Knowledge Management in Healthcare: Succeeding in Spite of Technology

Technology and healthcare always have had an uneasy relationship. On one hand, there is the promise of technology and the enhancements it offers healthcare. These include improved medical information access, streamlined reporting, automation, reduced errors and more efficient processes. On the other hand, technology has fallen short of its full potential in healthcare, as too many competing systems make integrated data difficult to obtain. Additionally, the burdens of data entry and analysis burdens overwhelm rather than streamline processes.

Healthcare faces these mistakes if it "applies" technology to organizational Knowledge Management (KM) without first identifying KM goals and understanding how a KM system will be used by administrators, physicians, managers, and staff. Technology facilitates knowledge exchange, but it is not the end-all to managing knowledge effectively. Technology designed to enhance the interaction among a community of similar-minded participants, such as healthcare employees, can greatly enhance the exchange of knowledge. But it is the process and culture of an organization rather than the level of applied technology that make a KM system a wealth or void of retrievable information.

Healthcare

An effective KM system is built on communication and education and thrives in organizations encouraging shared learning both within and outside of the hospital walls. These systems store historical knowledge and knowledge created during exchanges of information among people who are interested in learning. Knowledge management systems designed with goals in mind, versus just acquiring the most advanced technology, is what will support healthcare organizations in streamlining processes, reducing costs and improving care.

Knowledge Management in Healthcare: Succeeding in Spite of Technology

Why Knowledge Management in Healthcare?

Healthcare industry professionals are realizing that previous efforts, (e.g. searching for the elusive "best practice" and applying it as a commodity), bureaucratic and toothless performance improvement initiatives and poorly thought-out IT implementations, have not led to improved results and reduced costs. As a mindset, KM attaches importance to knowledge and identifies the value of knowledge at different levels. As a framework, KM facilitates knowledge access and transfer, which helps change behaviors and improve decisions. Knowledge management systems support healthcare workers in using available knowledge to develop organizational learning. This learning assists the employees in critiquing a compilation of practice ideas and successfully designing a customized "Best Practice" for the organization. A good KM system can help staff create and exploit new knowledge. It is capable of driving decisions, change and improvements to all levels of the organization. And, in this era of escalating costs and declining reimbursements, an effective KM system is virtually essential to a healthcare organization's process improvement and cost reduction strategies.

Hospitals can be isolated places, which make it tough to gather 'knowledge'. The clinical side has the measurable research and knows the outcomes, but the operational side of the hospital lacks this information. Consider this example. A hospital's operational staff may be well aware of the increased benefit to changing one of its products used for patient care management. Nevertheless, the staff struggles when it comes to demonstrating the cost/benefit to administration and to the physicians. A KM system offers a hospital staff access to strategies and contacts so they can learn how others have successfully carried out similar situations.

Can We Talk?

Hospital staff is willing to share their knowledge with others in the field, although it's often done informally, such as networking at a convention or conversations with internal and external peers. Effective KM systems capitalize on these opportunities.

How does a KM system change behaviors and improve decisions? One hospital department is concerned with retaining staff, especially in light of the current nursing shortage. Typically, the manager struggles with the staffing issues alone or relies on a few peers within the department. Yet, what if the manager could connect with a peer internally and solicit his or her advice, even though this employee works in an unrelated department? The insight and perspective from an "outsider" may be very useful. How about contacting peers at other facilities? An effective KM system would facilitate 'experience sharing' among people struggling with staffing issues. It also archives the solutions brainstormed from the interaction to use as a basis for growing the collective knowledge of the group. This information is then readily accessible the next time a hospital manager (within the hospital or from another facility) faces retention issues.

Another method hospitals typically use to gain knowledge is gathering ideas from a multitude of experts, as is done when attending a conference or a convention. Yet, how is that information disseminated throughout the hospital or healthcare organization if only two employees attended the convention? If it is difficult to share and build ideas within one department or even throughout one hospital, how can anyone expect cross-hospital exchanges to prove fruitful? Obviously, it is more difficult to share information when individuals are not physically together and even more complex when the individuals are employees of different healthcare organizations. The benefits of sharing such a huge reservoir of knowledge are colossal. Technology is a must in these cases.

