Physicians, other providers, management, and support staff—people—represent 70 to 80 percent of the cost structure of most medical practices. Information about patients, guarantors, payer plans, eligibility, clinical services, insurance claims, patient-due balances, referrals, cash collections, payroll costs, and much, much more facilitates and is evidence of their work.
Technology has provided us with the ability to gather, store, manipulate, use and communicate information more effectively and efficiently than ever before. However, the use of technology is no guarantee that information will flow effectively or efficiently. In fact, poorly designed software, inadequately configured and improperly applied to broken processes, produces a bigger mess quicker than no technology at all, reducing both the efficiency and the effectiveness of our most costly human resources and potentially reducing clinical and service outcomes.
New technology can enhance our ability to treat disease, automate processes to eliminate variability, reduce cost, dramatically improve productivity, identify trends and potential problems, and otherwise benefit humankind. In each of these situations, technology is the tool, not the master.
The same principle applies to information technology. IT is that set of tools that facilitates the flow of information so that individuals and organizations can achieve their potential. To be effective, technology must facilitate the flow of information in support of operational processes that allow people to perform their work.
Physicians and support staff need to drive the selection and use of technology tools in medical-practice networks. These decisions are operational in nature, to be made by those providing the medical services rather than be driven by a hospital IT department agenda. While an IT department must be involved in technology decisions, its members should serve as technology experts and facilitators, not as the operational decision-makers.
Applied Information Technology
Like any new technology, IT should be acquired and implemented to achieve specific objectives. Ideally, objectives related to needs and requirements are understood and documented before beginning the search for technology solutions. As with all key decisions made in a medical-practice network, the application of technology should be measured against four critical success filters. Does the proposed information technology solution:
- maintain or enhance clinical quality as defined by the practice physicians?
- maintain or enhance service quality as defined by the patients and their referring physicians?
- maintain or enhance physician (and staff) productivity?
- maintain or enhance operational or financial viability?
The application of information technology presents an opportunity to review operational objectives, performance expectations, existing systems, and current processes with an eye toward targeted performance improvement. Properly designed IT applications facilitate best practices found in similar settings rather than simply automating existing processes.
Proper selection of IT application software is based on the needs and objectives of the particular medical-practice network. Software selection should not be based on the hospital platform just because the current hospital vendor has a medical-practice application as a sideline. Any application software decision should be based on an independent evaluation that includes functional requirements and needs, considers multiple vendors (with no preselection determined by hospital incumbent software), and is based on a vendor's or solution's respective abilities to meet the physician network's objectives.
Within regulatory constraints, it is usually a business imperative that data captured in one system can interface with other software systems without manual intervention. In the past, many software decisions were based on the assumption that using two software packages offered by the same vendor would ensure a flawless data flow. In fact, some purchasers have been sorely disappointed when data flow was far from perfect. Because many software vendors purchase applications from other companies, one cannot assume that two products from the same vendor will use data in a seamless fashion.
On the other hand, in today's world of sophisticated interfaces, the ability of one application to "talk to" another virtually eliminates the incompatibility argument. With proper attention to mapping data and applying data validation/edit rules, interoperability usually can be achieved and is no longer a limiting factor in software decisions.
Making the best decision for each business unit (e.g., hospital, medical practices) based on the rules for success in that unit is an increasingly compelling objective.
Rather than selecting a single solution from a single vendor that may have a great practice management system and a fair electronic medical record (or vice versa), a physician network may be better served by selecting the best of breed for each application and dealing with the interfacing issues.
Marc Halley, MBA, is president and chief executive officer of The Halley Consulting Group, LLC, Westerville, Ohio. He is the author of Owning Medical Practices: Best Practices for Sustainable Results, a new book from AHA Press.