By: Mary Pat Fralick, COO

I am convinced that we would not need healthcare reform if each of us agreed to a personal reformation. “Huh?” Let me explain…

Recently, while listening to NPR (it was a Friday, so Howard100 was playing reruns) I heard a gentleman talk about four changes in everyday life that he believes would save the country more money and result in a healthier population than any healthcare reform proposal currently being considered. While I can’t remember the show I was listening to or the name of the author of these ideas, I do remember the four changes. The facts to support his ideas are ones that I found through research; he used others that were equally compelling.

#1 – Everyone who smokes should quit now. According to the American Cancer Society , the average lifetime medical costs for male smokers are 32% higher than for men who never smoked and 24% higher for female smokers. The ACS also estimates that smokers make about six more visits to healthcare facilities per year than non-smokers.

#2 – Everyone should ALWAYS wear seatbelts. According to the Division of Motor Vehicles , for every 1% increase in seatbelt usage, close to $100 million in annual injury and death costs could be saved.

# 3 – Severely overweight people need to lose weight. According to the Centers for Disease Control, 10% of the cost of healthcare in the US is related to obesity.

#4 – Women who are pregnant must seek prenatal care. Lack of prenatal care is the #1 cause of preterm births. According to the March of Dimes , in 2005, the cost of medical care for preterm births in the US was at least $16.9 billion. The average first year medical costs, including inpatient and outpatient care, were about 10 times greater for preterm infants than full-term infants.

I wasn’t a math major in college, but I was a mathlete in high school and it sounds to me like this guy is on to something! What would you add to this list? Here’s my suggestion:

Everyone who rides a bike should wear a helmet. According to the New England Journal of Medicine, bicycle safety helmets are highly effective in preventing head injury. It’s estimated that anywhere from 45-88% of brain injuries could be prevented by wearing a helmet and that every $1 spent on a bike helmet is estimated to save $30 in direct medical costs. Sounds like a good ROI to me!

By: John Smaling, Executive Vice President

As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.

Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:

1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.

2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.

3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.

4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.

5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.

While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.

By: Eric Egnet, CIO

Camp Concerned or the “CCs”

Camp Concerned is an overnight, all summer long camp…these campers need to completely adjust their living situations because what they have in place just isn’t working.

Hospital CIOs in the third camp have reason for concern. They know they will have to replace their inpatient system or upgrade to the latest vendor version. Their current system capabilities are insufficient, and/or the amount of time and money it would take to make it HITECH compliant is just not practical. They also don’t have a common ambulatory system for their physicians, so there is a knowledge that they will need to make a decision about that. Add to this, the significant amount of work and investment dollars required to enhance their IT infrastructure to support these new systems: the costs and timeframes are really starting to add up.

Most of the CCs have also had to downsize their staff this past year due to the current economy and there aren’t the internal resources to take on and execute these important initiatives. Outside help is needed to both manage and staff augment these projects and they are concerned about finding the right resources when they need them.

Funding for this Hospital CIO is a real problem. The capital that will be required to get the hospital from where it is today to where it needs to be is significant. The Hospital Board is concerned about the mounting costs and their ability to raise enough capital in this tight market. In fact, some are concluding that the costs just may be too great, and that they may need to sacrifice the HITECH incentives and deal with the penalties, to keep the hospital’s financial health in order. Sometimes strategy is what you don’t do.

Meanwhile, CCs are trying hard to find the most efficient and cost effective way they can accomplish the task at hand. There are deep discussions with their inpatient system vendor to identify creative ways to upgrade, while containing costs and spread them over time. On the ambulatory side, they are considering inexpensive ambulatory solutions that offer just enough to meet compliance requirements. Alternatively, some of these Hospital CIO’s are looking at license free open source EMR offerings that might fill the bill such as OpenEMR and ClearHealth.

Finally, from a resource perspective, these Hospital CIOs only have a small management team and staff that manage the day to day operations of the hospital. Without question they will need vendor and outside consulting firm assistance to help them on these many projects and initiatives. This will become yet another challenge for them as they diligently try to navigate through these difficult circumstances.

Which of those three camps do YOU belong in? Take the poll in the side bar and let us know what your concerns are in the comments!

By: Eric Egnet, CIO

Camp Kinda Concerned or the “KCs”

KCs are our day campers, they’re routine is changing but they don’t have to make the commitment of staying overnight.

KCs are a bit more cautious in their treatment of HITECH. It has been a discussion topic internally and has been proactively added it as an important project in their portfolio. Work is underway to determine what the CIOs need to do with their existing HIS inpatient system (replace, upgrade or maintain). If the choice is to replace, then they are moving quickly into the vendor selection process, otherwise there may not be enough time to get the system implemented. Alternatively, they are studying their options to upgrade to their vendors latest version, or to try and make do with the existing version of the system.

