share of high-flying IT projects – notably, an effort at FDA to use software, data mining and intelligent data analysis to reduce the $800 million price tag on new drug development in clinical trial settings. Now a principal at the firm of Booz Allen Hamilton in Rockville, Md., Chapman advises private companies looking to invest in or become part of one of the leading trends in healthcare, regional health information organizations (RHIOs).
As pressing as adopting HIT and creating RHIOs is for many healthcare providers, Chapman – a speaker at the upcoming Digital Healthcare Conference in Madison – strongly suggests that the stakeholders agree from the outset on the specific business or healthcare delivery problem they’re hoping to solve with whatever technology solutions are on the table.
For one RHIO, it could be the typical call for electronic medical records. For another, it could be e-prescribing of medications. For another, aggregating their clinical data for research. Whatever the solution is, and her firm fields a lot of them, “typically it’s incredibly important for stakeholders to agree on what they’re trying to fix or what they’re trying to improve,” Chapman said.
That is rarely crystal clear. In urban RHIO efforts, for instance, many players are reluctant to spend the significant dollars needed to upgrade their existing silos of patient information or other HIT solutions or bridge them to one another. Rural RHIO efforts tend to actually be easier because many are starting from the ground up and the pressing needs – reduce costs, improve patient access – are more universal and clear-cut.
And all of that costs money – big money. As in hundreds of thousands of dollars, even for a medium-sized RHIO such as the Indiana Health Information Exchange, recently begun in Indianapolis. More to the point, after the government grant money for startup (if you get any) runs out, what then? How do you make it pay?
• Read more about health information exchanges
“What is your sustainable funding strategy?” Chapman said. “That’s really ROI. There are RHIOs that have implemented software solutions [and] modified their business process, but perhaps it hasn’t yielded an ROI that allows them to go forward. Without addressing the ROI question very early and coming up with a sustainable funding model, you could be successful but then get into trouble later.”
Which begs yet another question – who pays? Many people may point to insurance companies, who stand to benefit greatly if RHIOs succeed in making healthcare delivery more efficient. But that places a great burden on them, as well, and the matter isn’t as black and white as all that. Government may have a role as provider of seed money or in supporting a national infrastructure as RHIOs band together. Local physicians may need to look at RHIOs as one more investment in their practice. And if individuals? long-term healthcare improves because of the technology being used, should everyone just be expected to chip in, as well?
“It’s probably going to be a combination of solutions, which is the hardest way to go,” Chapman said. “It’s got to be a shared investment. It would be a tremendous burden for any one stakeholder to take on.”
“Sustaining it is going to be the proof in the pudding. If there are genuine administrative savings, and you’re able to care for more patients, you will see an ROI.”
Flip side of efficiency
Irony rears its head on RHIOs when one considers that efficiency reduces redundancy; but redundancy, particularly in testing, makes money for the provider. And while Chapman isn’t suggesting any healthcare providers do it on purpose – independent studies clearly show otherwise – redundant tests do, in fact, bring in more dollars.
“The benefits of HIT are often in conflict with how you generate revenue,” Chapman said. “In order to make an investment to implement these solutions that are going to make you more efficient and improve your delivery of care, you’re taking a hit on the back end as well. Then you have to hope that there’s something about modernizing your healthcare delivery that attracts more patients, and it may take a long time to see that as an outcome.”
As will getting patients to use that information as the basis for choosing one physician or hospital over another based on those providers’ use of beneficial high-tech tools.
“For the average person to begin to realize that preventive health and high touch with their health data and things of that nature will result in long-term healthier outcomes, it will take a long time for that to begin to drive the market,” she said.
Technology’s shortcomings
Chapman the CIO is all too familiar with the gremlins within computer systems, so much so that she cautions against treating HIT as some sort of electronic messiah for the healthcare industry. People are people, after all, and putting new tools – however sophisticated – in their hands inevitably introduce new kinds of errors altogether.
“Certainly what you hope [for] is an increase in patient safety, and certainly a reduction in the need for people to personally validate with each other what’s been done to a patient,” Chapman said. “It’s fairly clear that HIT will improve quality and reduce, in particular, some of the tragic errors we see in this country as documented by the Institute of Medicine [of the National Academies]. But it’s important to not be naïve and not to come to over-rely on the technology – to be thoughtful about how you implement, how you train staff and how you look for new kinds of error sources.”
Technology won’t necessarily reduce a healthcare providers need for people, either. Given, for instance, a certain hospitals patient load and any government-mandated ratios between providers and patients, laying off a staff member, even if the technology allows it, is not doable. In addition, with a nursing shortage in the U.S. measuring in the hundreds of thousands, who wants to let trained, skilled people go?
“Often the labor savings, which can look like the biggest contributor of ROI, aren’t real,” Chapman said.
So how can RHIOs best get started and sustain themselves over the long haul? One good first step, as Booz Allen Hamilton has noted in the past, would be to let the private sector share in the progress the federal government has made in regard to health data standards. Chapman recalls her recent tenure at HHS, where she helped to begin a federal health architecture effort to create data and technology standards that would allow the government to standardize solutions to certain healthcare problems such as disease outbreaks. The idea was to give the Centers for Disease Control, the National Institutes of Health and the Department of Homeland Security, for instance, common ways to look at information.
“There a lot of that, particularly when you open up the box at the department of Defense: They have a very mature and robust set of programs and solutions for military health that are highly applicable to the civil setting,” Chapman said.
As a practical step, the Department of Health and Human Services might want to expand one of its eGov work groups called the Consolidated Health Informatics (CHI) initiative. The goal of CHI’s, which involves about 20 government bodies, is to adopt interoperability standards for health information for federal government systems.
“Rather than having standards in government that may or may not become de facto standards for the rest of the country, why not … break that barrier now?”