Knowledge Management ≠ Information Technology

Effective KM cannot be thought of, nor treated, as simply another exercise in information technology. Unfortunately, due to the access and distribution enhancements technology provides, healthcare administrators often have a distorted view of a KM system as an information technology system or as a solution that needs to be applied. While technology enhances sharing and information exchange, even the most technologically advanced KM system will not solve every dilemma. The keys to a successful KM implementation are:

· Identify the knowledge to exchange and distribute

· Determine how knowledge will be managed

· Match technology and resources appropriately to the culture and needs of the organization

Another fallacy about KM is that "knowledge" can be reduced to documents and then warehoused in a computer database for people to access as needed. The improvement resulting from a KM system comes from personal interaction, the sharing of experiences, taking action and recording the results, growing collective knowledge of a group and building new knowledge from the experiences of others. Technology based solely on warehousing knowledge "documents" or best practices are not successful in driving change and improvement in the organization.

It takes resources beyond technology to manage knowledge effectively. Group interactions must be facilitated, results must be archived and reinvested in the knowledge pool and management actions and change must be supported by the organization. Effectively managing and leveraging knowledge in an organization cannot be abdicated to the IT system.

Apply Thoughtful Technology

Organizations have a habit of buying the latest, greatest KM system on the market, if for no other reason than because others have done the same. Yet, elaborate systems that aren't called for tend to breed reluctance. Does the hospital or healthcare organization really need the latest and greatest? When analyzing the implementation of a KM system, first determine what is really necessary to meet the hospital's needs. For instance, take the simple suggestion box. Are the employees making practical suggestions or snide comments? Is the suggestion box readily accessible? Does the hospital culture encourage suggestions and incorporate them into the organization's routines? If so, this is a working and useful KM system. This is when technology can really enhance the system by extending its reach and providing a historical warehouse of implementations. But, when the suggestion box isn't used appropriately, then having the latest, greatest, technologically advanced computer suggestion box won't improve anything. Once again, an organization requires a "learning" culture to value the collaborative learning obtained through KM systems.

Some organizations overcome these obstacles by using technology as a tool instead of as a solution. Technology can enhance knowledge exchange by providing multiple access models (interactive events and data warehouses) and widespread distribution of new and innovative ideas. Thoughtful abstracting and archiving of events and documents enable managers to actively apply lessons learned by others and applies knowledge to their daily work.

Managing Competing Expectations of Users and Administrators

Unless it fills some need and is easily accessible in one's daily routine, a KM system will probably be ignored. Healthcare runs at a hectic pace and staff needs to spend as little time as possible navigating a KM system to obtain useful information. Administrators will not support KM efforts unless they see demonstrated results. Consider the following criteria when weighing the pros and cons of a KM system:

· What is the organization's purpose for the KM system?

· Where is the existing knowledge?

· How is the knowledge transferred?

· Who will have access to the system?

· How will access privileges vary among staff members?

· How will each department use the system?

· How will ideas be exchanged, in-house exclusively or
with other organizations?

· What is the structure of the KM system? Will it just
create directories of experts or will it also create active learning communities (active learning)?

· What amount of support will be required at each level?

· How user-friendly is it?

It never serves an organization to design a system with all the fancy bells and whistles, just for the sake of having slick features. Create a KM system consistent with the way the hospital staff will use it. If the purpose is to inspire employees to think 'outside the box', systems can be designed to facilitate this. The best way to manage competing expectations is to understand it all upfront. The healthcare industry, especially, does not have the bankroll to pay for underutilized features.

Key Components for A Successful KM System:

1. Fulfills organizational goals. A KM system structured around an organization's goals will support the efforts of employees to reach these goals. John Ager, Team Coordinator of the Endoscopy Department for Sentara Healthcare Systems, located in Virginia Beach, Virginia, has participated in monthly teleconference calls with colleagues nationwide. "It is part of my hospital's goal to do benchmarking. This hospital is very strong on sharing information and the previous methods were not effective. Prior to the teleconference calls, we were doing phone communication, which was difficult at best. Now we have set scheduled times on a monthly basis and we just recently picked up using computer-based knowledge."

