The Chairman at the marcus evans National Healthcare CMO/CMIO Summit 2014 (http://www.nhcmiosummit.com/
What shift is the US healthcare industry undergoing today?
It is shifting towards chronic disease management, health promotion and health management for entire populations, rather than just episodic disease management for individuals. This shift to longitudinal care brings many opportunities and challenges, as it changes the way patients are approached, and how data and information are managed.
How can healthcare organizations successfully make this transition?
A variety of things will have to happen. There must be better alignment between providers, hospitals and patients to align previously disparate goals. The alignment effort necessitates tremendous investment that will not necessarily bring in revenue, at least initially. For example, care navigators do not produce revenue yet they will be a significant expense. That is the disconnect as we shift from a delivery system based on fee for service to another payment model.
Healthcare IT will play a more significant role. When managing payments longitudinally, having a single progress note on paper or even electronically in a physician’s office will not be enough. The data must be available at numerous points of access simultaneously in real time.
The opportunity that CMIOs could miss is the chance to implement best practices. They might be tempted to take what is occurring on paper and translating it into an electronic format without evaluating the care process, looking at how care is provided and incorporating best practices.
How should hospitals plan for computerized physician order entry (CPOE) implementation?
First of all, they should not go in understaffed. To effectively implement CPOE it takes a significant crew of hands on the trenches working directly with doctors. Hospitals will have to decide whether they will allow physicians to have their own custom sets or if they will be standardized. Standardization that allows for some flexibility is best, to get buy-in into the process. Some physicians might implement changes willingly, while the orthopedist who visits the hospital once a week will not be so motivated.
Finding leverage points where people feel compelled to buy into a process is at times challenging, but it can be done. It just takes persistence, and more staff and man hours than you think you will need. A good place to start implementing CPOE is with the folks who will be more motivated, such as the emergency department and hospitalist groups, allowing the hospital to try the process on a more limited scope.
Any final words of advice?
With some effort, it can be a win-win for all parties. Physicians will wonder if they have to give up their autonomy and have their pockets picked, so whenever possible, they should be involved in the actual planning process. That is the only way to get their buy-in.
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