With rampant use of legacy further compounded by isolated use of best-of-breed point solutions (often Software-as-a-Service), we may be unintentionally losing the enterprise perspective much needed to realize the Patient Centered Care (PCC) dream. Do/should you have a “Best-of-breed OR Enterprise Strategy” or a “Best-of-breed AND Enterprise Strategy”? How do you manage and govern?
Phyllis Teater, Chief Information Officer, The Ohio State University Wexner Medical Center (OSUWMC)
Welcome, listeners. This is Sanjog Aul, your host. And we’re going to discuss on this segment, Maintaining Health IT Toolset for PCC, which is patient-centered care. And I have with me Phyllis Teater, who is the CIO at the Ohio State University Wexner Medical Center. Hello, Phyllis, thank you for joining us.
Hi. It’s nice to be here, thank you for asking.
Great to have you. What we want to talk about today is essentially about healthcare, which is known to have a heavy use of legacy systems, and we know that while modernization is underway, there is a long way to go. Meanwhile, a lot of software-as-a-service and best-of-breed point solutions are becoming available. They look compelling for the business and technology leaders. Keeping in mind Patient Centered Care, which is the next frontier of how care should be delivered, do we have a clarity about where we are going with it? And would it really serve the purpose, the enterprise perspective that one may want to have for patient-centered care? That’s what we want to explore. So, Phyllis, my first question is what do you think are the specific elements that are needed in a Health IT portfolio, in order to effectively enable Patient Centered Care?
Well, I think there are a number of elements. Some of which per your earlier comment that the industry maybe has figured out, some of which we don’t have figured out yet.
So when I think about the things needed to really do Patient Centered Care, there are a couple of things. One of them is to have a suite of tools for the patient to engage with. So how do they engage their health care digitally or electronically, in the same way that they engage their bank and the other services in their life, to be able to manage in an efficient but digital format? So, when you think about that, it’s a portal that allows them to communicate with their doctors and have the ability to schedule online. We have a system here at Ohio State that allows us to have the patients access services technologically while they’re in in-patient care. So when they get admitted to the hospital, they use a bedside tablet to be able to access services, connect with their care providers, order their meals and that kind of thing. These are electronic tools that you offer to the patients to make sure that they are able to interact in an efficient manner.
Another element that is needed and, at the forefront in the news today, is you need to be able to protect their information. So when you think about HIPAA and the way we’re required to protect information, that’s for the patient. This is patient privacy and to make sure that we are keeping their information close to the vest unless they provide consent to share it. So that’s very difficult, given the reality of all the cyber-attacks and crime, and certainly there have been many in the news recently. It’s very difficult to ensure that, given how much and how difficult all of the cybercrime is these days. But that’s the second sort of pillar I would say of the Patient Centered Care.
The third pillar is to have a robust, and we’ve chosen an integrated, electronic medical record to make your providers themselves, the doctors and nurses and extenders, efficient. So they can take good care of the patients and they’re not spending too much time on the computer. They’re able to interact with the patient in a natural way and they have all of the information they need at their fingertips.
And then the last area that I talk about … that I don’t think we have figured out yet in the industry is continuing down the road of interoperability. How do I make sure that any provider that’s taking care of me has all the information they need? Even if I saw somebody in another state last week, how do I make sure that they have all that information to be able to take care of me in the very best way?
Now about the SaaS-based, focused yet isolated point solutions that we may have for Health IT, and the promises that they will help us become nimble and agile, do you think they will really be conducive for patient-centered care? And what do you think would be the loss or what would we’d risk losing when it comes to the enterprise perspective, if we go this route, i.e. to use SaaSbased or isolated point solutions?
When you think about which tool you are going to use, you must validate it against the problem that you’re trying to solve.
So that’s a great question. And some of the things to think about there, we try to be very integrated and less best-of-breed or individual solutions for a particular audience. Because that’s where it becomes difficult. When you think about … a patient’s workflow for them to maybe renew their prescription on one tool and go to a different app to ask their other doctor a question. And go to a different app to do a third thing. That starts to feel difficult and clunky for the patient. And we believe it doesn’t provide the best care. Because they’re not seeing an integrated model either. But it’s the same thing for clinicians. If they’re having to use a bunch of different systems and their workflow, it’s this one to do their ER visit, but then when the patient gets admitted, we’re on a different system.
