Reporter’s Notebook


It was three conferences in two cities over eight days, with three vastly different experiences and countless strategies, all for the same ultimate goal: finding ways of improving the ailing U.S. health system.

A quirk in scheduling allowed me to cover the annual conference of America’s Health Insurance Plans (AHIP) in Las Vegas and then head to San Diego for both the midyear HIMSS Summit and the Annual National Institute of the Healthcare Financial Management Association (HFMA), all on a single trip.

Fortunately for a health-IT reporter, transformation of healthcare via technology was high on the agenda at all three meetings.

Obviously, health-IT was center stage for members of HIMSS, the Healthcare Information and Management Systems Society. Rather than preaching to the choir about the virtues of electronic health records, session presenters focused on implementation strategies.

Kate Reynolds, senior director of medical informatics at Evanston Northwestern Healthcare (ENH), explained how the three-hospital system in Chicago’s northern suburbs made workflow redesign the most important element of its $30 million, across-the-board conversion to EHRs.

“You can’t identify the participants until you identify the workflows,” Reynolds said. ENH identified 112 high-level workflows for its project, and found processes that would not have been so obvious to IT planners had they followed departmental structures. ENH has departments within departments which have no line in the budget, such as the one-person wound-care unit.

One of the most challenging minefields in IT strategy development is dealing with executive leadership, according to David Graser, senior vice president and chief information officer of West Jefferson Medical Center (Marrero, La.) “There’s nothing more jealously guarded than somebody else’s turf,” he said.

The clinical staff presents its own set of challenges for senior management and IT personnel alike. “There’s nothing that will get us bit faster than telling people how to deliver clinical care,” Graser said.

To get around these potential hazards, Graser said to frame the dialog in terms of sharing responsibility for achieving a common goal rather than “taking somebody’s candy.” He confers regularly with other “chief” officers and often attends meetings of the medical staff. “In general, they respect people who are really trying to help them,” Graser said of physicians.

Curiously, the only vendor booths to be found in San Diego that week were at the HFMA gathering just down the street from the HIMSS Summit. Plenty had all manners of revenue-cycle management tools on display.

QuadraMed, for example, was showing the latest version of its software that helps hospitals with “denial management.” For years, providers have been able to go online to seek treatment authorization from payers and check on a patient’s ability to pay, but often that happened during the post-service billing process. Now, hospitals can do all of that up front to collect accurate co-payments on the spot instead of having to chase down receivables later.

A few days earlier at AHIP, many of the same vendors were showing their wares to the payer community. Microsoft is trying to help health plans beef up their customer service as consumer-driven coverage gains.

One company, Connextions Health, which provides outsourcing to payers, is trying to help its clients fend off the growing competition in the individual-coverage market that retail clinics and Revolution Health might pose.

“Revolution Health is really trying to be the trusted source at the individual consumer level,” said Connextions Health executive vice president Robert Tazioli. “This could severely marginalize back-end providers of insurance.”

That certainly is an issue that has escaped the average health-IT professional. But, according to Tazioli, “It’s top of mind within the c-suite in the managed care industry.”

Live and learn.

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