2. Addresses social networks. If employees feel like they belong to a particular group, then they are more likely to share successes and failures with that group. Sharing failures is especially beneficial to a knowledge management system since people tend to learn more effectively when they're told/shown what not to do. Develop knowledge communities or communities of practice (COP's) around functional and clinical topics. Orchestrate events where staff can share experiences (especially failures) without fear of censure.Collective history of a social network is important. The background information from all participants in a COP builds a shared, historical base, which solidifies commitment to the group process and increases exchanges. "I've really enjoyed the participation," says Ager. "It has really helped me get a better picture of the field I'm in because I'm actually having a one-on-one immediate interaction with somebody as opposed to the old process where you'd have a fixed set of questions you'd e-mail to them. Then, you'd try to call them to get answers or they would fax their answers back to you. It wasn't as clear and concise. This is ongoing and I like the immediate and personal response back," explains Ager.

3. Archives existing knowledge. Create historical records by categorizing and abstracting knowledge gleaned from interactions. Make it easy for users to locate relevant learning. Ager uses his KM system to share documentation prior to the actual teleconference with the other participants. They use spreadsheets and data management for references when talking on the telephone. "I've found this aspect beneficial because as we are talking, I'm able to look at the information firsthand and it spurs questions for me too," says Ager. Additionally, all participants receive e-mail summations of the teleconference (created by the KM system coordinator). Call topics are based on the suggestions and questions introduced in previous teleconferences. If one facility has a specific question, the coordinator will request examples related to this question from all participants, summarize the information and then forward it to all facilities.

4. Facilitates "new" knowledge. Knowledge comes from many sources including knowledge forums, conference calls, research articles, surveys, and opinion polls. Encourage participants to exchange ideas and share experiences, challenges and successes. Most people are not able to develop an action plan simply by reading or analyzing data. Rather, they are more inspired by talking and exchanging ideas. According to Ager, "Participating in the teleconference calls is one of the best ways of sharing information that I've been exposed to in the last nine years since I've been working for this facility. It's given me real time data and real people to talk to. Issues constantly change. At one point, staffing was a priority at several of the facilities and because we shared information, other facilities implemented the shared ideas when it was the right time for them. It's easier than looking at a piece of paper with raw data on it wondering what to do with it."

Moving Forward

The explosion of information technology and its instant accessibility have created powerful solutions for the healthcare business. Healthcare must invest its resources and technology wisely. A carefully considered and well-resourced KM implementation will enable organizations to leverage data, knowledge and experience to improve patient care and lower healthcare costs. Why 'reinvent these conversations' when they've already taken place countless times? KM systems designed to serve an organization's goals, and built to foster social interactions that encourage the exchange of knowledge, will assist organizations in revolutionizing healthcare.

Sidebar: Keys to Generating New Knowledge
Use these ideas when designing a KM system:

· Create Communities of Practice (COP)

· Moderate COP processes to extract learning

· Make continuous learning available

· Determine how successes are shared and how failures are communicated

· Analyze failure for future learning

· Generate, abstract and categorize historical knowledge records

· Provide multiple access paths for participants

Knowledge Management in Healthcare: Succeeding in Spite of Technology

Shelley Burns is director of knowledge management at The Healthcare Management Council Inc., a benchmarking and performance improvement firm in Needham, MA. For more information, call (781) 449-5287 or visit the company web site at http://www.HMC-benchmarks.com.

