A Healthcare Information System

Mary Ann Dundon, MS

Selecting a healthcare information system is a difficult process, and doing it differently than it was done the last time can prove just as frustrating. A worthy question to pose to your senior management team and end users is, "How did you do it the last time?" Listen to their horror stories, and begin by writing down what you don't want to happen this time. Writing down what you do not want is an excellent way to begin identifying what you do want. The best place to begin this evaluation process is at the top. Take the opportunity to learn your organization's strategic plans. Where does your organization see itself in two to five years? Organizations will frequently assume an extraordinary amount of growth without considering technology solutions as part of the plan. Begin by reviewing the plans, discussing tactics, and identifying the budgeting process. Determine at the strategic level how information technology (IT) can help accomplish your strategic goals. Develop an IT mission and objectives for serving your customers (i.e., residents, family, and corporate stakeholders, etc.).

Budgets. Define your budgets as finitely as possible. Begin by planning on two percent of your company's annual revenues as a standard operating budget. Divide on-going operations, maintenance, hardware, software, training, networking, communications costs, and maintenance support. If your infrastructure and network need serious upgrading, identify capital costs for your upgrade. You may want to consider outsourcing aspects of your IT department, such as help desk functions, application hosting, and hardware/network management, allowing your organization to focus on your core competencies. Some organizations find it easier to outsource than try to maintain a talent pool because of frequent turnover. During the terror of Y2K, organizations began the process of inventorying what they had and where they were at risk. It might be a good idea to pull out those documents and update them to reflect where you are today. Based on strategic priorities, evaluate what areas need to be addressed first.

Prioritize. A Steering Committee will identify areas that put your organization at the greatest risk. They can help you answer questions such as: "Do you have specific compliance requirements that are not being met?" "Does it take 45 days to get information from your field organization and close month end?" Labor costs are your biggest budget item. Does your staff spend hours entering data into systems that don't talk to each other? Review your most recent surveys and highlight problem areas in care delivery. Do you have problems with documentation, care delivery, and being paid the appropriate reimbursement rate? Are your Medicaid AR days out of control? Are your private payers' receivables 90 days old? Once you identify the problems, your Steering Committee should define the type of software necessary to manage or resolve these issues. Upgrading information systems (IS) should not only make your users' jobs easier but also benefit them by showing a return. You may want systems to improve productivity, reduce time spent on paperwork, and help user workflow requirements.

Knowledge management. The regulatory situation today has become very complicated. Unless an organization has knowledge of your business operations, it will be extremely difficult to prepare for audits. The lack of knowledge may also hinder your ability to provide information necessary to deal with current and future regulatory requirements, especially in an environment where the expectations of each requirement are not made clear for several years (i.e., HIPAA). The more knowledge an organization has, the better off the organization will be in protecting itself against state surveyors. Aggregating information in real time helps your staff make proactive decisions and resolve problems before they become survey deficits. An effective Knowledge Management System will contain the following attributes: value in understanding how costs are incurred; characteristics associated with quality problems and risk incidents will be presented as alerts signaling the opportunity to prevent further problems; accurate historical information will provide the ability to negotiate based on cost and resource usage; the capability to initiate and create more efficient treatment plans based on valid data, and suggested alternatives will be based on cost and results. Users of these systems will find interaction with the programs easier and will be prompted by reminders, alerts, and notifications, while improved navigation techniques allow quick and easy access to information. Data is often available without the ability to analyze it. Software applications may not be integrated, making it virtually impossible to evaluate clinical and financial information for efficient operations. There is much data about quality, but there is an inability to analyze the information and show decline or improvements in quality long term. Systems today provide limited guidance for the correction of problems regarding quality or medical errors. Therefore, the need to have knowledge management applied to data allows trends to be seen and enterprise-wide intelligence to be used to get at the root of any problem.

Company. As important as the information system is to your users, the vendor who provides the software and technology platform are just as important--perhaps even more so. When evaluating the software and hardware needs and expectations of your organization and concurrently the vendor that will be selected to fulfill those needs, be sure to broach important issues like these: How well is the company positioned long term? How long has the company been supporting customers? What kinds of support services are available and how quickly are they provided? Are yearly enchantments to the product included as well as regulatory requirements? Picking a company with experienced employees and excellent customer service will go a long way with users in the end, even further than a special report or features that may still be under construction.

