Information Services A Key to 21st Century Medicine

1
Information ServicesA Key to 21st Century
Medicine

• George A.Vecchione
• President and CEO
• Lifespan
• HIMSS Annual Conference
• February 25, 2004

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A Decade Of Growth
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Right Message - Wrong Venue?

• Knowing the makeup of the audience - preaching to
  the choir.
• We must convince CEOs of hospitals and systems
  that
• Breakthrough medical technologies and growing
  consumer demand for measurable quality and
  efficiencies are going to change traditional
  models of care delivery.
• Information Services systems will be the 21st
  century enabler that will allow hospitals to
  benefit from these exciting new opportunities.
• Infrastructure investment decisions must
  incorporate the potential impacts of advanced
  information technology.

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Predicting The Future Is Dangerous Given We Rely
On Assumptions

• Lest we forget that in the 1980/90s our paradigm
  was shifting, we were all going to be seamless
  and integrated, capitation was the future leading
  to the closing of half our hospitals and the
  consolidation of the rest into a few super
  systems.
• Although less expansive in our assumptions the
  financial and intellectual investments being made
  in science and technology will enable pay for
  performance financing schemes to be deployed
  using evidence based medicine.

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Our Nations Research Agenda Alone Is Driving
Rapid Change

• NIH Research
  Grants FY 1996-FY 2002

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Advances Will Demand More Of Providers

• Modern medicine is extending lives and as a
  consequence increasing the incidence of multiple
  chronic conditions.
• Genome research will give practitioners advance
  notice of future medical problems - the impact
  will be significant as discoveries are translated
  into clinical practice.
• Health care will become more standardized as the
  science and evidence-based measurement of
  medicine improves.
• Prospective patients will evaluate detailed
  information about regional hospital quality and
  cost of care.
• Advanced IS systems are required to
  appropriately respond to these changes

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Health Care Is Late To The Game
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The Cost, Access And Quality Of Health Care
Remains A Frontline National Issue

• Americans are becoming more aware of the cost of
  health care as a consequence of increased
  deductibles and co-pays or through the
  elimination of heath coverage as a benefit.
• Service and outcome expectations are high.
• Providers competencies will be publicly
  reported.
• Payers on behalf of subscriber interests
  recognize the financial benefits that will accrue
  from improved quality and productivity and they
  should assist in funding the needed investments
  in Information Services that yield an appropriate
  return.
• Ability to enhance clinical operations, generate
  and share information when and where needed will
  be required to meet expectations.

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Infrastructure Investments are Required In A
Difficult Capital Market

• Infrastructure investment and increased bed
  capacity are a central focus of many hospitals.
• Constant pressures to reduce reimbursement levels
  have caused many hospitals to postpone needed
  capital investments resulting in many hospitals
  to be in need of significant infrastructure
  investments.
• General consensus is that demographics are going
  to drive demand for new beds, which would require
  significant capital investments.
• Hospitals continue to be viewed as presenting a
  risk to investors which means there will be
  restricted access to capital.

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Access to Capital Is BecomingMore Difficult
Source Fitch
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Capital Planning In The 21st Century Is About
More Than Facilities And Beds

• No argument that hospitals need to enhance
  facilities and ensure patient and physician
  service expectations are met, but advances in
  Information Services could change traditional
  patterns of care.
• The impact of new technologies and the capacity
  to better use information to design treatment
  protocols, coordinate care, reduce cost, manage
  utilization and improve quality and safety must
  be part of the equation.

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The Role of IS Leadership

• Ensure that technology implications have
  been fully incorporated into institutional/system
  plans and investment decisions.

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Decisions Should IncorporateMultiple Variables

• As part of senior management, you should advocate
  for the strategic value of a more appropriate
  level of investment in IS.
• Recognize that focusing on demographic
  projections based on current treatment patterns
  is only part of the equation.
• Model the impacts of information driven
  improvements in quality and productivity on
  corresponding future demand for physical and
  clinical resources.

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Would Capital Decisions Be Different If There
Were A Higher Confidence Level In The Acceptance
of Information Services Solutions As Having An
Impact On Clinical Quality And Productivity
Issues?

• Analysis says Yes.
• The Massachusetts study estimates a 2.48B
  savings with a 75 adoption rate of (1)
• Electronic patient/physician communications -
  167.8M
• E-prescribing - 140.7M
• Ambulatory CPOE - 290.3M
• Inpatient CPOE - 966M
• Regional data sharing - 23.8M
• E-ICU - 177.4M
• Disease management - 710M
• (1) The Massachusetts Technology Collaborative,
  2003

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SureScriptsA Rhode Island Quality Institute
Project

• The Business Case For Adoption of Electronic
  Prescribing
• United States Prescriptions
• The number of prescriptions in the United States
  continues to increase and is expected to exceed 4
  billion by 2006.
• Retail spending totaled 154 billion in 2001.
• Prescribing Errors
• As many as 28 of all hospitalizations, costing
  50B annually, are attributable to drug-related
  morbidity. (1)
• Illegible scripts generate 150 million calls
  annually from pharmacists to physicians. (2)
• Medication errors contribute to more than 7,000
  deaths annually, exceeding those attributable to
  workplace injuries. (2)
• (1) The Managed Care Institute - An Economic
  Prescription for America, September 2000
• (2) SureScripts

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Our Conclusion

• Informed capital investment decisions require
  consideration of the potential impacts of new
  Information Services applications to improve
  quality and safety.