Leadership & Management For The Health Care Industry

The contemporary health care industry is making substantial efforts to deliver quality care and increasing credentials driven by competition among the organizations. The main objective is to deliver effective health care service proposes to build the management and leadership capacity of health care managers and practitioners. There are many criteria taken into consideration for managing health care organization, such as:

Legislative role: The political & social factors influence on the productivity & accessibility of the health services. Higher medical costs reduces the utilization of services. Private insurance companies restraints from providing more benefits,& also increase premium rates. Non-insurers find difficulty to meet the expenses, & would be deprived of tertiary health care services. Private stake -holders expect profits from their investments, find hard to pay salaries to doctors & nurses, & ultimately derogate to invest in health industry. In such situations, managers or hospital administrators organise for public awareness camps, free consultation programs, special discount offers on investigative procedures, etc to attract customers/ patients.

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Science & Technology: Involvement of technology & varied branches of science,such as, toxicology,bio-medical research bio-instrumentation, bio-materials, genetics, rehabilitation engineering, nutrition & diet, & others have accelerated the procedure of the diagnosis & treatment providing quality to life. Medical informatics provide services in various areas, such as, knowledge management, guidance on best practices, education of professionals, & the public,& the use of new communication & computer technologies. Electronic medical record services helps for easy creation, storage, retrieval & research of medical data. It proves remarkable advantage for telemedicine & medical tourism industry. Therefore analysis of outcome measures in comparison to knowledge & technology should prove cost-effective & efficient.

Leadership & Management For The Health Care Industry

Organization structure: Operating standard equipments, sanitation, hygiene, availability of emergency & safety measures are essential components of hospital. The emerging science of quality management, such as, registered national hospital accreditation certificate, & international accreditation certification (JCAHO, JCI) has occupied the place of pride in hospitals. Six sigma approach for improving methodology, reducing variability & waste, giving greater patient satisfaction rates are highlighted for success.

Managing organization: Hospital administrator have to manage the hospital staff with varied behavioural & educational status.The dangers outcomes of strikes, facing contradictions of union leaders are the major risks involved. Relationship (transformational) leadership motivates & inspires the staff members to see the importance & rate value to the task. Participative leadership works best in circumstances of disasters, outbreaks of epidemics, etc.

Internet & social media: The easy availability of information & knowledge from various intelligent resources has rationally mandated issues, in case of medical negligence, malpractices, illegal procedures,& given power to redress the grievances of our citizens. Therefore, customer feedback reports helps gain goodwill & increase credentials of an organization.

The challenging role of hospital administrator deliberately attempts to make strategies,that principally devotes benefits of health care service to everyone.

Leadership & Management For The Health Care Industry

Ethical Issues in Health Care Management

One of each and every most significant ethical issue in health care management is the security of info about the patient, which is both private and personal. To begin with, patient medical records were widely available to any person and everybody; this nevertheless is no more the situation. Majority of hospitals these days maintain the patient records very secure and private today.

An ethical business organization of more and more health care executives, physicians and nursemaids is to protect themselves from the risk of getting communicable diseases coming from the patients, particularly when the patient records is not available in some manner. And even though, health care professionals do have the right to protect themselves from the several viruses that could be transferred by the patients to them, nevertheless, at the same time they must take care not in order to make the patients miserable by making these protective treatments very apparent.

Health Care

While marketing of hospitals, to make the people conscious of the hospital and its services is very essential to advertise any hospital. Attention requires to be taken that the hospital agencies and the vendors follow certain recommendations and moral principles concurrently. To manage the ethical consequences in health care marketing, the hospital agencies should ensure that the info they give through advertisement is completely precise and appropriate. Secondly, marketing in no way entails aggressively promoting and recommending such services to the patients whom they might not even need. So this should be ignored as well. Finally, a marketer or a chief should not forget his main motive, i.e. benefit of the patient. Profit making is important, but is not the be all and end all of health care marketing and management.

Ethical Issues in Health Care Management

Hima Mehta is a business entrepreneur who has great knowledge in software implementation methodology, healthcare consulting, project management and IT solutions.

