Here’s some scary news for you—two independent studies indicate that for the healthcare industry to fully meet the requirements of the HITECH Act by 2015 a 30 percent increase in staffing of information technology resources will be required (Studies conducted by the Bureau of Labor Statistics and the Office of the National Coordinator for HIT).
What is the HITECH Act? The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed in 2009 to improve American healthcare delivery and patient care through an unprecedented investment in health information technology. To date, participation is voluntary and CMS grants incentive payments to eligible hospitals who demonstrate meaningful use of a certified EHR system. However, if eligible hospitals fail to join by 2015, they will encounter negative adjustments to their Medicare reimbursements.
Not scared yet? Once the requirements are implemented and healthcare becomes more “wired,” will maintenance costs increase or decrease? There is compelling evidence that the difference in maintenance costs at the Stage 1 level of implementation where ancillaries (lab, radiology, pharmacy) are installed and Stage 4 where CPOE (computerized physician order entry) and CDSS (clinical protocols) are fully implemented, represent a two-fold increase. In other words maintenance and support costs double between Stage 1 and Stage 4. This scares me; in a period of declining reimbursements and systemic over-burden, it is in a word, unsustainable. This is the first part of a blog series describing how some advanced Lean healthcare delivery systems have faced this challenge.
For Lean healthcare systems and organizations, this will be less daunting. Many of these institutions have recognized tremendous improvement in cost, quality, service levels and patient satisfaction by using Lean to make quality the operating system. Many have also recognized that continuous improvement efforts are relying a greater extent than ever on the integration of (the right) technology and well designed (Lean) workflow. Fewer have turned the focus of their Lean transformation on how IT is purchased, implemented and supported.
To meet the challenges described above, healthcare IT departments will be required to shift resources from basic support to strategic implementation. Currently, 80 percent of the average healthcare system’s IT resources are engaged, day-to-day, in providing support. This leaves only 20 percent for strategic implementation. The demand going forward will require closer to an even split of these resources – herein lie both an opportunity and a challenge.
In general, this division of resources leaves the enterprise over-burdened on the strategic implementation side. So what happens? People do the best they can. When it comes to implementation of new technology or major upgrades, over-burden leads to short-cycled and, as a result, sub-optimal implementations. Areas often overlooked include fully understanding technical requirements, adequately surfacing the voice of the customer and translating it into the design and implementation requirements, and solid pre-go-live testing and validation.
Moreover, few organizations look back post-implementation and validate the cost-benefit analysis that justified the implementation in the first place. As a result, implementations are often suboptimal. This drives increased demand for support, which in turn inhibits moving from an 80-20 split to a 50-50 split between support and strategic implementation resources. It is a vicious cycle that feeds on itself to rob the organization of productivity and increases the cost of information technology ownership.
So how can Lean help? First, many of the support processes have significant waste embedded within them. Much of this is driven by a lack of standardization in the delivery of the service. By aggressively and relentlessly eliminating waste from these processes, the enterprise positions itself for success in shifting resources from support into strategic implementation.
The next step in the process is to dramatically improve the way that new technology is implemented. By implementing solid process rigor and by leveraging Lean tools such as 3P to design the technology and workflow “package” and implementation plan, we move closer to “defect-free” implementations. This in turn reduces the post-implementation support requests and demand on support resources, enabling the shift from just keeping the lights on to strategic implementation.
In part two of this series we will turn our attention to eliminating waste from the support processes, enabling a shift in resourcing toward strategic implementation. In part three we will discuss the use of solid process rigor combined with Lean tools such as 3P to drive “defect-free” implementations, thereby reducing demand for post implementation support and again enabling the shift from just keeping the lights on to strategic implementation. Part four will focus on driving ROI, and more importantly, being intentional with the reinvestment of the benefits derived from strategic implementations.
It is my intent through this series to leave you with a solid conceptual framework for assessing your IT operations and driving the improvements necessary to meet the resource challenges described earlier.
This week’s blog was written by Brad Schultz, a Vice President with HPP.
Brad serves as a Lean Healthcare facilitator, business consultant, and executive coach internationally with HPP. Brad began his career in manufacturing with GE Healthcare and joined GE’s Performance Solutions during its infancy and remained with the business unit for seven years. He provided significant leadership to adapt the firm’s products to the unique needs of healthcare clients and to translate the firm’s published materials into the language of healthcare.
Brad’s educational background includes a B.S. in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a M.A. in Business Administration from Marquette University in Milwaukee, Six Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.