I don’t get sick very often. Not to tempt fate or anything, but I’m a pretty healthy person. So I was a bit surprised not only by a recent bronchial infection, but by the number of times I had to provide basic information to my HMO. I’ve been a member there since I was a child. I mean, what don’t they know about me at this point?

Apparently quite a lot. Like my address. And the last time I’d been admitted: for a broken leg in 2000. How do you misplace information on orthopedic surgery especially since the stainless steel rod in my leg could actually pose a risk to other care episodes, like a routine teeth cleaning? I won’t even go into how long I spent in the waiting room. The whole experience made me feel resentful about my time investment and cynical about the general quality of care – and I haven’t even seen that Michael Moore movie. When it comes to healthcare, the answer to the question “Are you feeling better?” is a resounding “No!”

Checkup in Aisle 5!

The cost of a new, effective system of healthcare delivery would be instead of rather than in addition to what the U.S. population is now paying for an inadequate, incomplete system.¹

No wonder enterprising individuals and forward-thinking start-ups are looking into new ways to administer healthcare to an increasingly disaffected public. Politician promises (or threats, depending on your viewpoint) of national healthcare reform have hospital administrators apprehensive. A group of heavy-hitter companies including Wal-Mart and Intel have put their muscle behind a collaborative effort called the Dossia Network, which would offer employers an integrated platform of electronic medical records, enabling them to manage health insurance for their employees while giving employees more control over their personal medical information.

Regional health information organizations (RHIOs) are independent data exchanges that consolidate the often far-flung clinical data from across hospitals, ambulatory clinics, labs, and pharmacies – usually in a common geographic area. They offer electronic records to their member organizations with the aim of improving on-demand information access and thus the continuity of care across provider, prescriber, and payer organizations. RHIOs also allow doctors to exchange information with other doctors or care providers via both “push” or “pull” modes of data sharing.

As costs soar and care quality erodes, care providers get positively twitchy about the introduction of in-store medical clinics. Retailing giant CVS established the MinuteClinic brand – retrofitting its drugstores with small care centers where a board-certified nurse practitioner can diagnose run-of-the-mill illnesses, administer blood pressure tests and routine vaccinations, and refer patients (aka: shoppers) to medical doctors for more serious illnesses. The benefit to harried consumers is the time savings, as they can buy their groceries while they wait for test results. One major retailer we recently worked with reports market basket revenues grew an average of 18 percent for clinic patrons compared to those who simply did their routine shopping.  According to Fast Company, there are now around 350 for-profit clinics administered by 40 different companies. And, despite efforts by the AMA and other nervous industry groups, those numbers are likely to escalate.

In our work with healthcare providers, most of which are in the throes of formalizing their business intelligence (BI) programs or launching electronic master patient index (EMPI) capabilities, we’ve noted that the hurdles to driving better care through the use of information are largely cultural ones, so entrenched as to seem insurmountable to administrators accustomed to paper-based processes, doctors distrustful of new technologies and comfortable with misguided assumptions that the role of “regular source of care” is a static one.

In his book How Doctors Think, author and medical doctor Jerome Groopman reveals how doctors fall back on what they were taught in med school, do what a respected mentor would do, or even let experiences on a recent case guide their diagnoses.  So-called evidence-based medicine often gets short shrift where medical decision making is concerned. According to Groopman, doctors’ own cognitive mistakes account for most misdiagnoses.

“We use the encyclopedia approach,” one hospital administrator, also an M.D., recently explained to our team during a BI assessment engagement. “Absent readily available information, we carry huge binders and paperwork around with us all the time. It’s hardly efficient.”  Groopman tells the story of a physician with a similar toolset:

During my training, I met a cardiologist who had a deserved reputation as one of the best in his field, not only a storehouse of knowledge but also a clinician with excellent judgment. He kept a log of all the mistakes he knew he had made over the decades, and at times revisited this compendium when trying to figure out a particularly difficult case.²

The risks of paper-based medicine are legend. On the mild side, they increase patient wait times, fuel administrative cost overruns, and erode business process efficiencies. On the more dire end, they represent a roadblock to the continuity of care, which can have severe consequences. In our book, Customer Data Integration: Reaching a Single Version of the Truth, Evan Levy and I describe the real-life case of a pregnant woman whose doctor diagnoses preeclampsia, a serious complication of pregnancy, and prescribes bed rest and blood pressure medications. When the patient is rushed to an emergency room a few weeks later with severe abdominal pain, there is no information available about the prior diagnosis and the patient subsequently has a seizure.³ There are thousands of examples of where unavailable or incomplete medical information has resulted in the loss of patient lives.

