Anticlue

Opening Day at HIMSS

As a first timer here at HIMSS, I’ve realized you just aren’t going to see everything and do everything. You have to plan carefully and hit what you want to see. The opening was inspiring, but the theme was the same we need to improve and look at the larger picture of information exchange. We are truly and industry where knowledge is power, but there is a timeliness to the knowledge. It needs to be at the time of care.

After the keynotes, I went to the educational session, achieving cost-effective Disease Management. It regarded an early adopter implementation of Soarian Cardiology for disease management of stage 3 and stage 4 congestive heart failure, CHF, patients.

90 million Americans have chronic illness, 70% of the deaths are due to chronic disease – 287,000 relate to CHF. The other component is the cost of care according to the statistics provided 75% of the nations 1.7 trillion expense is in the care of chronic illness.

The other startling factor was the readmission rates of CHF patients at the represented institution the readmission rate was 47%, and CHF took a large portion of the total cost.

Obviously, a problem existed. The goal of disease management is to support the provider/patient relationship and plan of care, prevent exacerbations by using practice guidelines, and provide the tools needed to monitor patient outcomes. Therefore it seemed like a good fit to enable the tracking of the patient, reducing hospitalization/ed visits, and improving communication among providers.

The first step was to obtain physician acceptance in utilizing the system. It really isn’t worth a lot if the doc’s don’t use it. So in order to obtain buy-in, the concept was present to Administration, IS Committee, and Physicians. The planning was a team effort between the physicians, IS, and the vendor, and it was proposed to beta the implementation at a small, easilty monitored and managed beta site.

The Implementation needed a detailed workflow mapping from two points of view, the patients and the employees. For the patients, the look was to see with whom the patients interact and where they go for other departments. From an employee perspective It was to discover if there was time to have RN’s dedicated to enroll and manage patients in the system.

A CHF Management program was established. Within the program there is patient participation in their case, as they call in vital signs, sometimes using a device to interface this information. Phone calls are established asking standardized questions. These questions are normally asked by an RN. Also regularly scheduled office visits are necessary. A cool idea was to graphically show a picture of the improved health of the patient to the patients of the changes in diet, weight, and blood pressure, it really encouraged compliance.

In order to succeed the plan was to take an aggressive enrollment of patients, so every patient was informed about the program as a part of the office visit. Also all local family practicioners were informed.

One of the issue of implementation was that the southern dialect had an impact on the telephony’s system ability to interpret responses. The vendor took a surprising tack and worked specifically with the patients that had a strong accent affecting the equipment. This was nice to see.

In order to maintain improved compliance, if the patients missed a check point, a phone call would be given to ensure they were in good shape. Although this type of followup was viewed as big brother watching, it did improve patient compliance and active participation.

The ROI for this project was seen in the availability of hospital beds for capacity planning due to the decreased readmissions. Downstream revenue as preventive care measures were provided.

An audience member had a really good point to have the disease management system deployed across all comorbidites would see a significant improvement.

All in all it was a good session, even if the statistics provided were just of this institution.

The next session was on creating long term, successful technology partnerships. The panel comprised the industry heavy-weights, CIOs from Memorial Sloan-Kettering Cancer Center, Froedtert & Community Health, John Hopkins University and Health System, and University of Kentucky Chandler Medical Center. Quite a good mix of leaders!

The overwhelming sentiment of the session was that execution is key, and good contracts lead to good partnerships which leads to good execution.

Recommended honesty in expectations in the negotiations, one needs to be honest about the requirements and culture of our institution, and the vendor needs to be honest about the products features/functions. There needs to be a sense of commitment to the partnership and to the success of the project. One really good idea was to include the project plan in the contract.

The other good point was to go in depth on strategic alliances and use your blue-print contract and spend the time that is needed. However for smaller non-strategic alliances go with the boiler-plate contract.

The panel covered what the qualities of a good partnership are, an eloquent statement truly capture the chasm between the two parties, one is a publicly traded for profit company, the other is a non-profit steward of restricted resources. In order for them to meet on mutual ground there needs to be a spirit of collaboration, continuous communication, candid concise clear expectations, and a commitment to success of both parties. Items to look for in an alliance are a cultural alignment, access to senior management, and access to technical developers.

Next the panel covered the myths of contracting.

The first myth is that one must use the vendors contracts, again this is a false hood. The recommended approach is to use a master services agreement for large contracts and a minor agreement for smaller contracts.

The next myth was that famous line about not agreeing to risk based contracts because of ‘Revenue Recognition’ or ‘Our Accountants won’t allow it’. A nice line that overcomes this negotiation tact is that vendors should not inflict their internal constraints on us.

This was followed by the myth of needing to have a signed contract before any project planning or assigned personnel are dedicated. The approach to mitigate this negotiation tatic was to have the selection committee narrow the decision down to two vendors, then as a part of the negotiation with both vendors have language which covers the rights of refusal for expertise in our sole judgment, and take the time required to get a complete plan in the contract.

Points arose around the fact that is impossible to anticipate everything, so to include contingencies is necessary but so are adjudication steps. Remember contracts are also guidelines to relationship management. Project planning is where the true meeting of the minds occurs. An aside is that the value of project plans can not be understated, more comprehensive skills are needs, as project management is a science that blends with the art of project management.

Another myth covered was that vendors will not do risk/reward or fixed fee contracts. A fixed fee contract is that if either the vendor or the institution is unable to deliver a product within a time, penalties are incurred. Such a contract requires careful attention to ensure terms and conditions are being adhered to and nurtured.

Items that must be kept in the communications is what is wanted and what is expected. Targets must be achievable within a fixed fee, risk/reward contract. Also system acceptance is way after live, Sloan gave an example of one system acceptance was a % improvement in AR Days until final billed, and in order to achieve that the vendor comes back on site for best practice reviews and visits.

A fully endorsed tactic was to engage in dual track negotiations all the way through to signed agreement, negotiating terms and price simultaneously. This manner is that both of the recommended vendors from the committee are chosen and aggressively negotiated with, including project plans.

Finally a favorite situation of mine popped up, when the business unit tells you they have selected vendor X and they have already informed the other vendors they are out of the running. In order to overcome this risk, a re-education of the departments, perhaps even detailing the mistakes made in destroying the competitive environment. Another idea was to explain the amount of the commission in tangible dollars, ie the commission for this sale is the price of a Ferrari or reviewing a Master Technology Agreement with all the department heads at once, it is good practice to include the office of general council and supply chain purchasing. Also enlightening the business unit about the hazards of losing negotiating leverage, a conversation with both vendors, explaining as IT we have business obligations but we make the choice and we need to do appropriate due diligence. Due to the enormous risk, it is a best practice to have any technology contract funneled through IS.

The final point on a risk/reward contract was that it is conducive to something and yet not to others, if you are unclear as to where you want to be as an institution, this is not a good contract mechanism.

For me, it was very informative the different tactics needed to take. I’ll continue with a further review a little later today, I’m off to the convention floor.