What Do Healthcare Organizations Want From A Consultant?

Health Management Technology questioned leading consultants in the healthcare industry about the reasons Chief Information Officers and Information Technology managers come to them for help.

The top three topics pressing healthcare information technology, according to consultants interviewed

Expertise, experience, and the available resources are what drive a client to a consultant. Healthcare delivery systems expect the consultants to guide them through the maze of technology, systems, regulations and the myriad of other changes arising daily in the industry.

"In most organizations, both Information System (IS) management and Chief Executive Officers (CEOs) are most cognizant of the need for change", says Donald Jacobs, President, Inteck, inc. "However," Jacobs continues, "neither seems to know how to introduce change without further disrupting their organization. Most have undergone downsizing and the staff of the healthcare organization is already concerned. Introducing additional change is often interpreted as a prelude to future layoffs. So, there is a credibility problem and a gap that must be understood and dealt with carefully."

Ralph Farngoli, Jr., President of Beacon Partners, Inc., says, "Higher levels (board of directors and senior management) have a global view of the issues. Department level buy-in pushes out the decision making. There is still some `silo effect', especially in Integrated Delivery Networks (IDNs)."

Agreeing with both Farngoli and Jacobs is Richard D. Helppie, President and Chief Executive Officer of Superior Consultant Holdings Corporation. He says CEOs absolutely are aware of the need for changes. Least aware, in his opinion, are the technically oriented people in various disciplines, including medical technology and IT personnel. Helppie also feels that change requires a cultural transformation from the healthcare industry's former model to today's imperatives for cost, quality, access and satisfaction.

Jacobs says his firm takes several actions to ensure their professional staff is up to date and ready to deal with fluctuations in the industry, including a healthcare information library using all available media. His firm's consultants maintain company-paid memberships in professional organizations such as Health Information and Management Systems Society (HIMSS), Healthcare Financial Management Association (HFMA), and American College of Healthcare Executives (ACHE): This enables them to network with others in healthcare to exchange concepts and activities both in healthcare and IT.

Custom studies, modeling, and determining the impact of government policies and regulations on revenue are some tools used by Abt Associates, Inc., according to David Kidder, President.

Other firms address process improvement with the organizations' present system and/or assist with selection of new systems to support changes. By applying technical knowledge, using the best tools for integration, and changing workflows of disparate systems, the experts support clients through the process.

INFORMATION SECURITY

A major issue is information security and appropriate access to that information. Frank Cavanaugh, Partner, PricewaterhouseCoopers, LLP, feels "the Achilles heel for this issue is the password." Over time, the number of different passwords one person may have in a large system becomes a problem of efficiency. A security protocol with clean lines of access that will make sure the person viewing the record is known and appropriate to that level of information is the goal. But, Chief Information Officers (CIOs) say those are the things we should have been doing all along.

This is all part of a bigger picture, according to Jacobs. He says, "When they (hospitals) address the computerization of medical records--and transmission is just one part--security comes into play. However, this is not a new subject. As hospitals allowed physicians to electronically view patient's results, they should have addressed the beginning of a security problem."

"Point of access with electronic records is global, so risk of unauthorized access is greater", says Cavanaugh. With old paper charts, there was a singular point of access. Staff would challenge anyone perceived as an intruder. Now, anyone with the right equipment can dial in from anywhere in the world, and the system may not know it has been violated. Nor would the intruder be challenged. What security measures are being utilized? Video cameras recording every transaction can be an effective tool. Voice print, fingerprint, and hand geometry are other measures but are not yet widely used.

The key high-risk areas in security and confidentiality reside with the healthcare organization's staff", says Dr. Richard C. Howe, Senior Vice President of Superior Consultant Corporation. "The biggest risk to overall security is appropriate training and compliance by internal staff within an organization. Most technical security systems currently in operation are very sophisticated and can adequately meet all federal and state requirements for electronic transmission of medical records. Therefore, even with new and proposed security regulations coming from Washington, most healthcare organizations will be able to comply from a technical point of view."

