Guide for Developing an Information Technology Investment Road Map for Population Health Management

Chapter 2: Challenges Facing Leaders Accountable for PHM IT Investment

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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Challenges Facing Leaders Accountable for PHM IT Investment

Creating an IT investment strategy for any new business model can be a challenge. Beyond this expected challenge, leaders accountable for creating a rational, long-range PHM IT investment road map face additional issues that further complicate the decision-making process.

Ideally, IT strategy is thoughtfully crafted to support a business strategy designed to achieve an organization’s overall mission, vision, and business objectives. However, nationally, the health care industry is in the early stages of gaining clarity and cohesion in the various business models that will align payment with the delivery of consumer value. Leaders accountable for creating a rational PHM IT investment road map will be challenged to articulate a concrete long-term strategy given the dramatic business experimentation and learning that is currently under way.

Further, although IT governance has always required political prowess,28 the rapidly evolving dynamics of PHM can further complicate this process. The evolving Accountable Care Organization (ACO) environment is prompting new configurations of partner networks required to manage outcomes and cost over the full care cycle. Organizations may be thrust into situations that require common PHM capabilities with external partners that otherwise would be considered competitors in their fee-for-service business. As a result, we are seeing shifts in the identity of ‘‘stakeholder’’ and ‘‘decision maker’’ roles relating to PHM IT investment.

Beyond PHM strategy and IT governance, health care delivery organizations often lack key competencies for PHM IT discernment. Fluency with claims data manipulation, interpretation, and actuarial experience critical to competing in the ACO marketplace either do not traditionally reside within a health care delivery organization or may not be positioned to support business model innovation. For instance, health care organizations may have statistical competencies embedded in a research unit that could be applied to predictive modeling; however, that expertise often is not integrated with the strategic planning, care delivery, IT, and business intelligence units.

The alignment of competencies required for PHM is occurring in the wake of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which stimulated a dramatic shift in the percentage of health care delivery systems and independent physician groups migrating to EHR platforms.29–31 To date, the benefits garnered from EHR implementation have been slow to develop.32–34 It is clear, however, that successful EHR adoption serves as a foundation to enable PHM. The value of health IT investments will be maximized further when coupled with care redesign and incentive changes promoted by value-based payment models.32,35,36 Despite the foundational role of EHRs in PHM, Table 1 describes several unintended consequences of EHR implementation that can hamper an organization’s ability to develop their PHM IT capabilities.

Finally, the unprecedented investment in health care technology and analytic innovation that will ultimately result in higher consumer value currently presents organizations with several challenges. Existing technology vendors are consolidating their portfolios to focus on PHM-related solutions. Both established companies and a surge of new entrepreneurs are entering the field with the potential for higher value portfolio and niche products. However, a single, integrated mature solution that meets all PHM IT needs does not exist in today’s market. As a result, health care organizations must cobble together their PHM IT solutions.

Rapidly developing technology along with hyped-up sales and marketing promises make it difficult to develop clear build-versus-buy scenarios. Overlap in product functionality across vendor product suites can confuse buyers and/or lead to investment redundancies. These challenges are compounded by the financial pressures that make it difficult for organizations to devote the clinical, business, and technical resources needed to gather requirements, let alone understand the detailed capabilities and limitations of various IT alternatives.

In summary, leaders with PHM IT strategic and investment accountability already face challenges related to current or residual stress from EHR implementation and optimization, budget pressure, hiring and retaining skilled talent, and executing on other high-priority projects (eg, health information exchange, International Classification of Diseases, Tenth Revision, security). The national trend of value-based transformation has added new challenges to this already difficult situation. Recognizing that one or more of these challenges currently exist within an organization enables leaders to work together to mitigate negative ramifications.

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29.  Blumenthal D. Launching HITECH. NEJM. 2010;362:382– 385.

30.  Charles D, King J, Patel V, Furukawa MF. Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008–2012. ONC Data Brief, no 9. March 2013. Accessed July 7, 2014.

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35.  Audet AM, Squires D, Doty MM. Where are we on the diffusion curve? Trends and drivers of primary care physicians’ use of health information technology. Health Serv Res. 2014;49:347–360.

36.  Krist AH, Beasley JW, Crosson JC, et al. Electronic health record functionality needed to better support primary care. J Am Med Inform Assoc. Epub ahead of print, January 15, 2014. doi:10.1136/amiajnl-2013–002229.

J. Hunt, PharmD, MS