So in those areas, where it’s about the individual stakeholder’s workflow and efficiency, we can do very much work towards an integrated solution that can connect the dots for that particular stakeholder in the health care process. Where remote or hosted systems are very helpful, are in areas where we maybe have a destination point where the information goes, maybe to communicate to other providers, that’s something that’s applicable to try to get some efficiency and some economies of scale by using a system that is outsourced and maybe a point solution. Because it’s not being used by the patient and others to try to provide the care or work their own workflow or so really it’s about the user… and they need an integrated way to interact with their record and their information. Or is it something where we’re performing a function that has a different stakeholder, so now we can think about a different tool?
What’s the best way to rationalize and perhaps evaluate the suitability of any legacy Health IT application and systems that we may have for Patient Centered Care?
Well, some of the things that are concerning are that some of the legacy tools find it very hard to keep up with privacy and security standards of today. And then there are some of the difficulties we all have in responding to the risks and threats that are there now in the IT market. And so that’s a sure thing to always evaluate with legacy systems: are they keeping up and in addition, of course in health care… are they keeping up with the regulatory requirements or are they keeping up with meaningful use, are they able to do advanced payer interaction to make sure that we’re being paid on time and in a seamless flow?So, really keeping up with the regulatory and payer environment isanother way to make sure that you’re assessing legacy systems’ ability to do that, because …what we see is that over time their ability to deal with sort of outside influences does start to degrade because the technology is older.
Is there some sort of a negative connotation attached to these legacy systems? Because technology is older, there may not be flexibilityrelated to the new workflows that we want. Do you think that as part of the patient-centered care initiative, we should try to get rid of all these legacy systems?
Well, it’s a big investment. So I think that just because of course there are legacy system isn’t a reason to get rid of them. It is a reason, though, if and when they get to the point where maybe their communication protocols are not functioning well, because they’re older ones. And they maybe can’t communicate with other systems. Or certainly when their privacy or security concerns or workflow concerns are making us particular stakeholders inefficient or making it more difficult … to do the job. We really look at it on a system-by-system basis, whether a system is no longer able to fit either into our strategy or it’s no longer able to support the function because it’s falling behind in the technology world.
Let’s take a quick break, listeners, we will be right back after these messages. And let’s explore what are the myths and mistakes that undermine our ability to objectively evaluate and effectively manage the Health IT tool set for patient-centered care. And would we be able to somehow accommodate shadow IT, which of course exists in many organizations, to achieve those benefits while still ensuring an enterprise perspective very much needed for Patient Centered Care? Please stay tuned, listeners, we will be right back.
Welcome back, listeners. Phyllis… I mentioned before the break about the myths and mistakes we always have when it comes to figuring out how to evaluate and effectively manage the Health IT toolset in context of Patient Centered Care. So what are those and is there a creative way to still accommodate shadow IT, which we know in many cases exists, while still being able to create an enterprise perspective we need for Patient Centered Care?
Sure. I think the most common myths and maybe mistake that I see, and that we encounter here, I believe, is that we often have a tool that we have either seen or that is coming in one of our existing systems, that we think the tool sounds really exciting.
And so for instance we’ve been looking at the use of the video visits, which is really where you do an online visit with a physician. There are some clinical cases where that is appropriate. But we need to be sure that we would be using that to solve the right problem. If we are looking to make sure that our patients are able to see their physician when it’s convenient for the patient, if it’s really about making our current patients’ lives easier, we would use a tool, a video visit tool that integrates right into our existing physicians’ workflow. So you know they would be in the office, they would see a patient in their office and then they might go in the clinic … And then they might go back to their office and see a patient in their next appointment slot on video. So … we would use a certain toolset to enable that workflow but … we are hoping perhaps to expand our capacity to see a certain kind of patient and use a different tool. Because it’s not an appointment we can offer from our current doctors. Because we want to expand capacity and maybe our doctors are at full capacity.
So when you think about which tool to use, always validate that back against the problem that you’re trying to solve, to be absolutely sure that you are solving the problem with the right tool, because there are so many wonderful, very helpful tools available to us now in health care IT. And our users are becoming very savvy about what tools can really help them. Just to make sure we’re always going back to the problem we’re trying to solve.
We know that the new Health IT tools will continue to evolve. And we will have more temptations for accommodating these tools.Every time we do it, would there be a standard guideline you would propose which would help us evaluate objectively as we bring those in? … So we’re not just doing this willy-nilly.