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The New Approach to Healthcare Enterprise Information Management - EHR, EMR, EIM

Introduction -

The lack of a healthcare specific, compliant, cost-effective approach to Enterprise Information Management (aka EIM) is the #1 reason integration, data quality, reporting and performance management initiatives fail in healthcare organizations. How can you build a house without plumbing? Conversely, the organizations that successfully deploy the same initiatives point to full Healthcare centric EIM as the Top reason they were successful (February, 2009 - AHA). The cost of EIM can be staggering - preventing many healthcare organizations from leveraging enterprise information when strategically planning for the entire system. If this is prohibitive for large and medium organizations, how are smaller organizations going to be able to leverage technology that can access vital information inside of their own company if cost prevents consideration?

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The Basics -

What is Enterprise Information Management?

Enterprise Information Management means the organization has access to 100% of its data, the data can be exchanged between groups/applications/databases, information is verified and cleansed, and a master data management method is applied. Outliers to EIM are data warehouses, such as an EHR data warehouse, Business Intelligence and Performance Management. Here is a roadmap, in layman terminology, that healthcare organizations follow to determine their EIM requirements.

Fact #1: Every healthcare entity, agency, campus or non-profit knows what software it utilizes for its business operations. The applications may be in silos, not accessible by other groups or departments, sometimes within the team that is responsible for it. If information were needed from groups across the enterprise, it has to be requested, in business terminology, of the host group, who would then go to the source of information (the aforementioned software and/or database), retrieve what is needed and submit it to the requestor - hopefully, in a format the requestor can work with (i.e., excel for further analysis as opposed to a document or PDF).

Fact #2: Because business terminology can be different WITHIN an organization, there will be further "translating" required when incorporating information that is gathered from the different software packages. This can be a nightmare. The gathering of information, converting it into a different format, translating it into common business terminology and then preparing it for consumption is a lengthy, expensive process - which takes us to Fact #3.

Fact #3: Consumers of the gathered information (management, analysts, etc) have to change the type of information required - one-off report requests that are continuously revised so they can change their dimensional view (like rotating the rows of a Rubik's cube to only get one color grouped, then deciding instead of lining up red, they would really like green to be grouped first). In many cases, this will start the gathering process all over again because the original set of information is missing needed data. It also requires the attention of those that understand this information - typically a highly valued Subject Matter Expert from each silo - time-consuming and costly distractions that impact the requestor as well as the information owner's group.

Fact#4: While large organizations can cope with this costly method in order to gather enough information to make effective and strategic business decisions, the amount of time and money is a barrier for smaller or cash strapped institutions, freezing needed data in its silo.

Fact #5: If information were accessible (with security and access controls, preventing unauthorized and inappropriate access), time frames for analysis improve, results are timely, strategic planning is effective and costs in time and money are significantly reduced.

Integration (with cleansing the data, aka Data Quality) should not be a foreign concept to the mid and smaller organizations. Price has been the overriding factor that prevents these tiers from leveraging enterprise information. A "glass ceiling", solely based on being limited from technology because of price tag, bars the consideration of EIM. This is the fault of technology vendors. Business Intelligence, Performance Management and Data Integration providers have unknowingly created class warfare between the Large and SMB healthcare organizations. Data Integration is the biggest culprit in this situation. The cost of integration in the typical BI deployment is usually four times the cost of the BI portion. It is easy for the BI providers to tantalize their prospects with functionality and reasonable cost. But, when integration comes into play, reluctance on price introduces itself into the scenario. No action has become the norm at this point.

What are the Financial Implications for a Healthcare Organization by maintaining the status quo?

Fraud detection is the focal point for CMS in their EHR requirements of healthcare organizations, Let's take a deeper, more meaningful look at the impact of EHR. Integration, a prominent component of Enterprise Information Management in the New Approach, brings data from all silos of the organization, allowing a Data Quality component to verify and cleanse it. The next step would be to either send it back to its originating source in an accurate state and/or put it into a repository where it will be accessible to auditing (think CMS Sanctions Auditors), Business Intelligence solutions, and Electronic Health Records applications. With instantly accessible EHRs, hospitals and their outlying practices can verify patients with payors, retrieve medical histories for diagnosis and treatment decisions, and update/add patient related information. What impact to treatment does a review of a new patient's history have for both patient and practice? Here are some elements to consider:

1. Diagnosis and treatments that are based on previous patient dispositions - reducing recovery time, eliminating Medicare/Medicaid/Payor denials (based on their interpretation as to fault of the practitioner in original treatment or error incurring additional treatment).