Technology. Evaluating the platform or technology recommendations of a vendor is extremely important when selecting a system that will grow with your organization and your newly developed strategic plan. Many companies are moving toward Windows or Web-based products. Understand the vendor's migration pathway, because you may not be buying what you think. Are you evaluating a new product developed post PPS environment, or is the vendor merely using techniques to make the screens look more modern? Make sure that the technology provides you the tools to mine the data you are collecting. Your new software should allow access to portal data for all who need it, whether the corporate office, the facility, or the regional manager on the road. Additionally, technology will assist in the training process for staff by providing self-paced, computer-based training (CBT) that can be completed, scored, and recorded automatically at the convenience of the staff.

RFP. Once the RFP process is completed and evaluated by your team, you should be narrowing the list of vendors to a maximum of two to three. The next steps involve setting up vendor presentations and demonstrations. The most effective demos are the ones that are defined by your staff. While demo scripts for each area are prudent, don't let your audience become divided by functional areas. For example, avoid mixing clinical and financial teams. One group will dominate the questions, while the other group will become frustrated. If questions regarding Medicare are the only ones answered, staff who manages resident care will leave without getting the information they need. Vendors should be polite and answer every question. Be sure to request an agenda and a summary of any outstanding questions for follow up after the meeting. This is a good time to reiterate vendor selection objectives with your Steering Committee. It is important to keep the Steering Committee focused on the larger picture, not just their special area of interest. Oftentimes, the less sophisticated the selection team is about software, the more impressed they will be with bells and whistles. More sophisticated users, particularly in very large organizations, learn the value of productivity and what a software solution can do to meet objectives versus being enamored by fancy features and pretty screens.

Site visits. Whether you take your users to visit sites where the software is installed or you assemble a core team to visit the vendor's corporate headquarters, make sure your team participates in the due diligence process. In addition to the list of customer references provided by the vendor, talk up your selection process among your peers. Find out if your vendor is involved in trade associations and how committed the vendor is to the senior care market. As we know, the healthcare industry is about relationships and networking. In addition to the traditional site visits and telephone referrals to the vendors' customer base, talk to others' business contacts that know the quality of the people who work for the vendor. Your relationship with the vendor will likely last three to five years. A vendor's best sales people are satisfied customers and business associates who will validate the vendor's reputation.

Post-selection. One last word of advice: Remember, your selection process does not end after the contract is signed. It's just the beginning. The implementation and training process is equally important to the successful acceptance of a new system by your staff. It's the buyer's responsibility to carry on the process even after the system selection. Make sure your business plan and the vendor's plan are in sync. If you have multiple IT projects going on simultaneously, be sure to communicate all projects to the vendor. This helps to avoid resource contention. Stick to your schedule and assure you stay within your allocated budget. This may not always be possible, so plan for the unexpected and work through it. Make sure your staff commits to the training process. Help alleviate staff concern and uncertainty by including tests and evaluations as part of the adult learning process. Avoid implementation during a potential survey process. This should be self explanatory. Ask the vendor to return in six months to do a post-live evaluation. This will help identify areas that need additional help. Lastly, and most importantly, keep track of measurable statistics and improved productivity (improved AR days, reduction in billing default rates, improved timeliness on completing MDSs, etc.). You will want to report your success to the senior management team!

Mary Ann Dundon, MS, is Director of Business Development for Shared Healthcare Systems (SHS) in Anacortes, Washington. Mary Ann has worked in the healthcare related software industry for over 20 years in a variety of positions from Development, Product Management, and Sales and Marketing. As a current member of the Assisted Living Federation of America, Mary Ann has served on the Board's Leadership Council alongside providers and association supporters. Mary Ann completed her undergraduate work at St. Joseph's University in Philadelphia, participated in MBA programs at Drexel University and the University of Pennsylvania, and graduated Summa Cum Laude with a Masters of Science degree in Applied Psychology from the University of Santa Monica. She has been the recipient of multiple innovative performance awards along with an Honorarium from the Cambridge Academy of English in the UK.