Aligning ALM Strategy with Market Disruptions

Aligning ALM Strategy with Market Disruptions

By Robert Basham, Director - Information Management, Scripps Health

Robert Basham, Director - Information Management, Scripps Health

Traditional Application Lifecycle Management (ALM) modeling in healthcare has undergone a total transformation in the last eight years. Historically many organizations adopted a best of breed approach that allowed each of the organizations verticals to select the best of breed vendor that would offer the best solution for the needs of that department. Laboratory departments would advocate and select the best lab system for their needs as did radiology, pharmacy, finance and all the other departments across the organization.

Healthcare information technology and the healthcare industry have been radically changed in last eight years. Many people across the Information Technology space would say that healthcare is the last to adapt to new technology and 20 years behind other industries. Healthcare has leapfrogged into the frontier. There are few industries that have been impacted by federal regulation, financial models, payer mixes, retailization of healthcare, consumerism and market competition. Each of these disruptive market forces would make any organization review their ALM strategy but their business model. Together these forces have prompted every healthcare organization across the country to reevaluate and pivot to quickly address the market changes.

"The consumerism of healthcare has moved from a concept to our patients demanding that they expect the conveniences they experience when shopping on Amazon"

This has required C-suite executives and organization boards to reevaluate their business model and ensure that they have a laser sharp strategic focus to understand how to navigate the shifting healthcare landscape not only in the short term but also the long term to quantify ROI and the financial viability of the organization. I believe that Scripps Health has worked hard to balance the needs of the San Diego region to provide world-class healthcare and a sound financial model that can quickly pivot in changing times.

In 2009, few people were aware that the American Recovery & Reinvestment Act (ARRA), which was meant to repair America’s highways would impact healthcare. The ARRA had $19 billion earmarked for the development of healthcare information infrastructure and assistance for healthcare providers’ adoption of healthcare information technology in the HITECH section of the act. The HITECH section pushed every healthcare organization in the country to review their Application Lifecycle Management (ALM) strategy for their Electronic Health Record (EHR). 2009 was the beginning of seismic changes that rocked the healthcare industry. Healthcare organizations quickly began to realize the HITECH program would not only be the carrot to change the ALM for their EHR and the stick for future Health and Human Services (HHS) reimbursement. The HITECH incentive program drove providers and hospitals to adopt and demonstrate that they “meaningfully use” certified EHR technology. In parallel HITECH drove the health information technology vendors to adopt to meet established standards and to be Certification Commission for Healthcare Information Technology (CCHIT) certified.

In 2010, the Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) and nicknamed Obamacare, moved the entire U.S. healthcare industry into new modes of reimbursement and care delivery.

As organizations and vendors jumped into the process of validating that their systems were certified, they soon began the full-court press to attest to meet the new requirements of Stage 1 and Stage 2 criteria for Meaningful Use and to demonstrate that eligible hospitals and eligible providers were meeting the metrics. Most organizations began to realize how much manual intervention was required to extract, analyze and report out on the data out of their best of breed disparate systems in order to report back to the government that they were meeting the standards.

Concurrent to the federal and regulatory changes that impacted healthcare, the consumerism of healthcare has moved from a concept to our patients demanding that they expect the conveniences they experience when shopping on Amazon or booking an airline seat to be applied to their healthcare experience. We have moved beyond a point where healthcare organizations always felt that a patient’s healthcare information was for the clinical care team to use exclusively. The consumer has prompted a new paradigm–the patient owns their data and healthcare organizations need to provide that information to them in real-time while allowing bi-directional communication with the care team.

These federal mandates and market forces have tremendously impacted the healthcare landscape. Some hospitals have closed, many have merged and other hospitals became ambulatory care centers. Private physician practices have also been hit with reduced reimbursement and the rise of disruptive models of care- the retailization of healthcare—where consumers are now getting care at retail locations or through virtual office visits.

Consumerism has come to the forefront where patients are demanding patient-centric technology that allows them to engage in their care with real time results, access health information, bi-directional communication and the ability to schedule appointments directly at the patient’s convenience and with their device preference. Organizations must meet these needs by offering e-visits, check-in kiosks, mobile apps, patient portals, and applications for the patient to communicate while in a hospital or and back at home.

Scripps Health, like all healthcare organizations, is navigating all of these forces and working hard to balance the needs of the San Diego region to provide world-class healthcare and a sound financial model that can quickly pivot in changing times. Three years ago Scripps realized that its application portfolio was a federated Electronic Medical Record (EMR) model consisting of more than 80 disparate applications that served various stakeholders needs was not going to meet the needs of the organization moving forward. Scripps moved forward and selected an integrated platform that stretches across our inpatient and ambulatory settings. This seamless platform now allows our physicians, nurses, technicians and staff to work more efficiently and collaboratively to meet the needs of our patients. The Epic system will also replace the different programs we currently use for patient billing and paying our bills with one streamlined revenue cycle system. In short, the transition to Epic will help us continually improve the already excellent care we provide, now and well into the future.

After nearly three years of planning, preparation and training, we began our transition to the Epic electronic health record and revenue cycle system on April 1. During this Wave 1 implementation, the Epic platform will be put into place at Scripps Green Hospital, Scripps Clinic, Scripps Coastal Medical Center, Scripps Proton Therapy Center and Mercy Clinic, as well as in our revenue cycle and Scripps Health Plan departments.

It is impossible for me to accurately count the number of Scripps staff and physicians who have been involved in some way in this project. From assessments to workflows to product upgrades, testing, training, administration, communication–the list goes on and on. This is one of the most complex projects ever undertaken at Scripps. It is inspiring to see what can be accomplished when people from many disciplines work together toward a challenging but common goal.

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