2. Instant fraud detection of patients seeking treatment for the same malady across the practices within the organization. Prescription abuse and Medicare fraud saves money not only for the payors, but the healthcare organization as well.

3. The Association of Fraud Examiners states that 9% of a Hospital's revenue each year is actually lost to fraud.

One overlooked but common impact is in the cost of managing patient records. Thousands of file folders in storage with new instances being added each time a new patient enters into the system. Millions of pieces of paper capturing patient information, payer data, charts, billing statements, and various items such as photo copies of patient IDs, are all stored in those folders. The folders are then stored in vast filing cabinets - constantly being accessed by filing clerks, nurses, practitioners and assorted staff. Contents of the files being misplaced or filed incorrectly. Hundreds, if not thousands, of square feet being consumed for storage. The AHA projects that an enterprise leveraging Electronic Health Records will recover no less than 15,000 square feet of usable space. That space can be used for additional services, opening up new channels of revenue. The justification is easy: how much would it cost the hospital to build out 15,000 square feet for a new service? The average cost to build space utilized for Health Services is per square foot, or 5,000 total. An EIM solution through the New Approach would be less than 20% of that. Not only has the EIM solution reduced dollars lost to fraud, lowered the days for payor encounters to be paid, increased cash on hand, but it will also open up new services for the patient community and revenue back to the healthcare organization.

Electronic data is costly in its own way. Bad aka "Dirty" data has enormous impact. Data can be corrupted by error in data entry, systems maintenance, database platform changes or upgrades, feeds or exchanges of data in an incompatible format, changes in front end applications and fraud, such as identity theft. The impact of bad data has a cause and effect relationship that is pervasive in the financial landscape:

1. Bad data can result in payor denials. Mismatched member identification, missing DRG codes, empty fields where data is expected are examples of immediate denials of claims. The delay lowers the amount of Cash on Hand as well as extends the cycle of submitted claim to remittance by at least 30 days.

2. Bad data masks fraud. A reversal of digits in a social security number, a claim filed as one person for the treatment of another family member, medical histories that do not reflect all diagnosis and treatments because the patient could not be identified. Fraud has the greatest impact on cost of delivering healthcare in the United States. Ultimately, the health system has to absorb this cost - reducing profitability and limiting growth.

3. Bad data results in non-compliance. CMS has already begun the architecture and deployment of Sanctions Data Exchanges. These exchanges are a network of data repositories that are used to connect to health healthcare system, retrieve CMS related data, and store it for auditing. The retrieval will only be limited to the patient encounters that show a potential for denial or fraud, so the repository will not be a store of all Medicare and Medicaid patient encounters. But, the exchange has to be able to read the data in its provider data source in order for CMS to apply certain conditions against the information it is reading. What happens when the information is incomplete or wrong? The healthcare system is held accountable for the encounters it cannot read. That means automatic and unrecoverable denials of claims PRIOR to an audit, regardless of claim legitimacy.

The Price Fix by Big Box Healthcare Technology Firms

Are the major healthcare software and technology vendors (Big Box) price gouging? Probably not. They are a victim of their own solution strategies. Through acquired and some organic growth (McKesson, Eclipsys, Cerner, etc), they find their EIM solutions lose their agnostic approach. This is bad...very bad for health systems of all sizes. With very few exceptions, the vast majority of healthcare organizations DO NOT BUY all applications and modules from a single stack player. How could they? Healthcare systems grow similarly - some organic, some through acquisition. When a hospital organization finds over the course of time, an application that is reliable, such as a billing system, there is tremendous reluctance to remove a proven solution that everyone knows how to use. Because the major technology providers in the healthcare space act as a "One Stop Shop", they spend most of their time working on integrating in their own product suite with little to no regard to other applications. Subsequently, they find themselves trapped: they have to position all products/modules to maintain the accessibility and integrity of their data. This is problematic for the hospital that is trying to solve one problem but then must purchase additional solutions to apply to areas that are not broken, just to be able to integrate information. That is like going to the hardware store for a screwdriver and coming back with a 112 piece tool set with a rolling, 4 foot cart built for NASCAR. You will probably never use 90+% of those tools and will no longer be able to park in your own garage because the new tool box takes up too much space!

