For many health systems and hospitals, 2018 could well be a year of reckoning with regard to their electronic health record (EHR) systems.

With the massive investments many entities have made in recent years to get their EHR systems up and running, healthcare organizations need to move beyond implementation to using the huge amounts of clinical data available to support performance improvement and the transition from volume to value. But now begins the hard part of making the systems work—and live up to everyone’s expectations.

Where We Are Now

The industry-wide transition toward value-focused care, is greatly increasing the demands on IT departments. A focus on data collection and reporting describes the IT needs of traditional brick-and-mortar-based providers. But the IT needs of today’s providers are much more complex: Health systems are tasked with much more predictive data usage as they move quickly toward managing the health of full populations of attributed patients, which encompasses both the quality and the costs (and benefits) of care.

Pam Arlotto

In some areas, the shift from fee-for-service to pay-for-performance, or value-based care, is proceeding much more rapidly than in others. But as a health system’s patient (and payer) mix continues to change, it eventually reaches a tipping point—and suddenly IT is in the hot seat.

“There are two types of health systems out there,” says Pam Arlotto, CEO and president of Atlanta-based Maestro Strategies. “There are those that are proactively saying, ‘we have to be ahead of that tipping point,’ so they make their investments in their data and technology ahead of it. And then there are those that are just beginning to realize the effects of this shift, and they’re saying, ‘We've got to play catch-up.’”

Where We're Going

For the most part, healthcare IT over the years has operated as an implementation culture. “The industry has had a propensity to want to buy something new and implement it,” Arlotto says. “But there's going to be a real shift from implementing new systems to using what the health system has already invested in, and perhaps augmenting these technologies with cloud- or niche-based systems, as needed.”

Although it might seem that simply optimizing a provider’s EHR might be sufficient, Arlotto says these systems typically can do much more to support value-based care. “There's a whole next level—call it the care management platform—with multiple layers that include interoperability, analytics, care management tools, and ways to engage with patients and consumers.” Attaining that additional functionality requires some investment, but it also enables providers to make better use of the investment they already have made.

Spending wisely on IT to ensure information and systems are accurate, complete, accessible, and secure should be high on a health system’s list of current priorities.

Anil-Jain“Almost everyone I speak to agrees that, regardless of what happens with the Affordable Care Act, value-based care is here to stay,” says Anil Jain, MD, a practicing physician and vice president and chief informatics officer for IBM Watson Health. “Measuring doctors and hospitals on how well their patients do instead of how much they do for a patient is not going to change, based on the reimbursement models we see coming from private payers and Medicare.”

Jain says the sensitivities about protecting health information are also a long-term concern, so investing in cybersecurity remains a necessity. 

“We still have a vested interest in protecting the privacy and security of this pristine information, so those kinds of investments, I think, are here to stay,” Jain says. “And if you look outside the United States, I think a lot of the finance people are asking themselves whether they have made enough investment on the IT side for rules like the General Data Protection Regulation the EU is dealing with. Something like that may come to the United States as well, where it goes beyond just protected health information (PHI) and also involves personally identifiable information (PII).”

Some health systems and hospitals with IT personnel on staff are inclined to undertake expansion of their EHR system capabilities in-house, despite the complexities involved. “A lot of people who try to do it themselves soon realize it’s much more efficient and effective to find people who can more quickly exploit the value of their data, and do it in a standardized way,” Jain says.

Going forward, Jain says that healthcare financial professionals should plan to support their IT leaders in four key areas.

Cybersecurity.It is simply not going to be good enough to rely on a single vendor, because most hospitals have multiple vendors. Providers should have IT leaders who are comfortable working with all types of vendors to ensure end-to-end cybersecurity.

Data warehousing. Providers should reevaluate the intent and energy being put into any massive enterprise data warehouse and reconsider whether such an investment is still necessary or appropriate.

Block chain.Even for organizations not making any investments this year, block chain is something to get familiar with now. “Block chain is the future of how we instill provenance and ensure credibility as money—and soon data, as well—flows in health care,” Jain says.

Automation.Applying artificial intelligence and cognitive computing to low-value manual tasks is something that will be appreciated by consumers and stakeholders alike. Automation also can help reduce the variability inherent in this type of task.

Beyond coming up with good IT solutions, there remain at least two more challenges: adopting these new tools and successfully changing the way decisions are made. “Changing the decision-making process is harder than getting all the right tools in place,” Arlotto says. “That’s especially true in health care, where the culture has been consensus-driven for so long.”

What You Need to Know

  • Most IT departments need to be spending less time on day-to-day support and more on strategic, transformational work.
  • Health information systems soon will have to accommodate a more patient-centric data model as the industry moves away from provider-centric data.
  • CFOs should listen to their instincts; if IT costs feel like they’re out of line, the CFO should review the organization’s spending plans to ensure future capabilities are developed in the right areas.

Publication Date: Tuesday, May 01, 2018