The security identifier for patients has not been defined and is a hot political issue within Congress and the public, Howe continues. The Computer Based Patient Record Institute (CPRI) developed a position paper that stated the Social Security Number (SSN) should be used for the universal patient identifier. However, the public and Congress feel that use of the SSN is not secure since it is too easy today to determine a person's social security number.

GOVERNMENT REGULATIONS-Same impact as Y2K?

Changes in existing government rules and regulations, plus new ones coming out of Washington almost daily, have a major impact on healthcare organizations' strategic planning, according to almost every consultant with whom we spoke.

But, Howe says, "In my opinion, political backlash regarding a universal patient identifier will stall, if not kill, implementation of the Health Insurance Portability and Accountability Act (HIPAA)."

Jane Metzger, Vice President, First Consulting Group, believes that those regulations may have the same, if not greater, impact as the Year 2000 issue. And it's not just IDNs and large institutions who are concerned about this impact. Kidder feels that the effect of government policies is also a concern of nursing homes and other private sector facilities. They're looking at changes in revenues and how to respond to new regulations.

Roger Nutter, President, The Nutter Group, says emphasis in recruiting for healthcare executive positions reflects the concern about meeting regulations. Legal affairs and risk management positions top the job list.

DATA INTEGRATION

"Healthcare organizations are increasingly concerned with integrating data from their various systems," says Jacobs. "We help them understand that it is not simply a system integration problem. There are usually "data handling" processes used by their staff throughout the organization that have to be modified. Since this causes changes in the way the staff must work, there is often concern by the staff. We help them to overcome this by providing education and training programs after we define new processes."

But system integration is not just buying an interface engine and connecting various systems. Organizations need the ability to obtain data for planning and evaluation on a timely basis. And this information must be accurate. Quality is an increasingly hot topic.

Jacobs's group works with senior management and IS directors to mutually develop a methodology to measure Information Technology (IT). This re-opens channels of communication between management and technology. They also help the organization develop or review its strategic IT plan which aligns organizational goals with those of IT.

Another universal issue is the cost of resources. Fargnoli believes larger institutions are prioritizing best use of dollars to reap substantial benefits to the delivery of patient care without interruption. The continued expense of supporting the increased amount of technology is a budget item that may be overlooked or unappreciated by senior levels of management.

Jacobs agrees that organizations that have made a tremendous investment in IT are questioning what they have gotten for it. Y2K caused a tremendous credibility gap between IT and senior management. Therefore, return on investment is increasing as a topic.

The hidden piece of the IT budget--increased demand for personal computers (PCs) at all levels--will be a major factor in the planning process. "In some larger institutions, the ratio of PCs to staff is above a 1-to-1 level as demand grows", says Cavanaugh. "Clinicians want access to information at the most convenient place. Home health staff wants greater portability. Other areas want wireless access. And the increase in the IT budget is not just for capital expenses but also for support services."

PricewaterhouseCoopers collected data during the last quarter of 1998 that indicated IT expenditures for staff and equipment are up an average of 3%. Some institutions have realized a 4% increase in IT budget. By supplementing an organization's staff on a long or short-term basis, consulting firms help them to solve their technical expertise deficiencies. One of the key positions that currently seems to be in scarce supply is a project manager to direct complex upgrades or new installations.

The process of recruiting and retaining IT executives and finding candidates for other upper level positions has taken on a new complexion, according to Nutter. For example, institutions are looking for Corporate Compliance officers who will lead the organization through the auditing and compliance jungle.

Corporate nurse executive's roles change with organizational changes. It is highly important that candidates possess unique skills in making clinical financial decisions and understanding integration issues as the movement toward electronic clinical systems gains momentum. Another position in demand for Nutter's group is the IS health information manager.

There also needs to be a big investment in replacing equipment to meet the requirements of newer systems. This trend is not expected to slow down, but will be a new component of IT budgeting.