In addition, campers have a fair amount of work to do in the areas of IT infrastructure, integration, security and encryption of patient information. The existing environment may be fine for what they are doing today, but it will not meet the future requirements of HITECH. This Hospital CIO will likely solicit a third-party firm to come in to perform a HITECH assessment to validate and find gaps in their plans.

These CIOs may already have a central ambulatory solution in place for their physicians, but this is likely not the case, so they are also evaluating vendor offerings with the goal of making a selection soon. They must have both implementation and an integration plans to connect the ambulatory application EMR, with the hospitals internal EMR, to meet the interoperability requirements of HITECH. Some hospitals may be fortunate enough to be using a vendor who offers integrated solutions for both inpatient and ambulatory. However, most hospitals will need to integrate different vendor solutions to accomplish this. The cost of the ambulatory solution will be a factor so they are reviewing a broader list of vendor offerings and negotiating options that best meet their needs and budget.

The Hospital Board is certainly well aware of the 44k in physician incentives, as well as the penalties, for not achieving compliance. Some funding is available today but additional capital will need to be raised and secured. The Board wants to know the total costs of all these initiatives, but the Hospital CIO and their team are still working through the discovery and negotiation phases, and need more time to size everything up. KCs will soon provide them with best and worst case scenarios.

Based on the magnitude of projects and work identified, these Hospital CIOs are going to run into resource constraints. Their direct reports, management team, and IT staff all have some capacity, but they’re already juggling many important projects. CIOs are not going to be able to hire additional staff because of these difficult economic times, and they know they are going to need to bring in outside consulting and staff augmentation resources to achieve the goal. The challenge will be finding these quality resources once the national demand grows exponentially.

Are you waffling between the stress of being concerned and feeling safe at home?

By: Eric Egnet, CIO

Over the past few months, I’ve been talking with Hospital CIOs about HITECH. I wanted to hear it from the horse’s mouth rather than from all the politicians, firms, and agencies who have been hyping it to no end. In my discussions, a clear pattern has begun to take shape. Hospital CIO’s fall into three different camps when it comes to their HITECH efforts and concerns. I’ll detail the three types of campers over the next three days…

Camp Not Concerned or the “NCs”

These guys aren’t going to camp yet, so they aren’t too worried about the implications of changing their routine.

The Hospital CIOs in this camp have read a few articles on HITECH but have not had any meetings or discussions internally on the topic. They feel that things need to shake out before they take any serious action. With the number of projects already on their plate, HITECH is not something NCs plan to lose any sleep over. They are aware of the $44k incentive for their physicians, and how they will need to demonstrate “meaningful use” by 2011, but these campers are not worried about it. In the future the NCs plan on becoming better informed and educated on HITECH, but they are going to wait until there are definitive answers and definitions.

These CIOs feel good and are confident about their existing IT infrastructure and their current HIS systems, both on the inpatient and ambulatory side. There are no plans to switch HIS vendors and they are confident they will be able to close any gaps identified once a thorough analysis is performed. If an ambulatory solution is needed, NCs will select one of the major vendors, after some proper due diligence, and then either manage the project in-house or outsource it. In fact, they may even opt to have the system “hosted.”

Hospital CIOs in this camp are also confident that they have enough or can hire enough full-time IT staff to commit to these projects and they certainly don’t need a third-party firm to come in and provide them with a HITECH assessment. Funding will not be problem, as working capital has been promised, and will be provided by the Hospital Board to address HITECH initiatives that are required.

Are you concerned yet, or are you still feeling safe at home?

By: Robin Shine, Senior Vice President

In September our minds turn away from summer vacations and long warm days to thoughts of back to school, rededication to long work days, and FOOTBALL. Whether you are a fan of high school, college, or the pros weekends will soon be filled with games featuring your favorite teams.

As I listen, read, and absorb all of the information and speculation on the ARRA HITECH legislation, and the debates surrounding the definition of those crazy words “meaningful use,” some questions come to mind in juxtaposition with football!

• What costs more: the new Cowboys stadium or the HITECH portion of ARRA?
• Which are worth more: NFL TV contracts or ARRA incentives?
• Does pre-season football camp remind you in any way of HIMSS?
• Which are more complicated: the rules in the NFL rule book or the CCHIT rules?
• Who is their team’s projected MVP: Tom Brady or David Blumenthal?
• Which produce more revenue for their institutions: BCS football teams or university medical centers?

So, as we all continue to learn more about “meaningful use” send us your comments and questions regarding the definition debate AND the meaning of football or post your own questions on the VCS Blog.