Intro -

The lack of a healthcare specific, compliant, cost-effective approach to Enterprise Information Management (aka EIM) is the #1 purpose integration, data quality, reporting and performance management initiatives fail in healthcare organizations. How can you build a house without domestic plumbing? Conversely, the organizations that successfully deploy the same initiatives point to full Healthcare centric EIM as the Top explanation they were successful (February, 2009 - AHA). The cost of EIM can be staggering - preventing many healthcare organizations through leveraging enterprise information when strategically planning for the entire system. If this is prohibitive for large and medium organizations, exactly how are smaller organizations going to be able to leverage technology that can access vital information inside of their own company if cost stops consideration?

The Basics -

What is Enterprise Information Management?

Enterprise Information Management means the organization has access to 100% associated with its data, the data can be exchanged between groups/applications/databases, information is verified and cleansed, and a master data administration method is applied. Outliers to EIM are data warehouses, such as an EHR data warehouse, Business Intelligence and gratification Management. Here is a roadmap, in layman terminology, that healthcare organizations follow to determine their EIM requirements.

Fact #1: Every healthcare entity, agency, campus or nonprofit knows what software it utilizes for its business operations. The particular applications may be in silos, not accessible by other groups or departments, sometimes within the team that is accountable for it. If information were needed from groups across the enterprise, it has to be requested, in business terminology, of the host team, who would then go to the source of information (the aforementioned software and/or database), retrieve what is needed and submit that to the requestor - hopefully, in a format the requestor can work with (i. e., excel for further analysis instead of a document or PDF).

Fact #2: Because business terminology can be different WITHIN an organization, there will be further "translating" required when incorporating information that is gathered from the different software packages. This can be a nightmare. The gathering of information, converting the idea into a different format, translating it into common business terminology and then preparing it for consumption is a extended, expensive process - which takes us to Fact #3.

Fact #3: Consumers of the gathered information (management, analysts, etc) have to change the type of information required - one-off report requests that are continuously revised so they can modify their dimensional view (like rotating the rows of a Rubik's cube to only get one color grouped, then determining instead of lining up red, they would really like green to be grouped first). In many cases, this will start the gathering process once again because the original set of information is missing needed data. It also requires the attention of those that understand this information rapid typically a highly valued Subject Matter Expert from each silo - time-consuming and costly distractions that impact the particular requestor as well as the information owner's group.

Fact#4: While large organizations can cope with this costly method in order to collect enough information to make effective and strategic business decisions, the amount of time and money is a barrier for smaller or cash secured institutions, freezing needed data in its silo.

Fact #5: If information were accessible (with security and accessibility controls, preventing unauthorized and inappropriate access), time frames for analysis improve, results are timely, strategic planning is effective plus costs in time and money are significantly reduced.

Integration (with cleansing the data, aka Data Quality) should not be another concept to the mid and smaller organizations. Price has been the overriding factor that prevents these tiers from using enterprise information. A "glass ceiling", solely based on being limited from technology because of price tag, bars the concern of EIM. This is the fault of technology vendors. Business Intelligence, Performance Management and Data Integration providers have unconsciously created class warfare between the Large and SMB healthcare organizations. Data Integration is the biggest culprit in this scenario. The cost of integration in the typical BI deployment is usually four times the cost of the BI portion. It is easy for typically the BI providers to tantalize their prospects with functionality and reasonable cost. But , when integration comes into play, unwillingness on price introduces itself into the scenario. No action has become the norm at this point.

What are the Financial Implications for a Health-related Organization by maintaining the status quo?

Fraud detection is the focal point for CMS in their EHR requirements of healthcare organizations, A few take a deeper, more meaningful look at the impact of EHR. Integration, a prominent component of Enterprise Information Management inside the New Approach, brings data from all silos of the organization, allowing a Data Quality component to verify and clean it. The next step would be to either send it back to its originating source in an accurate state and/or put it right into a repository where it will be accessible to auditing (think CMS Sanctions Auditors), Business Intelligence solutions, and Electronic Wellness Records applications. With instantly accessible EHRs, hospitals and their outlying practices can verify patients with payors, get medical histories for diagnosis and treatment decisions, and update/add patient related information. What impact to therapy does a review of a new patient's history have for both patient and practice? Here are some elements to consider:

1 . Analysis and treatments that are based on previous patient dispositions - reducing recovery time, eliminating Medicare/Medicaid/Payor denials (based on the interpretation as to fault of the practitioner in original treatment or error incurring additional treatment).