"CIO's have expressed a lot of frustration over the pressure of fixing the Y2K issue, calling it a money sink," says Metzger. Across the country, those expenditures and the tightened finances have cut back on resources to implement systems that will benefit patient care. Considering return on investment, how do you value the Y2K fix?

STEPS

Metzger and her colleagues take steps to make sure their clients, as organizations, are compliant and that any new technology offers more nimble solutions to IT issues. She feels movement toward newer technology, like data warehouses, is slower than hoped for because of financial constraints. Also, CIO's and IT managers are taking longer to make decisions about systems changes and equipment purchases.

Jacobs feels there are few meaningful products available to achieve the ideal system. The most popular are interface engines, repositories, and data warehouses to address the integration issue and lack of timely information throughout the organization.

He also feels the industry is not being aggressive in their approach to the issues, but is focused on ensuring that products are Y2K compliant and that clients have the most current version.

Cavanaugh applies process improvement techniques with the organization's present system and/or assists with selection of new systems to support changes. Applying technical experience, the best tools for integration, and changing workflows of disparate systems are some of the many tools used to help effect a meaningful change.

LOOKING BEYOND Y2K

Organizations are looking at the advantage of new systems and strongly looking at new practice development -- "kicking the tires" on browsers, Internet, Intranet, and Electronic Medical Records (EMR). They are planning activity beyond Y2K, which has gotten most of the attention over the last year or two and has delayed other projects.

Some are looking at clinical systems, decision support and systems that manage clinical information. Others are looking at new technology such as pen based PCs, smart cards, and running pilot programs. But, few new systems have been implemented. Most institutions are trying to leverage existing technologies that are effective and are finding that legacy systems are not effective.

The second tier of consideration is a data repository, but organizations, especially those with large outpatients departments, recognize the need to capture and integrate meaningful data.

Howe says that one of the key roadblocks to implementation of a data warehouse is the lack of understanding of the required feeder systems that are needed to actually collect and pass the data to a data warehouse.

Howe's opinion is that there is going to be a huge post-Y2K tidal wave of unmet IT needs, and the IT organization is not going to be able to respond in a reasonable time frame. The upcoming IT demands coupled with a critical shortage of IT staff will spell disaster for many CIOs and their IT organizations. This is the post Y2K backlash.

WHICH SEGMENT OF THE HEALTHCARE INDUSTRY HAS MOST TO ACCOMPLISH?

Physician office practices lace uncertainty. There are so many of them it's difficult to determine what shape they're in and what steps need to be taken. Those that have IT and link to larger networks will need to determine if they'll be able to safely access information on the larger system or will it become unavailable because their office system is non-compliant. Larger practice groups and hospital owned subsidiaries are addressing this issue, but the smaller, independent groups may be left out in the cold.

In the view of Ralph Fargnoli, medical schools are content with books and blackboard and lag behind in the use of technology. The cultural diversity and control issue between chairs and administration feed this insulated viewpoint. Medical schools affiliated with large hospitals have more realization of changes. Although there is some sense of need on the board level, it is a slow process. Independent schools are in their own environment-not on board with the local community.

There will be continued change in all segments of the industry: providers, payers, and vendors. A hot topic is continuing interest in IT as an integral part of the future of healthcare. Right now, the spotlight is on IT because of Y2K. When that is over, how will IT be viewed?

Health Management Technology will continue their discussions with healthcare consultants on a regular basis and encourage readers to respond with topics of interest for future articles.

Healthcare Consulting/Health Management Technology Discussion Contributors

* Ralph Fargnoli, Jr., President, Beacon Partners, Inc.

* Frank Cavanaugh, Partner, PricewaterhouseCoopers LLC

* David Kidder, Managing Vice President, Abt Associates, Inc.

* Roger Nutter, President, The Nutter Group

* Jane Metzger, Vice President, First Consulting Group

* Donald Jacobs, President, Inteck, Inc.

* Richard D. Helppie, President and Chief Executive Officer, Superior Consultant Holding Corporation

* Dr. Richard C. Howe, Senior Vice President, Superior Consultant Holding Corporation