Clearly the need for clean, well-integrated data has become a life-and-death issue in healthcare. The irony here is that when the topic of information comes up, it’s usually not in the context of improving the quality of care or physician pay-for-performance programs where doctors are financially compensated based on patient satisfaction, but on cost savings. Of the dozen managed care organizations I’ve worked with in the past year, all of them expressed the need to monitor expenses while only seven articulated the goal of care improvement. Indeed, we often heard more urgency from HMOs and hospital networks about workforce optimization – automating the planning of nursing staff relative to the number of occupied beds in a hospital – than we did about clinical pathways or care plans.

Provider, Heal Thyself

Healthcare organizations are increasingly finding themselves in the same position as the “old media” companies. Newspapers desperately search for ways to increase their circulation while aggressively cutting back editorial space. Meanwhile first-movers like Craig’s List, CareerBuilder.com, and web-based news portals intercept fleeing advertisers and watch their subscriber counts soar.

What can healthcare providers do to keep patients, and keep them happy – and even perhaps keep them alive? Here are a few data-centric suggestions for providers who have begun looking over their shoulders:

• Stop thinking like a healthcare company. Providers are notorious for making known vendors and established consultants their trusted advisors. Instead, they should think like retailers. “Cerner and McKesson don’t have all the answers,” one HMO administrator confided to me recently, as if it were a secret. “What we’d really like to know is what McDonald’s and Target are doing.”
  
  
• Adopt a customer focus. Many healthcare executives take what they think is the high road when it comes to patient relationships, maintaining that patient satisfaction is a natural by-product of quality of care improvements. But the patient experience transcends the examining room; and if patients are unhappy, they are likely to vote with their feet. As with most businesses, understanding and optimizing the total customer experience – not just when the patient is sitting in a paper gown on a table, but in the waiting room, in line at the pharmacy, or in recovery – is the key. Indeed, it can differentiate a provider from its competitors.
  
  
• Go get the data. So overwhelmed are they with their far-flung and heterogeneous data sources that healthcare organizations and payers alike don’t know where to begin. Some look toward established clinical systems such as Epic or IDX to furnish initial patient data, while others consider external partners such as pharmacies or labs for initial data integration and subsequent analysis efforts. Beginning with a deliberate, evolutionary approach to both data provisioning and the delivery of functional applications is a critical success factor for business intelligence in healthcare.
  
  
• Bring doctors on board. Doctors need to see the introduction of patient dashboards and other analytics capabilities not as threats to the way they do their jobs, but as additional tools in their collective tool kit. This means enlisting care providers early and often in decisions they’re not accustomed to, but that they nevertheless often welcome: technology selection, user interface design, and business requirements gathering.
  
  
• Don’t ignore patient privacy – but don’t let it render you inert either. Patient medical record privacy has been legislated via HIPAA and healthcare providers are falling in line. But privacy has become the platform on which many healthcare organizations have rested their “do nothing” excuses. As my colleague Shravan Miriyala wrote in his article, Challenges to BI in Healthcare: Lessons Every Industry Should Heed,  managed care doesn’t imply managed data. Data governance and data management should thus be adopted as critical components of any new EMPI, BI, or “voice of the patient” initiative.
  
  
• Invite the CIO to the table. The boardroom table, that is. Like many companies, healthcare providers are prone to consider IT as a cost center, not a strategic enabler. For critical business initiatives to be successful, they must leverage information systems. The CIO and his or her organization should be seen by executives and boards as key contributors to strategic success.

Conclusion

In an age of increasing competition among health plans, information that can be used to enhance accountability is becoming a critical component of rational marketplace behavior.⁴

Cynics claim that the information age has passed healthcare by. Others would say that healthcare providers – as cost and resource constrained as they are – need to choose their battles carefully. There’s truth in both cases. But as the sources and volumes of healthcare data continue to grow, the urgency for better patient information increases apace. If they truly want to play in a rapidly changing market, healthcare providers need to get busy making the infrastructure and data improvements necessary to stay in the game.

References:

1. Gumbiner, M.D., Robert, Curing Our Sick Healthcare System, (AuthorHouse, 2006).
2. Groopman, M.D., Jerome, How Doctors Think (Houghton Mifflin, 2007), page 21.
3. Dyché, Jill and Evan Levy, Customer Data Integration: Reaching a Single Version of the Truth (John Wiley & Sons, 2006). Chapter 8 details the various drivers of integrated customer data by industry.
4. Millenson, Michael L., Demanding Medical Excellence (The University of Chicago Press, 1997), page 326.
   

Recent articles by Jill Dyché

• From Popcorn to Meat and Potatoes: Data Governance Evolves
• Confessions of a Data Governance Sponsor
• Data Governance in 3-D
• Taking It From the Top: When Data Governance Doesn’t Work