Chapter 5: Developing and Gaining Support for a PHM IT Investment Road Map - Step 4 & 5
Excerpted from original article published by Population Health Management, copyright Mary Ann Liebert, Inc.
Guide for Developing an Information Technology Investment Road Map for Population Health Management
Jacquelyn Hunt, PharmD, MS, Richard Gibson, MD, PhD, John Whittington, MD, Kitty Powell, Brad Wozney, MD, Susan Knudson, MA
Many health systems recovering from a massive investment in electronic health records are now faced with the prospect of maturing into accountable care organizations. This maturation includes the need to cooperate with new partners, involve substantially new data sources, require investment in additional information technology (IT) solutions, and become proficient in managing care from a new perspective. This seven-part series, with excerpts drawn from the article originally composed by leading authorities on population health management and enabling IT, will help organizations chart their position on the population health readiness spectrum and enhance their chances for a successful transition from volume-based to value-based care.
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Developing and Gaining Supportfor a PHM IT Investment Road Map
Step 4. Conduct a gap analysis between PHM business requirements and current IT capabilities
Many organizations moving toward accountable PHM are, understandably, in the fledgling stage. As a result, their initial list of ‘‘must have’’ PHM business requirements is at high risk of changing. Creatively leveraging existing technology and options for rapid learning can advance an organization on its journey quickly and at a low cost of entrance.
Table 4 provides a template for considering how existing systems may provide the capabilities needed to fulfill an organization’s PHM business requirements. The intent of the template is to quantify the ability of various IT alternatives to deliver on an organization’s PHM JTBD. For instance, as a manual workaround, capable analysts can work in a spreadsheet to accomplish a business need. Once the volume of data increases, the need to scale exists, and funding is available, the organization can upgrade to a more sophisticated, automated, and integrated solution.
We observe organizations struggle to gain clarity on the potential of their existing EHR to deliver on their PHM business requirements. Certainly, there is benefit to leveraging existing technology and minimizing the complexity of the organization’s IT architecture. Additionally, the HITECH Meaningful Use EHR certification program44 impels EHR vendors to provide foundational components for at least basic PHM. The allure of relying on the existing IT system must be considered in balance with potential limitations. Considerations include the breadth of EHR capabilities relative to the PHM business requirements for each stakeholder, speed to market of new functionality, ability to leverage alternative data sources and integrate with other solutions, and the organization’s backlog of existing EHR projects and resource constraints.
Assessing current state IT capabilities also requires a meticulous understanding of the advantages and disadvantages of available data sources in relation to the needs of specific user roles. For instance, claims information generated from billing data can provide insights into population-level cost of care opportunities, as well as specific patient-level care gaps opportunities. Accordingly, a business intelligence solution incorporating claims data may provide health care executives with sufficiently accurate information to identify high-level cost savings and determine population-based program development opportunities. However, the imprecision and time lag of claims data often render this an unacceptable data source to support automated messaging from a physician to his or her patients regarding recommended care changes. For instance, an automated message prompting a breast cancer survivor to schedule a mammogram following breast removal surgery is unacceptable from the perspectives of physicians and patients alike. Any solution that attempts automated patient outreach must include a mechanism to capture patient-specific information to enable mass customization of patient activation messaging while maintaining and even promoting the intimacy of the patient-provider relationship.
At the completion of this step, organizations should have a solid understanding of how their existing technology investments might be leveraged to support the organization’s PHM strategy. It is common to find that many stakeholder JTBD can be supported using existing platforms. Doing so enables the organization to learn quickly and refine its specific business requirements. However, additional investment in a new PHM solution ultimately may be required to scale a program across the organization, drive standardization and efficiency into the process, and/or integrate functions with other stakeholders.
Step 5. Create a PHM IT investment road map, budget, and time line
Desired business requirements not met in the current state should be identified and prioritized for investment. When considering budget allocation, IT investments should be balanced and, ideally, synchronized with investments in care model redesign. For example, a sizable investment in a sophisticated data warehouse with longer term deliverables of integrating data from multiple sources should be balanced with short-term registry investment to immediately support care teams’ improvement capabilities. Similarly, purchasing a high-end case management platform could be premature in the event that care coordinators have not been hired, trained, and incorporated successfully into care teams.
Business leaders should consider developing an estimate of revenue improvements or expense reductions (either in utilization or cost of delivery) that PHM IT implementation, along with care model redesign, is expected to yield. Budget adjustments or capital requests may be warranted or justified based on this potential return on investment. Lastly, when investment in an external solution is warranted, it is wise to keep in mind that the PHM IT market is immature and vendor consolidation is likely. These points argue for shorter term purchasing commitments with reevaluation in several years.
44. HealthIT.gov. About the ONC HIT Certification Program. http://www.healthit.gov/policy-researchers-implementers/about-onc-hit-certification-program#Certification-Program-Overview. Accessed July 7, 2014.