Well, let’s take a look at it in terms of building blocks. So I would look at the first building block to be the patients themselves. And one of the things that we want to see in every patient engagement is every opportunity to present the right information at the right time. So if you don’t have that right, then it’s hard to drop this blueprint and be a perfectionist. I think the next building block, and we are seeing a lot of this already in the industry, is with the proliferation of the wearable devices that allow patients to engage much more significantly in their day-to-day health.
And then also opportunities to engage with health information online, that allow them to be much more active participants. We are very active in this because, and just to give you a couple of examples, we are very focused on access and the ability to use access to make sure that patients are engaging proactively in their health and have the opportunity to see a clinician when they need it. We have recently done a telemedicine pilot that allows individuals to have a telemedicine or a live video engagement with a physician. And another thing that we’re doing is making sure that through our patient portal, our patients have an opportunity to schedule appointments online and then also engage in a messaging communication with their providers.That allows them to engage little bit more when the health care encounter is needed, as opposed to the traditional only when a provider is available.
And for us that really is just the start of things, this has been mentioned, we’re also in the process of building a new regional academic health campus in Bloomington and one of the things that we envisioned for that new campus is an interactive and collaborative clinical research and educational experience for our patients.
And we do see the interaction, the engagement of the patient as being a very important part of that campus experience and we look forward to seeing a degree of innovation in that… So … another building block is making sure that the patient has the opportunity to engage.
The next one I would say is making sure that we’re taking advantage of the existing interoperability platforms. And as I mentioned before, that could be through health information exchanges and could also be through some of the vendor initiatives that we’re seeing to enable interoperability.
And then from a process perspective, we do have to get the patients comfortable with interoperability so that we’re not forcing the opt in or opt out options for a patient, when they interact with a provider or they interact with a system. It’s going to be important that they’re comfortable enough with knowing that their records are going to be shared and it’s in their best interest to have those records shared.
Right. And that is the art and the science, I think, of picking the right suite of tools to help us achieve Patient Centered Care. And it’s really playing out and doing tabletop exercises which we do here to make sure you understand from a use case. So how’s the physician going to use that? And in what circumstance, the same thing with a patient-centric tool that the actual patient would use. When is the patient going to use it, how are they going to hear about it, how do they know it’s time to use that tool? So it’s often about that contextual situation in which a patient or a caregiver or a staff person is using the tool to make sure it’s the right tool. So it’s important to always have that use case and the understanding of how the stakeholder interacts with the tool to validate that we’re buying a tool that’s going to solve the need that we have. We again looked at some tools we were wanting to do and we’ve done a lot of discussion around online visits, we had a particular surgical population that we thought that their follow-up appointment would be an option to do via an online tool and they were able to do a video visit. And upon investigations we found that, as we walked through the tabletop discussion, that we actually had payer contracts, many of our contracts where it was required for the follow-up to be in person. It said right in the contract. So we wanted to be sure that we’re following our payer regulations and our payer requirements. And so we realized that’s not the right tool to try to make that patient’s life easier because they’re required to come back actually in person.
With the changing business landscape, and we know technology innovation is on a fast track anyways, what tried and tested practices do you recommend for managing and governing Health IT toolset at all times, especially in the context of Patient Centered Care?
I think applying a test for: are we improving the delivery, efficiency, safety? Are we really using a tool that hits our organizational goals, in terms of improving quality, improving efficiency, providing experience for the patient that is the most convenient way to be able to acquire that service? And just really developing what are our core values in terms of selecting tools and deploying them. And then making sure that every time we look at a tool, we really match them up against those characteristics and make sure, because it’s a big investment, that we’re not investing in tools and deploying tools and offering tools that end up not hitting the mark in terms of the goals of delivering Patient Centered Care.
There have been many tools, I think, that have been purchased by organizations and we have a couple tools, too, where they end up not being useful. Fortunately, that doesn’t happen too often here at Ohio State. But we have been known to believe that we were investing in a new tool or new process even if it was just using one of our existing tools that was going to work. So we test for that. We’re fortunate to have a link with our research organization here at the Medical Center that does biomedical informatics research and they are able to help us validate that. So choose metrics that help you make your goal, that help you meet your goal. And make sure that you’re measuring those. When you start piloting a tool or deploying a tool, make sure you are actually achieving a solution that you sort of envisioned when you purchased the tool.
Once again, thank you, Phyllis, for sharing your thoughts and insights about how we can best develop an optimum Health IT toolset in order to achieve the Patient Centered Care dream.
Thank you once again. And listeners, I invite you to find more conversations about IT driven patient-centered care, as part of our Health IT series at CIOTalkNetwork.com /ReThinkHIT