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Managing Healthcare IT:

Managing Healthcare IT:

Our first contributor is Rachelle Kaye from the Maccabi Institute for Health Services Research, Israel. She outlines the importance of vision, leadership and collaboration when planning a healthcare IT system.

Planning, designing and implementing a healthcare IT system, whether it be at the individual organisational level (such as a health fund or HMO) or at a national level, is a tremendous challenge, not so much because of the technological issues as the “cultural issues”. As Rachelle Kaye puts it: “Working with a computerised system in healthcare means changing the way we do things – and we all go to great lengths to avoid change.”

The first thing that is essential to planning a healthcare IT system is vision. “You need to envision the kind of healthcare system you want and how the IT solution will work to support the system, and establish clear goals and pragmatic objectives,” says Kaye.

Hand in hand with vision is leadership that is unswervingly committed to achieving the vision and seeing it through, despite all of the obstacles and mis-steps along the way, and that is willing to make the required investment of time, energy and resources.

The third "must" is alliances and collaboration. “You can’t build a workable functional healthcare IT system without the full collaboration of your physicians and healthcare professionals. They are the only ones who can make the system really work and therefore you need to ask ‘what's in it for them?’”  

A practical example

The development of the Healthcare Management Information System (HMIS) developed by Maccabi Healthcare Services is an example of the above principles.

Vision: Maccabi, the second largest health fund in Israel, was one of the first healthcare organisations in the world to recognise the strategic potential of information and communication technology for managing comprehensive healthcare systems. It embarked upon the development of its HMIS in 1984.

Leadership and investment: The first systems built were the organisational infrastructure systems: a membership/citizen registry, a provider claims management system and a financial management system. These were developed under the guidance of steering committees that included professionals and representatives of all of the major stakeholders and dedicated managerial and IT staff. All of these were accountable to the CEO who chaired the overall project and committed resources. Maccabi invests an average of 1.5% of its total yearly budget of approximately 1 billion Euros every year for the ongoing development and maintenance of its ICT system.

Alliances: The next step was the development of the Electronic Medical Record in all physician clinics. “This was a fully collaborative step between management and physicians,” says Kaye. “The initial implementation was voluntary but within a few years, working with an EMR became a mandatory and essential tool for healthcare providers.”

Maccabi ICT System today

The Maccabi HMIS is a dynamic e-health system including an e-laboratory, a totally digitalised imaging service system, telemedicine, e-prescriptions for drugs and on-line drug utilisation monitoring, e-consultation including online imaging consultation, online drug consultation, and virtual specialist consultation.

The ICT system provides the physician with comprehensive online information about patients, including all lab results, results of imaging tests, allergies, visits to other physicians and healthcare providers, and all medications prescribed. As Kaye explains: “It alerts him to potential contraindications when prescribing a drug; reminds him to send his diabetic patient for a HA1c test or a periodic eye exam; and provides him with online consultation on the appropriate use of expensive imaging technology and new drugs.”

Maccabi has also transformed its information system into a tool for patient collaboration, education and communication via a secured patient internet site that enables the physician to access his own information including physician visits, laboratory test results, results of radiology tests, personal drug list, diet and nutrition, cardiac risk factors and personalised chronic disease management.

“The system is vital for management and is enabling Maccabi to provide high quality care while maintaining a balanced budget, in an era of constrained and even shrinking resources,” concludes Kaye.

Dr. Rachelle Kaye is Director of the Maccabi Institute for Health Services Research and Deputy Director of the Division of Planning and Finance in Maccabi Healthcare Services in Israel. She has been an active professional in the area of healthcare management including the development and implementation of health management information systems for over 35 years, in North America, Israel and more recently, in Europe.

Move Forwards with Continuity, Collaboration and Communication

Our second contributor is Angelo Rossi Mori from the Institute for Biomedical Research in Rome, Italy. He believes that for synchronised care provision and governance, it is vital to achieve continuity, collaboration and communication among the various actors involved in the healthcare ICT solution.

 

Continuity, Collaboration and Communication

According to Angelo Rossi Mori, two approaches to innovation are possible in the healthcare sector. The first approach deals with healthcare informatics.

“A technological novelty should be assessed when it is introduced by the market, to realise its optimal usage and its efficacy compared to other solutions. It should be maintained, updated and replaced when required. This is the case for most current ICT administrative solutions and successful novelties such as local EPR systems, authoritative knowledge on the web, e-booking, e-prescribing and patient summaries.”

