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Laying a Solid Foundation

Refocusing on the four fundamentals of managing population health.

Over the past decade, I have worked with a broad set of healthcare providers and vendors, from The Office of the National Coordinator for Health Information Technology (ONC) and its Beacon Communities, to the CMS Innovation Center program, and on to private and public provider and payer systems. This has allowed me to analyze many clinical models, technology approaches and business cases.

One main observation is that providers have responded to changing clinical or policy environments by cobbling together a conglomeration of technology solutions, which leaves data spread across disparate IT systems. As a result, providers are unable to get a full understanding of their populations, the risks they face, or how to effectively track and manage those patients and their caregivers. 

Based upon my experience, when systems take this technology approach, it is time to revisit the fundamentals of the healthcare IT game.

Before Taking a Shot
I first learned about the importance of fundamentals while on my high school's basketball team.

For the first two weeks of practice, our coach didn't allow us to take shots. Instead, we were taught that fundamentals win championships, so we focused on the basics-defense techniques and strategies, as well as body positioning and endurance. In effect, we delayed gratification (i.e., shooting the ball) in deference to laying a solid foundation.  We also identified our team goal, which was to win a championship. That goal drove us through the pursuit of the basics, and it paid off for our team.

Refocusing on the fundamentals is also critical for healthcare IT leaders as organizations adapt to this challenging era of rapidly evolving policy, business and risk-based populations. While the mission in healthcare may not be championships per se, but setting and attaining goals, such as the Triple Aim, affect to positively impact our entire population is a priority for most institutions. Toward that end, you may wish to consider these four foundational basics:

1. Map the near-term and long-term goals of the provider system.  How does that new system map to the current one, and what will it take to support the goal? Who are the participants in your ACO or Clinically Integrated Network, and what does their technology look like? Be sure to get a fresh view on these goals and be brutally honest about how it positions you for future success. Setting these goals will help frame the foundations for change.

SEE ALSO: Saving Healthcare From Technology

2. Unify all data, and enable it to be available to applications and analytics across the organization.  This will allow you to view real time statistics to understand risk exposure, quality gaps and overutilization.  It will also allow you to deliver critical, fundamental results quickly, to help close gaps in care and drive intelligent utilization. Include financial data to give your system a sense of how to evolve from a largely fee-for-service world to a risk-based environment without putting system financial viability at risk. Also, ensure that your environment supports clinical and business model testing and future iterations of technology systems. The alternative, rigid and expensive-to-modify systems will have a massive slow-down effect on your strategy's ability to evolve.

3. Have strong, clinically experienced technology leadership.  Clinicians who deeply understand the art and science of healthcare -- yet can also "speak geek" to both clinicians and technologists -- are critical in this new system's construction. Include them in your leadership team in clear, unambiguous roles.

4. Test new care models in response to market shifts.  A sound IT strategy and data approach enables providers to develop a culture of experimentation, trials and iteration.  Introducing new care models can have a profound effect on the system's finances, and a strong testing environment allows for immediate and actionable insights.  Taking this approach will dramatically decrease the time and cost to iterate and move forward.

Note that none of these four basics define the exact technology to deploy or what a user interface will look like. In the basketball analogy, selecting and implementing technology can be swapped in for taking shots on hoop. Again, fundamentals are driven by the goals and demands of the system, which in turn helps to truly define the critical healthcare IT infrastructure.

"Who are the participants in your ACO or CIN, and what does their technology look like?"

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Stay Focused
Healthcare IT, in my experience, has proven to be a bellwether of the overall organization and is reflective of overall operations, approach and experience.  A discordant set of systems, reactionary leadership and lack of clear communications can be massively disruptive to organizations in the long haul - as provider systems will need to accommodate diverse clinical and business models to drive the future of care.

So take a step back, examine the system and rededicate yourself to the fundamentals. This approach is critical in the current, rapidly evolving healthcare environment.  Remember that fundamentals in sports win championships, and in healthcare they drive better care, lower costs and create winning experiences.

Dr. Brad Miller is Vice President of Clinical Solutions at Caradigm.

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