IT resources - including people - must be utilized. In today's economy, leveraging internal IT staff to administer a solution post-deployment is a given. If those IT resources do not feel comfortable in supporting the integration plan, then status quo will be justified. This is the "anti" approach to providing solutions in the healthcare industry: the sales leaders from Big Box technology firms want their sales people in front of the business side of the organization and to stop selling to IT. While this is a common sense approach, the economy in 2010 mandates that IT has to at least validate their ability to administer new technology solutions. The prospect of long-term professional consulting engagements to follow post installation has been shrinking at the same rate as healthcare organizations profit margins.

Empowering the healthcare organization to utilize its existing IT staff to administer and develop with the new products is not part of the business plan when Big Box players market to the industry. It is the exact opposite - recurring revenue from lengthy, and sometimes permanent, professional services consulting engagements is part of the overall target. The initial price quote for a Big Box solution is scary enough, but the fact remains that it is still not representative of what the ongoing cost to maintain through consulting arrangements. This is a variable cost, which is difficult to predict, and drives finance managers and executives crazy.

Solving the Dilemma - A Better Solution through a New Approach at a Fraction of the Cost

When Healthcare Business Experts combine talents with Technology Architects, EIM Solutions cost drop dramatically. This is the New Approach to Healthcare EIM, providing the way health organizations will be able to provide successful solutions at significantly reduced costs - opening the door for health systems of all sizes.

The EIM Firm (using the New Approach) versus Big Box Healthcare Technology Providers:

Smaller, more agile firms bring many benefits to Healthcare Organizations of any size. The benefits:

1. They are focused on specific verticals - just like the Big Box Health Technology providers. Subject Matter Experts (SME) in the smaller firms typically are industry veterans with years of experience and success in their approach who see their resume as a service offering better utilized when they are able to apply their methods for successful strategy planning as opposed to learning the methods of a Big Box player. Their income is better since their revenue is applied into a smaller operating cost, extending lower pricing for solutions that are MORE EFFECTIVE and offering stronger client/vendor relationships as the SME limits themselves to a certain number of clients.

2. Solutions built on proven approaches and strategies. Again, the firm's SMEs are able to define a methodology that can be re-used or re-configured in each client instance. This saves time and money for the client as delivery is accelerated and the cost of architecting is eliminated.

3. The firms themselves develop solutions and methodologies agnostically. Their understanding of the diversity of systems that exist in the technology of a healthcare organization allows them to not only develop adaptable solutions but also add a Business Process Management Plan (BPM). The BPM will define for the organization EXACTLY how information is received, processed, cleansed, stored, shared and accessed. It also will define an action plan for training IT for administration and support as well as end users at all levels on how they will leverage it going forward. BPM planning in a healthcare organization is a low six figure investment with an outside consulting group. The EIM firms will include it in the cost of the solution. Basically, it is the difference in being told what is wrong and here are the recommendations to fix it versus here is what is wrong and this is how it will be fixed with the new solution.

What is a typical EIM Firm solution?

1. Solution Assessment, noting the current systems, data sources and methods of sharing information as well as business processes, key personnel identification that are gate keepers if information, timeliness of providing information and overall effectiveness in leveraging enterprise information for strategic business planning. See figures 1 for an example of the information process flow visual component of an actual assessment.

2. EIM solution that contains an integration engine that accesses all data sources - reading and writing back to the database or application, providing data quality services and maintaining HIPAA as well as HL7 requirements. See Figure 2 for a diagram.