The second approach – connected health – stems from new organisational models for an economically sustainable evolution of healthcare, such as chronic disease management, patient empowerment and clinical governance. The main challenge is the proper management of long-term conditions (70-80% of the healthcare budget) with an active role of patients and informal carers¹ . “The innovation of healthcare processes and governance will benefit from methodological and practical support in the management of the information content,” says Rossi Mori.

The necessity for integrated solutions

To improve appropriateness and quality, integrated solutions should be designed to cope simultaneously with organisation and information. They should be endorsed by all the actors involved in the care process (clinical and social professionals, informal carers and patients themselves), to support primarily the continuity of responsibilities and the awareness of the activities performed around the patient.

“The ICT solutions should cope with Continuity, Collaboration and Communication among the actors,” adds Rossi Mori, “This will support the synchronisation of activities across facilities – especially when clinical pathways involve primary care, hospitals and social care – according to a mutual recognition of responsibilities and a natural coherence of objectives and plans.” ²

Governance based on routine notifications

Care provision and the effective governance of the shared processes should be based on routine “notifications” about the evolution of care mandates and about the collaboration among the actors (i.e. responsibilities, health issues, goals, plans, contacts and exchanges of information).

“Notifications are the key elements to facilitate the coherence of the “system” across all the actors involved, at home and in the different facilities,” explains Rossi Mori.

Systemic indicators, based on notifications and interpreted in the context of reference clinical pathways, can measure the organisational issues for care provision and governance. Clinical indicators are suitable to describe the care process and its outcomes.

Connected health demands communication

The initial idea of longitudinal EHR produced a bias towards the clinical issues and interoperability of systems, versus the organisational and managerial needs. These latter require new methods and tools to support the 3C’s across facilities and to control the overall behaviour of the system – especially on long-term conditions with a relevant role of patients and informal carers.

Most eHealth roadmaps of EU Member States are focused on the first approach, extended to the technological infrastructure for the longitudinal EHR.

“Connected Health should instead be anticipated by a cultural and organisational change that requires the ability (and an effective willingness) to communicate among the actors, facilitated by an adequate number of innovators working closely with healthcare professionals and managers.” ³

Angelo Rossi Mori is a researcher at the eHealth Unit, Institute for Biomedical Research of the National Research Council in Rome, Italy. He was a founder of PROREC Italy and the Italian affiliate of HL7. He has prepared several international standards on eHealth, mainly on semantic interoperability, the content of the EHR and on continuity of care. Since 2001, he has worked on the analysis of national strategies for the balanced and pervasive deployment of eHealth, and on the related processes of change management. He is developing methodologies for the production and the evaluation of eHealth roadmaps and for the design of initiatives to share clinical documents and organisational information for continuity of care across healthcare facilities.

¹ see the International conference “Improving Care for Chronic Conditions – the added value of eHealth", Rome, 10-11 October 2005, jointly organised by EHTEL, the National Research Council of Italy - Institute for Biomedical Technology in co-operation with ESQH and NIZW.
² see the International conference “Continuity, Collaboration, Communication: Challenges for Healthcare and Opportunities for eHealth”, Rome, 24-25 May 2007, jointly organised by EHTEL, the National Research Council of Italy - Institute for Biomedical Technology in co-operation with CPME, EFN, HOPE, PGEU, UEMS.
³ RIDE D4.3.1 – “Policies and strategies”. Deliverable of the EU Coordination Action “RIDE - A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability” 2007-08-15

Management Engineering and Process Improvement

Increasingly, Management Engineering and Process Improvement (ME-PI) professionals are helping healthcare organisations manage their healthcare ICT solutions in a variety of beneficial ways. They can play an important role in helping administration control operating costs and maximise the effectiveness of available resources. They can influence the efficiency with which medical and professional staff provide care while minimising the chance of error. They can also provide valuable information that can help organisations make strategic decisions about a new service’s financial impact, actual cost and trends.

The footprints of ME-PI in an organisation can be found in gains in productivity and revenue, increases in process and quality outcomes, and decreases in costs and inefficiencies.

There are a variety of ME-PI approaches/programmes that can significantly improve the performance of today’s healthcare organisation. The most well known are:

• Six Sigma: focuses on reducing performance variance (such as the time at which routine lab results are reported each morning).
• Lean: focuses on reducing the time to accomplish work (such as the time it takes to produce a lab result).