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If You Accept The Conclusion Then Caution Is
Recommended

• Blind support for Information Services as the
  solution is a doomed strategy
• Although there is a sense of urgency, time is not
  the enemy.
• You are changing a highly ingrained culture which
  will only respond to training and recognition of
  benefits, leading to increased acceptance of
  Information Services solutions.
• Successful system implementations evolve from a
  plan that involves users at the front end and
  through implementation.
• Leadership, leadership, leadership!

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The Lifespan AnswerPursue A Balanced Approach

• Recognized that investments in facilities and
  beds will be required no matter what the future
  impact of advancing technologies and systems.
• Clearly established Information Services as a
  system priority with corresponding standing
  within the management structure.

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Lifespan Answer - Continued

• Introduced as an absolute requirement in our
  facility planning that any design incorporate a
  common Information Services platform.
• Focused on building coalitions with other
  providers to advance the Information Services
  agenda for improved quality and productivity.

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Lifespan In Transition

• 1998
• 5 hospitals and other non acute providers
• Member satisfaction with system value was not
  apparent
• Hospitals and physician alignment was weak
• 50M loss
• Information Services a sub-division of Finance
• 2003
• 4 hospitals and acute focus
• Satisfaction with system services very high
• Hospital and physicians closer aligned
• Positive bottom line
• Information Services managed by SVP/CIO reporting
  directly to CEO

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Management Viewed Information Services As A
Powerful Tool For Effecting Positive Change

• Determined that improving the quality of
  information and how it was transmitted among all
  communities within Lifespan would
• Build allegiances
• Reduce costs
• Improve overall quality
• Enhance physician and patient satisfaction
• Positively differentiate Lifespan in a very
  competitive market

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Comprehensive Information Services Plan Was
Executed Almost Flawlessly

• Information Services breathed life into the plan
  and achieved functionality as promised.
• Implementation was sensitive to the users and
  instilled confidence.
• Patience and training were key.

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Staying True To The PlanHas Resulted In Real
Progress
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Improved Physician Relations

• Lifelinks
• Secure web based browser presenting clinical
  results on a real time and wireless basis
• Available in physician offices and homes
• Linked to physician education and reference sites.

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New Business - Reduced Costs

• Automated laboratory
• Built capacity for new outreach business reducing
  unit cost for hospital generated laboratory
  studies
• Integrated with Lifelinks
• In 1999, 250K tests and in 2003, 1.2 million

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Quality Improvement

• Physician Order Management (POM)
• MD initiates order electronically to pharmacy,
  laboratory, radiology,etc.
• Order recorded in clinical record
• Order status and results immediately available
  via Lifelinks
• 60 of all physician orders at Rhode Island
  Hospital, our largest hospital, are entered
  electronically.

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POM Example of The Impact of Leadership
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Investments Have PositionedUs Well For The
Future
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Collaboration Will Accomplish Far More Than Any
Single Entitys Efforts

• At every level, national, regional and local, all
  sides of the health care equation should find
  ways to collaborate with the goal of designing
  new approaches focused on improving knowledge
  dissemination and standards of care.
• One such effort is the Rhode Island Quality
  Institute.

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Rhode Island Quality Institute

• A collaboration among hospitals, physicians,
  nurses, insurers, business, academe and
  government for the purpose of improving the
  quality, safety and value delivered by the health
  care system in Rhode Island.
• Areas of Focus
• Safety in Care Delivery
• Technology Infrastructure
• Evidence-Based Medicine
• Alignment of Incentives
• Specific project
• SureScripts Electronic Prescribing in Ambulatory
  Setting

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Rhode Island Quality Institute
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Development of Advanced Information Services
Should be Encouraged

• Random information technology Centers of
  Excellence are not the answer for a national
  problem.
• Current reimbursement structures do not
  adequately support the significant investments
  required to develop advanced Information
  Services.
• Good public policy would encourage payers and
  providers to collaborate in the development of
  systems that help to ensure that care practices
  result in efficient, high quality medicine.
• Direct care to providers who demonstrate high
  standards.
• Do not financially penalize providers who reduce
  utilization while improving quality.
• Develop incentives to encourage providers to
  adopt proven Information Services solutions.

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Lessons Learned

• Demonstrate that Information Services is a
  Priority
• CEO has to be the Information Services champion
• CIO should relate directly to the CEO
• Allocate necessary resources - even in difficult
  times
• Link Information Services implementation to other
  institutional priorities
• Educate the Board
• Resource intensive, so decide what you want to
  accomplish at the front end and monitor progress
• Lifespan Information Services Strategic Plan
  Focus on quality, communications and improved
  business practices
• Information Services Strategic Council Inclusive
  membership, monitors and updates plan as necessary

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Lessons Learned

• Information Services is a powerful alignment
  tool
• Lifelinks facilitates physician interactions with
  our hospitals.
• POM assists hospitals and physicians to work
  together towards the common goal of improved
  quality.
• Automated laboratory offers significant
  opportunities to assist community based providers
  to improve operations and interactions with their
  audiences.
• Leadership in Information Services is a catalyst
  for broader initiatives - Quality Institute.

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Lessons Learned

• Do not under-estimate the time and energy
  required to implement
• Not everyone agrees the investment in Information
  Services is warranted.
• Introducing new processes has implications at all
  levels and change is difficult within a hospital
  and very difficult across hospitals.
• Educate as to the benefits and the process, early
  and often.
• Approach the Development of Information Services
  Positively
• View as a strategic investment center rather than
  a cost center.
• Consider information services to be part of the
  solution, not part of the problem.