Healthcare Revolution Needed
By Bill Bysinger, for Healthleaders Online, Oct. 14, 2002
Is it time for an industry wake-up call?
I see considerable talk from healthcare leadership about wanting to be more efficient, more organized, more leading-edge, more cost-effective, and more integrated. Everyone says they want to achieve a higher quality of care through better information, more informed patients, and easier access to services.
However, when I go to hospitals and practices, what do I see? Paper, paper, and more paper, as well as frustrated staff with little time to do their jobs, exhausted patients who do not feel they are getting the proper or timely care, and practitioners who are trying to keep up with patient load and the time constraints of recording their work and findings.
I keep asking myself, "Why is this happening?" More money is again being spent on bricks and mortar, but little is being proactively spent on improving the information infrastructure.
Over the past 10 years I have seen some brilliant technology and process companies come into the healthcare space (not dot-coms) with good technology and process automation. However, in a short period of time they become frustrated with the lack of interest or acceptance to new ways of applying technology for process change and quickly they leave the market. Healthcare does not embrace change well.
HIPAA was supposed to provide a way to move the industry to a common data structure, a closer commonality of inter-related healthcare processes between entities, and an efficiency in securing and creating confidentiality of patient records. But what has happened?
- HIPAA is not being taken seriously even though fines can exceed $100,000.
- According to the latest announcement from CMS, less than 3 percent of covered entities have applied for an Administrative Simplification Transaction Rule extension.
- More lawyers are involved than healthcare providers in generating comments.
- Everyone wants a free ticket to get to compliance with no charge or time allocated.
It seems as if the industry has taken a hands-off attitude in trying to create any level of economy of scale or efficiencies. Yet everyone complains about claims inefficiencies, sluggish reimbursement, bad information, too much paperwork, and the erosion of quality.
I, for one, do not get it!
There is no such thing as a free lunch and everyone in the industry had better start to understand it. We must invest in change and begin to create a collaborative environment that will deliver cost effectiveness, process efficiencies, faster reimbursement, and a higher quality of integrated data for a more seamless healthcare environment.
Over the last 30 years in business, a number of industries have had to make massive changes to survive. A few examples:
- In the 1970s, the manufacturing sector, based on pressure from foreign suppliers;
- In the 1980s, the automobile industry, based on Japanese and European competition;
- In the late 1980s, the banking industry, based on the influx of Japanese banks and banking customers demanding better service;
- In the 1990s, the telecommunications industry, based on the deregulation of the 1980s.
- In addition, in the 1990s, the healthcare industry was pressing for a managed care model that struggled to become a reality.
All these other industries collaborated to create change and invested in implementing that change. By contrast, the healthcare industry continues to talk about change but does not make it happen on the scale that will make a difference.
Why is healthcare different?
It is not different.
Let's begin with the simple truth begin moving the industry rapidly to change to stop the complaining and start the process to deliver a new model of healthcare.
The fundamentals that must take place are:
The entire industry must admit that change is not only good, it is required,
The industry must to be committed to the change,
A driving event must be the foundation for the change,
A new model for healthcare operation must be predominant across the industry,
A cross-industry collaborative action must create the change.
Healthcare has some of these elements in place, but others are not even close:
No admission of change has gone beyond the rhetoric,
Little commitment has been shown (proof is the current slow implementation of HIPAA)
The driving force should begin with healthcare legislative change in the form of HIPAA and Gramm-Leach-Bliley.
A new model has not been brought forth to be widely accepted, although in some of the eHealth initiatives there are components of a new model for healthcare integration. As well, the Institute for Healthcare Innovation has a new model for outpatient care.
Cross industry collaboration again should be HIPAA as a starter and eHealth as a continuing force.
Many in healthcare continue to talk about having no time and no money to implement change. I have heard this same cadence since 1993 when managed care was supposed to be the savior. It turned into a failure partly due to the fact that there was no commitment, no driving force, and models were built on focused wealth versus economies of scale and efficiency.
Investments must be made. Change does cost time and does cost money, although both can be metered and the end result can far outweigh the investment in time and dollars. The industry must be focused on the over-time results, not the overnight successes.
The current economy is a classic example of the problem. Most financial analysts believe the reason it is not working is that few organizations are investing and that most are retrenching, hoping to survive. The United States economy was built on risk-taking, investing, and striving to be better. For some reason over the last few years it has become too easy to be focused not on change or innovation, but trying to get rich quick.
Healthcare should be a leader in the process of change since it affects every person who resides in the United States.
- Now is the time to invest in a new future.
- Now is the time to make the commitment.
- Now is the time to create the momentum for change.
- Now is the time to create a model for change.
