US healthcare IT leaders focused on financial pressures

US healthcare IT leaders are coming under growing financial pressures, with their top business priority being to sustain financial viability in the face of massive pressures including falling reimbursements and mergers.

The second related top business priority is to improve the operational efficiency of care, followed by clinical improvement.

Jennifer Horowitz, the vice president of HIMSS Analytics told a media briefing in Orlando this morning: “Changing payment models was a top concern, as were policy mandates and financial considerations.”

She said the findings of the annual HIMSS Leadership Survey were “No surprise with changing reimbursement models and the introduction of accountable care”.

The poll of US healthcare IT leaders showed that worries about lack of financial resources is now the number one barrier to delivering IT strategies, displacing worries about lack of staffing resources, which was cited as the main concern in 2013.

The three top priorty areas for staffing were staff with skills in clinical application support, network architecture support and clinical informatics.  “These have been the same top areas for the last few years, said Horowitz.

The findings also indicate that the majority of US hospitals plan to continue increasing IT spend.  Some 65% of those surveyed said they expect their operating budget to increase in the next year, a figure slightly down from 76% last year.

Asked to identify their priorities for the next two years achieving meaningful use was named as the highest priority, with a high degree of optimism about meeting the requirements on stage one and two.

Some 90% sad they have already reported meeting stage one and 71% said they believe they will meet stage two by the end of 2014.

Topping the list of financial priorities was converting to ICD10, with a national switch planned by 2014.  Some 69% say that is their primary financial IT focus, and 92% say they are ready to meet this requirement.


Healthcare CIOs must wrestle back control of technology from government

Healthcare CIOs need to wrestle back control of the technology agenda from government if they are to drive improvements in productivity.

CIOs in the US healthcare industry need to seize back the initiative on technology and make the case for investment in information technology as the driver of transformative change in healthcare.

To do so they must grasp the nettle on proving return on capital investment and IT as a strategic driver of productivity, argued Saum Sutaria, MD, director healthcare systems and services, McKinsey.

Dr Sutaria told the CHIME HIMSS CIO Summit in Orlando that healthcare “has failed to increase productivity and that IT is still viewed as a cost centre by most Chief Executives and Chief Financial Officers”.

“You have got to take control of technology agenda from what has been government regulated.  Otherwise you will find it very different to change peers views that technology is a cost.”

Too much attention had been paid to chasing meaningful use dollars rather than thinking about how technology is used to deliver transformative change.

He told the assembled US CIOs: “This coming era may be when this group of individuals has to take more action based alternatives.”

“Should the tech strategy actually drive the business strategy in healthcare for a change?”

With massive healthcare in the US the biggest financial reality facing most providers was cuts in medicare reimbursements. “This has got to be about better more efficient care that is information enabled. Number one priority is to get more efficient.”

But Dr Sutaria sad the current wave of provider mergers would not drive real productivity.  “Most of value from mergers and acquisitions is coming from the old bag of tricks: raising prices and cutting overheads.

However, CIOs are not yet stepping up to take on the leadership challenge of productivity and making the running in the board room.  But nor is anyone else.

“A lot of people on CIO shop are being shrinking violets on where is the ROI coming from this huge investment.  How do we get the return? We don’t want to admit that today. “

Taking a tough realistic line on what the return on investment was for capital intensive investments is against cost of capital would result in different types of investment decisions.

“You’ll find that a lot of traditional infrastructure heavy investments just don’t meet the bar,” said Dr Sutaria.

He added: “The first step is to wrestle the technology agenda from government.  “We’ve seen orgs chase meaningful use dollars and then it just stops.  But meaningful use dollars don’t come close to delivering return on the investment needed.”

The McKinsey director called on the audience of CIOs to rise to the challenge.  “Many of executives in this room have the ideas that could transform healthcare delivery but not be willing to put that agenda on the table, and traditional management not being willing to put on the table either.”

To take on this daunting challenge he urged CIOs to form new alliances on productivity. “This group could do more to identify coalitions in their organisations outside their current walls.”

One key axis for CIOs to lead on is how to engage with consumers, “Need to step outside of normal world, engaging with consumers, find out what they want and use that to drive changes in operations

He added: “Some 80% of what physicians do could be done better by computer. And it’s the 80% of what they do that needs to be changed to get better decisions and patient outcomes.”

He concluded; “We have the most educated service workforce in any industry today and greater variability.”

Thoughts on US health IT from HIMSS

I was away at the HIMSS health IT trade show in New Orleans this week, and was struck by just how similar some of the themes from the Big Easy were for the English NHS.

The main one was how much everyone is talking about interoperability and the need to make data liquid between different healthcare providers and avoiding lock-in within any one system.  This was something that ONC co-ordinator Dr Farzad Mostashari described as the tendency to data ‘hoarding’.

Interoperability is the focus of the next stage of meaningful use and looks to be the priority for the next couple of years, after four year in which the dash to EMR has been the focus.  The suggestion is that the US is inadvertently creating islands of unconnected digital data.

There was also some interesting research out from Black Book Consulting suggesting that a lot of family doctors are unhappy with the EMR they put in to meet meaningful use requirements and are now looking to change.

With the DH apparently gearing up to have another push on EPRs in England, its interesting to get a perspective on what happens once record systems have gone in.  A theme I heard a dozen times over the week is that getting an EMR live is just getting to the starting point, the real job comes in getting the clinical and business benefits from changing processes, redesigning care and reviewing performance.

As well as interoperability there was again a lot of vendors pushing analytics and smart use of data to actually make use of the vast piles of data being generated bu the US healthcare system.  Healthcare providers now need to use data effectively to deliver a better patient experience based on understanding how and when they want services, in the way Wallmart or Amazon, was the main message of Thomas Warner, chief executive of Louisiana’s biggest healthcare provider, Ochsner Health System.

The need to provide patients with access to services through the channels they want to use was also the message of Dr Kate Christensen, medical director, internet services at Kaiser Permanente.  She told me that they love being able to view test results, book appointments, order prescription refills and email their physician. Interestingly, she says that Kaiser no longer thinks internet services save money, by reducing office visits, but they do lead to better patient retention and more activated patients, more likely to better manage their health.   Some 4m Kaiser patients now use My Health Manager, over 63% of the total. Another striking figure quoted by Dr Christensen is that over 22% of patient visits are mobile.

The other big theme that is getting a lot of attention in the US is population health management and accountable care organisations, paying a fixed fee for providing all the healthcare for a given population.  A big move from fee for service payment models. It’s all part of the attempted shift to new payment models that can contain runaway healthcare costs.

Just how big that challenge is was set out by former-president Bill Clinton who said the US healthcare system was broken and spending roughly one trillion dollars more a year as a percentage of GDP than leading European healthcare systems.  he said the soaring costs of healthcare – about 2.5 trillion dollars a year – were hobbling the US economy and one of the main reasons that median household incomes hadn’t increased in a decade.

Clinton said health IT had a vital role to play both in integrating the system and empowering citizens to take better care of their own health.