3. EHR Data Warehouse. A repository to build Electronic Health Records through the integrated data flow.

4. EHR Portal for patient entry (when additional information needs to be added) via a browser.

5. Business Intelligence Dashboards for metrics, AD Hoc analysis and Performance Management Scorecards on organizational goals and objectives.

6. Onsite implementation and integration of the EIM solution.

7. Onsite training during installation for IT and end users. Ongoing training provided via webinars, documentation and technical support staff.

8. Relationships maintained by the Subject Matter Experts for the life of the solution.

9. Stimulus "HITECH" Act pays ,000 per physician for an EHR solution implemented. The SME creates the grant request to be submitted so the healthcare organization receives Stimulus funds to pay for the total EIM solution

Key Element of the Solution

Onsite Delivery and full time support are key. But, the most important element is training. Why? As noted earlier, it is paramount that existing IT investments, namely personnel, be able to not only administer but also conduct development as the need arises. In Healthcare, CMS managed Medicare/Medicaid is already margins that are in the negative. As private payers follow suit, the number of uncollectable encounters will increase, impacting current profitability models and increasing future cost for treatment. By mitigating IT costs, the Total Cost of Ownership (TCO) qualifier should actually evolve to a Return on Investment (ROI). ROI is immediate for this solution approach, but it is sustained year over year by leveraging internal IT to support and develop. Now, the Healthcare Organization has eliminated costly professional service consulting engagements and re-investments into new feature licensing. This takes a variable cost every year and makes it a fixed, yet smaller amount - a sensible financial approach to accomplish a proven strategy.

Summary -

Why EIM? Whether it is Omnibus, "Obama"-care or an edit (not overhaul) of the Healthcare industry, Healthcare Organizations know these truths:

1. Electronic Health Records are necessary for the Fraud detection unit of CMS. Each organization must comply with accessibility, HIPAA and format. Fraud reduces overall revenues for a hospital by 9% (ACFE)

2. EHR/EHR have proven to be highly effective in eliminating internal waste, patient fraud, practice fraud and paper overhead. Vast amount of space within the facilities that had been used to store patient records in hard copy can now be utilized to provide additional services and open new revenue streams.

3. Bad or "dirty" data in electronic or hard copy format is costly. According to the AHA (September, 2008), the average cost of a patient record with good or accurate information is 3 annually. The annual cost of a patient record with bad information is ,054 annually. On average, 18% of patient information within a healthcare organization is bad.

4. Strategies developed by healthcare organizations without 100% of the information they own that is also timely and relevant are ineffective. Objectives cannot be defined, successful processes cannot be identified and improvement plans have little to no metrics in which to determine success.

5. Stimulus/HITECH Act pays ,000 per physician when EHR is part of the EIM solution. With the smaller EIM firms, Stimulus pays for the entire solution.

Why a New Approach EIM Firm?

1. Subject Matter Expertise from consultants that have proven methodologies.

2. Agility to adapt to the client need instead of the Big Box approach of the client adapting to their product limitations.

3. A Better Solution at a Fraction of the Cost. Their solutions are based on needs and not features.

4. Relationships with the vendor, resulting in improved services, maximum values from vendor solutions and a focused approach to the client needs and goals.

5. A Return on Investment as opposed to a Total Cost of Ownership. Clients need to see solutions that immediately pay for itself and then recover lost revenue while offering channels to new profit centers.

The New Approach to Healthcare Enterprise Information Management - EHR, EMR, EIM

Scott Schledwitz is a Subject Matter Expert in Healthcare Strategic Planning, Information Integration, Data Quality, and Balanced Scorecard Methodologies. He has developed solution products and practices for compliance measures, reporting and planning utilized by various agencies within the United States on the Federal and State levels. Within healthcare, he has consulted with hospital systems ranging from 1 to 100 campuses, providing them assessments and solutions to improve information efficiencies, extend information across the enterprise, develop organizational strategies that start at the top and cascade to the individual contributor. Through a Balance Scorecard Methodology, he has advised these organizations on how to identify their objectives, successful processes, define projects to overcome deficiencies and view the results in an easy to understand dashboard.

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