Both are comprised of analytic tools and management techniques to form breakthrough improvements in performance.

In his white paper entitled "Rapid Change in Healthcare Organizations", Management Engineering-Process Improvement Task Force Member Marty Kohn, MD, explores this topic in some detail by examining the theories of several management experts who have developed theories and recommendations for dealing with the complexities of change and the conflict of ideas and goals that can develop. For more information on ME-PI, please email JoAnn W. Klinedinst , CPHIMS, PMP, FHIMSS.

“What is the value of Management Engineering and Process Improvement?”

Healthcare organisations are complex structures whose peak performance is measured in quality of patient care. Each new day requires the effective integration and coordination of professional, support and administrative staffs; sophisticated clinical and information technology; critical processes and inventories; and facility resources.

Changes within the organisation, such as growth, innovation, patient demographics and financial fluctuation, continually impact the environment and place strain on information management, decision making and quality management processes. Only with specialised direction and oversight of the systems and processes in place can healthcare organisations confidently optimise resource and capacity utilisation and ensure system and process effectiveness.

Assistance from ME-PI professionals can help individual stakeholders and executive management to:

• Facilitate change
• Apply project management principles and practices to achieve project schedules and budgets, and rectify problems relating to process, facility, and programme
• Educate staff on operations management principles, continuous process tools and techniques, processes and procedures related to change, etc.
• Provide integrated IT support by helping to define and interpret user requirements for workflow, data, ergonomic issues, staffing and equipment
• Influence, where applicable, the number of service lines for patients and the schedules of affected staff by ensuring quality and consistency of processes.

A critical factor in hospital-based process improvement is the introduction and proper alignment of ME-PI professionals within the organisation. Goals are more likely to be achieved if the ME-PI function is placed high enough in the organisation to access planners, decision makers and the critical operating information they use. For full effectiveness, the position requires:

• Full visibility throughout all functions and levels
• Authorisation to directly observe or work with any or all levels of the organisation
• Access or response to executive-level decision makers
• Direct reporting lines to, and support of, executive management
• High-level recognition of PI activities to drive and facilitate interdisciplinary teams
• CEO alignment for support of the organisation’s vision
• COO alignment for support of operational optimisation
• CIO alignment to meet the challenges involved in collecting, utilising and maintaining information – the lifeblood of the organisation.

Questions anyone?
Challenge us to help you with your (healthcare ICT related) questions. Send your input to emea@himss.org (subject line: question time) and we will research and publish your questions and our answers in forthcoming issues of the eMessenger.

The HIMSS Mission

The Healthcare Information and Management Systems Society (HIMSS) is the premier professional member organisation exclusively focused on providing leadership for the optimal use of healthcare information technology.

The HIMSS mission is to lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation and community affiliations. HIMSS EMEA brings this mission to Europe, Middle East and Africa.

HIMSS EMEA

HIMSS in Europe, the Middle East and Africa (EMEA) is dedicated to bringing together all the major players in the Health ICT community to transcend borders and languages and engender a truly regional dialogue. As members of HIMSS EMEA, individual professionals (managers, administrators, clinicians, technology experts and users), vendor companies and IT providers meet, interact and learn from one another.

With the opening of its EMEA office in Brussels, HIMSS is now positioned to provide activities, programmes and education specifically designed for the EMEA Health ICT community. Guided by a Governing Council of members from within the EMEA region, HIMSS EMEA focuses on the needs of individual and corporate members to ensure dedicated services and membership value.

Membership benefits include

• A monthly e-newsletter - HIMSS EMEA eMessenger – delivered to your inbox on the third Thursday of every month.
• A series of educational eSeminars on topics reflecting the challenges of the Healthcare ICT community in the EMEA region. Following April’s successful inaugural eSeminar on Electronic Health Record systems, HIMSS EMEA is planning a challenging programme for the coming months, which covers hot topics like Privacy Protection and Patient Safety. For detailed information, please have a look at the schedule for 2007.
• An interactive website targeted at the main issues and experts within our community. This includes a weekly “Expert View” on the issues that matter to you as well as industry news (RSS feed in partnership with Healthcare IT News Europe).
• Access to the latest industry and policy documents on the HIMSS EMEA online resource centre.
• Significant member discounts on the World of Health IT Conference and Exhibition, the HIMSS Annual Conference & Exhibition, the HIMSS bookstore and HIMSS events.

To learn more about HIMSS EMEA take a look at our website: www.himss.org/emea