Looking at Outpatient IT Optimization in an Integrated Environment: Three Consultants’ Perspectives on the Challenges

Aug. 18, 2019
Senior consultants at the Versatile Health consulting firm share their perspectives on the challenges involved in optimizing IT operations in the ambulatory space, in the context of integrated health system management

An ongoing disconnect is causing problems for the administrators managing outpatient organizations, including medical clinics—a disconnect between the kinds of resources available on the inpatient side of healthcare, and on the outpatient side. In many environments, hospitals are utilizing in-house information technology staff to manage IT and EHR (electronic health record) operations. Yet at the same time, the physician practices affiliated with those hospital-based organizations are not benefitting from a trickle-down effect; instead, they are often left to their own devices to determine how to solve technological issues.

As integrated health systems shift into value-based contracting, it will be especially important to optimize the ambulatory environment: an ambulatory IT continuum means a more compliant and secure EHR and IT environment—one that should qualify for government incentives, safeguard PHI (protected health information), and protect the practice from potentially catastrophic breaches. This also keeps pace with healthcare consumers’ demand for consumer-friendly wellness.

Adding to this is the complexity inherent in healthcare and EHRs: this involves patient engagement applications, telemedicine, care management, etc. These systems require a sophisticated infrastructure that ensures availability, meets performance and access requirements for a diverse healthcare organization, and maintains the confidentiality and integrity of all its associated data. It also must be seamlessly integrated into other systems at an affordable cost.

With regard to all these challenges, three senior executives at the Marlboro, Massachusetts-based consulting firm Versatile Health, spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland. Todd Whitney, the firm’s vice president of enterprise architecture, Andy Ruth, its vice president for strategy development, and Jason Record, its vice president for solution architecture, recently discussed these issues with Hagland. Below are excerpts from that interview.

Your consulting firm covers a range of areas, correct?

Andy Ruth: That’s correct. We were formerly known as Concordant Health. We had started about 17 years ago in the HC space, and through various acquisitions, the same line of business and core customer base has stuck around. Basically, we connect, support, and optimize technology at the ambulatory practice level. Technology enablement, provider assistance, and practice productivity.

What are the core challenges your customers are facing right now in the evolving environment?

Todd Whitney: Starting from the business side, costs are probably their biggest challenge, in terms of managing service delivery costs. That’s probably their number-one challenge. So our approach is to leverage technology to drive efficiency, and control their overall cost.

Jason Record: Our niche is that we’ve got a tremendous amount of experience with these independent physician associations and their IT support. We got into that when the government incentives to implement EHRs emerged, and there was a lot of money to shift to EHRs. So that was step one. And then, so, they’re recording this information electronically, but that information isn’t actually helping them practice medicine, it’s actually a detriment. So our organization helps to smooth that out for them, and the different IT needs in their ecosystem. It’s not just the technology at the practice level, but at the back end, and making sure the system is working as efficiently at both ends. And it has to be operated at the cost level they can afford. And more and more large practices are buying up these practices and assimilating their systems. So we want to help them focus on practice medicine.

Whitney: That, and improving efficiency.

Are you seeing the tremendous amount of business activity taking place right now, helping, or hurting, or both?

Record: It’s both. And we work with the organizations as the business processes are evolving forward. We’re helping the physician practices, but we’re also helping the health systems as they’re onboarding the physicians. Sometimes, there are also divestitures of practices.

Whitney: This is where our value comes in. Ultimately, for these end-user providers, they’re getting assimilated into these larger provider organizations, which, done correctly, gives them greater options around their ultimate goal of providing high-quality care. So now they start bringing in elements like greater intelligence around data analytics. And you’re having folks like Relay Health and other entities helping them to look at efficiency; and they’re often choosing from multiple EMRs, in terms of what best suits their organization. If you’re a provider providing specialty care, one EMR might be better than that. And the health systems already have those options. So they’ll have the Cerners, the GEs, the Epics, the eClinicalWorks. And depending on which services the providers are providing, there are different benefits.

Record: The biggest areas we’re focusing on right now is the support of the ambulatory providers. We have a managed services team that supports the practices themselves; we have a single point of contact helpdesk, where they can call in or submit an electronic ticket via email, to get help, so they don’t have to figure out whether their problem is with the EHR or their individual. And if an issue needs to be escalated to the EHR vendor, we will take on those tickets, and see those through to resolution. We try to resolve as much as we can remotely, but we also have a team of field service reps who go onsite to resolve issues. And we have experts on that team who know the back ends of EHRs, so they make sure all those things are working as well as possible. So really, that’s the scope of our biggest focus.

Whitney: To build on what Jay’s saying, we build and leverage technology to better manage the application and the security of the data, in a really efficient manner. One of the biggest struggles is workflow efficiency, and having the understanding and the visibility of knowing how the application performs relative to the level it needs to perform at.

Record: And our experience has led us to carefully pick technologies. This isn’t one large enterprise, it’s a grouping of small businesses, and you need to figure out what works best in the environment.

What are the biggest trends you’re seeing in that environment right now?

Whitney: That distributed environment is evolving forward even faster, where there are more and more folks integrating into the EMR systems. And the biggest piece of that distributed environment is that, as a healthcare organization, you want to maintain security across all those entities. So that’s one of the challenges. But in our world, what we bring is the ability to ensure that regardless of whether it’s on-prem or a cloud solution, that the technologies and policies are in place across the ecosystem.

Record: The hunger and the need for data in healthcare is only increasing now. And the analytics and business intelligence that you get out is only as good as the data that you put in. So we feel our work is really foundational to the whole solution, because we’re enabling the efficient practice of medicine through the use of technology. If the provider is so frustrated with the technology that they’re throwing their tablet into the dumpster—something we’ve seen—then they’re not going to get the use out of it.

So it’s the optimization that matters, on behalf of the actual clinicians?

Record: Yes, and the thing is that these practices are pretty frugal, and they don’t want to spend money, especially if they don’t know why they need to invest. So focusing on the life cycle of products is very important. We’re really focused on their needs.

What’s going to happen in the next five years?

Record: In my mind, the real challenge is how these practices keep up with the pace of evolving medicine and technology, and making sure that they have the appropriate partners to do so. If these practices want to remain independent and practice medicine, they’ll need to evolve forward well.

What should CIOs, CMIOs, and other senior healthcare IT leaders in patient care organizations, be doing right now, with regard to all of this?

Whitney: One of the biggest challenges or opportunities for improvement, is going to be around pure interfacing—personal recognition. Most of the data is still being input by keyboard. The ability to use voice commands along with facial recognition for authentication, all of those technology improvements will lead to greater efficiency. As that technology improves, the efficiency will get better.

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