Wednesday, August 19, 2015

FY16 Strategic Planning

As we gather together stakeholders for strategic planning of next year’s priorities, what are we hearing and what we have learned?

1.  Clinicians are overwhelmed by the current demands of Meaningful Use, hundreds of quality measures, population health, care management, and patient/family engagement.    All of these are good ideas individually but the sum of their requirements overwhelms providers.    In an era when we’re trying to control costs, adding more clinical FTEs to spread the work over a large team is not possible.  The end result is that providers spend hours each night catching up on the day’s documentation and are demanding better tools/automation to reduce their strain.    However, current EHRs are in an early stage of development and are data capture tools rather than customer relationship management systems.   As we gather requirements for FY16, we’re thinking about the projects that could be innovative breakthroughs, replacing human work with a next generation of technology and workflow.

2.  The consumerization of software (BYOD devices and apps) has created infinite demand and high expectations.   The difference between the $2 app and the $2 billion dollar EHR is that the $2 app is easier to use, more convenient and possibly even more useful.  There is no question that EHR transactional systems will need to exist to support compliance and regulatory imperatives, but increasingly we’ll look to third party apps to provide modular functionality on top of the transactional systems.

3.  The cloud is clearly the way that people want to work.   Social networking ideas of collaboration, file sharing, availability anywhere/anytime, multiple device support, and convenience are driving forces.    The good news is that Amazon Web Services offers low cost, HIPAA compliant hosting/storage/groupware/mobile support.   We’ve learning as much as we can about AWS.

4.  It’s increasingly difficult to balance supply and demand for IT.   Stakeholders prefer to discuss the vision for the future rather than the details of allocating existing resources in the present.  Incremental progress no longer feels satisfactory and users want a big leap forward.   The solution to this quandary seems to be spreading work among as many parties as possible - IT, third party solution providers, business owners, power users, and energetic innovators.   Unless there is a sense of federated collaboration, build and buy, central and local support, IT will be seen as  the rate limiting step

5.  ICD10, the Affordable Care Act, Meaningful Use, and the HIPAA Omnibus rule may be the focus of regulators and legislators, but they are not the focus of most users.   Stakeholders want to know when their projects will be accelerated and when the distraction of federal regulations will end.    Big change management projects in IT are hard on users, forcing them to accept decreased short term service for long term gains.  The problem is that the agenda of most IT departments has been co-opted by federal programs and the users are no longer willing to wait.   This is one of the reasons I have suggested that Meaningful Use Stage 3 be deferred.   Providers and the industry need more time to catch up on all the deferred projects and adjust to the thousands of pages of new regulations that have already been finalized.  

With these observations, what are we planning to do in FY16?    Over the next month, we will present a 5 page list of “bottom up” stakeholder enumerated high priority projects, categorized as core, advanced, and innovative.

Stakeholders will refine these categorizations and I hope they will collaboratively agree on focus areas for the FY16 and beyond.   I look forward to optimizing our governance, our projects, and our vision to accommodate the needs of stakeholders in the post Meaningful Use era.


Medical Quack said...

I keep saying part of the governments issue with healthcare stems to having too many folks from the financial side of the business running HHS and CMS and not enough clinical representation and thus they don't understand.

We all know financial models get modified to a degree to work in healthcare as some of the methodologies are the same but we are people and not sticks of data running through the world and we need time to make adjustments and changes. The feds seems to have what I call a case of "Stat Rat Fever" and that's not limited to just health care.

Pharmacists now are also feeling the statistical pressure and data input. I had one get in touch and tell me what's going on in their world. They too with predictive medication adherence "scoring" (aka excess scoring") are going crazy.

They too have their "quality reporting" to do with software and have P4P to meet and the need to bring one star patients up to 5 star levels with compliance. It's kind of crazy as if there's not enough data, patients default to one star and that's not good or accurate. This same pharmacist has to call those one stars and is finding out that the patients their software calls patients "outliers" are actually filling their prescriptions and paying cash, so again it's the data and the way it's being used causing issues. As a patient paying cash, it doesn't make me feel too good either being "scored" as an Outlier:) This has to be fixed too:) These scores get sold to insurers and gosh knows where else and it comes back around to total patient care and the doctor sees a patient "scored" as an Outlier and maybe not taking their medications when in fact they are.

This prediction scoring is not normal and customary monitoring at all with evidence based data, but rather 300 metrics that the PBMS created that are proprietary and can't be verified for accuracy. So here, how long before these "scores" appear in EMRs is maybe a question to ask at this point too? After listening to this pharmacist, they too are overwhelmed with all their documentation and calls for intervention with prediction scoring and it bugs them that the software calls patients "Outliers" too:) These scores will bounce back to doctors as well in time if not already in yet one more form of reporting and frankly in my opinion, this part of reporting is "skewing" some of what monitoring and care is actually needed. The scores too are "secret" and patients don't get to see this side of medication compliance either, kind of scary and not the best for encouraging participation in their care at times as well.

Angelique Mattin Russell said...

I do not envy you but I do admire how thoughtfully you are approaching the strategic planning process.

I agree delaying MU Stage 3 would be a major blessing; how can we optimize technology rushed into place for Stages 1 and 2 if we can't take a break from checking the boxes for the next round of mandatory implementations?