Back to the Future
In early 2000 I published an article in HealthLeaders based on some work I did in 1999 about healthcare creating a collaborative, seamless information environment that could deliver efficiency, quality, and cost-effective care. That model is as follows:
A Proposed Process Model for a New Form of Healthcare
The following is an example process of patient provider collaboration. Collaborations may be different based on the needs of the partners, however, using an enabling technology like the Internet can jump-start the process. For eHealth to happen beyond providers and payers it must have a patient and practitioner model for collaboration. This model is not dissimilar to a buyer and a supplier relationship in traditional electronic commerce.
An Example eHealth Collaboration Model:
Prior to visiting the physician's office for care a patient is provided an electronic questionnaire that can be filled out and transmitted back to the physician's office. The questionnaire is used to assess the patient's problem, determine prior treatments, and determine patient's expectations for the care and treatment.
Patient visits a physician's office for care; no papers are filled out at the office because all information has been transmitted electronically prior to the visit.
Physician's office has taken the electronic information from the patient and incorporated it into the chart.
The physician reviews what chart information is available with the patient to make sure that all medical history is up to date.
The physician reviews the data, examines the patient's condition and makes treatment recommendations. Based on access to online Evidence Based Medicine information, and others diagnoses from online care based clinical results.
Based on the diagnosis the physician provides the patient with Internet sites that are relevant to the patient's problem, and encourages the patient to seek information on relevant websites that can add to the patient's understanding of both the condition and the treatment.
When the patient encounter is complete the chart is electronically updated from the physician's handheld device, the claim is automatically generated from the billing system and electronically transmitted to the payer, the patient receives an EOB prior to leaving the office and the physicians claim is adjudicated in real time.
The patient and the physician continue electronic communication. The patient is set up with a secure connection to the pertinent information on the chart that could be updated by the patient. This updating can insure chart completeness.
The physician communicates over the course of care to make sure that all referrals and care out of the purview of the primary physician are updated in the patient chart.
Using This Model, the Following Scenario Could Work:
The patient is surfing the Internet when he discovers a new treatment for his ailment.
The patient emails the physician with the link and asks if the physician has heard of this treatment.
The physician receives the email and forwards to a colleague specialist who may be familiar with the treatment. The specialist agrees with the course of the new treatment.
The primary physician emails the patient with the response from the specialist and initiates an electronic referral to the specialist.
The patient sends an electronic authorization for chart sharing with the specialist and the three collaborate on the patient's chart and the follow-up treatment.
In this model the patient has been proactive in initiating care based on knowledge achieved from the Internet. All of the players in the continuum of care are working together for the good of the patient. The patient aids the physicians in the proactive care process, and the information is flowing both from external sources as well as internal sources to insure the chart is used and updated.
This proactive and collaborative process is set up to safeguard the patient in pursuing courses of treatment outside of the patient/physician relationship that may detrimental to the patient's prescribed care.
In addition, other patient safeguards can be accommodated in an eHealthcare collaborative model, including:
- Drug interaction issues can be resolved if the chart is up to date and an online pharmacy is brought into the collaborative process.
- Other test and treatment centers can be integrated electronically to make sure information is flowing properly and correctly. The patient is involved to ensure everyone knows where in the continuum he or she are and what actions have been taken.
- Diagnosis and treatment paths can be monitored over the eHealthcare collaborative network.
- Using an electronic medium to be the collaborative connector for all the information and follow-up saves time and effort.
This is collaborative, proactive healthcare.
When I put these thoughts forward in 1998, 1999, and 2000 at conferences and in published articles, many healthcare professionals were saying this is what we needed to do as we drove into the new millennium. However, we are 2 years going on 3 years into the new millennium and what I see is the same healthcare model that has been in place since the early 1980s. Not much change has taken place.
Yes, there are pockets of enlightenment, but they are not very widespread. The majority of providers still operate on the same old chart-based paper models, most payers are still using the same old adjudication technologies for claims payment, and most hospitals are still not using integrated systems. As a result, most patients are still as frustrated as ever with their lack of good information before, during, and after their healthcare encounter experience.
Now is the time to change, implement HIPAA, work on electronic collaboration, move to integration, and create simplified homogenous data to delivery quality and efficiency.
It is time to look beyond our antiquated transaction based claims model for information acquisition to new integrated medicine models for diagnosis, treatment, care longitudinal history and cross collaboration.
There is no time like the present. We need a groundswell for real change, not just talk. It all begins with cross-industry collaboration and implementation.
Whether you agree or disagree, please let me know.
Bill Bysinger is the principal of WGB Advisory where he advises healthcare organizations and healthcare technology organizations on HIPAA, eHealth, and technology solutions for the healthcare provider market. He may be reached at 360-981-0173 or firstname.lastname@example.org