2 . Instant fraudulence detection of patients seeking treatment for the same malady across the practices within the organization. Prescription abuse and Medicare dupery saves money not only for the payors, but the healthcare organization as well.

3. The Association of Fraud Examiners says that 9% of a Hospital's revenue each year is actually lost to fraud.

One overlooked but common impact with the cost of managing patient records. Thousands of file folders in storage with new instances being added each time a brand new patient enters into the system. Millions of pieces of paper capturing patient information, payer data, charts, billing statements, and even various items such as photo copies of patient IDs, are all stored in those folders. The folders are after that stored in vast filing cabinets - constantly being accessed by filing clerks, nurses, practitioners and assorted employees. Contents of the files being misplaced or filed incorrectly. Hundreds, if not thousands, of square feet being consumed with regard to storage. The AHA projects that an enterprise leveraging Electronic Health Records will recover no less than 15, 000 sq ft of usable space. That space can be used for additional services, opening up new channels of revenue. The justification is simple: how much would it cost the hospital to build out 15, 000 square feet for a new service? The average cost to build room utilized for Health Services is $65 per square foot, or $975, 000 total. An EIM solution with the New Approach would be less than 20% of that. Not only has the EIM solution reduced dollars lost to fraud, reduced the days for payor encounters to be paid, increased cash on hand, but it will also open up new services for the individual community and revenue back to the healthcare organization.

Electronic data is costly in its own way. Bad also known as "Dirty" data has enormous impact. Data can be corrupted by error in data entry, systems maintenance, data source platform changes or upgrades, feeds or exchanges of data in an incompatible format, changes in front end applications together with fraud, such as identity theft. The impact of bad data has a cause and effect relationship that is pervasive from the financial landscape:

1 . Bad data can result in payor denials. Mismatched member identification, missing DRG codes, empty areas where data is expected are examples of immediate denials of claims. The delay lowers the amount of Cash available as well as extends the cycle of submitted claim to remittance by at least 30 days.

2 . Bad data masks sham. A reversal of digits in a social security number, a claim filed as one person for the treatment of another family member, healthcare histories that do not reflect all diagnosis and treatments because the patient could not be identified. Fraud has the best impact on cost of delivering healthcare in the United States. Ultimately, the health system has to absorb this cost - reducing profitability and limiting growth.

3. Bad data results in noncompliance. CMS has already begun the architecture and deployment of Calamité Data Exchanges. These exchanges are a network of data repositories that are used to connect to health healthcare system, retrieve CMS related data, and store it for auditing. The retrieval will only be limited to the patient encounters that display a potential for denial or fraud, so the repository will not be a store of all Medicare and Medicaid patient encounters. However the exchange has to be able to read the data in its provider data source in order for CMS to apply certain conditions against the details it is reading. What happens when the information is incomplete or wrong? The healthcare system is held accountable for the incurs it cannot read. That means automatic and unrecoverable denials of claims PRIOR to an audit, regardless of claim capacity.

The Price Fix by Big Box Healthcare Technology Firms

Are the major healthcare software and technology vendors (Big Box) price gouging? Probably not. They are a victim of their own solution strategies. Through acquired and some organic growth (McKesson, Eclipsys, Cerner, etc), they find their EIM solutions lose their agnostic approach. This is bad... very bad for wellness systems of all sizes. With very few exceptions, the vast majority of healthcare organizations DO NOT BUY all applications and modules from the single stack player. How could they? Healthcare systems grow similarly - some organic, some through acquisition. Whenever a hospital organization finds over the course of time, an application that is reliable, such as a billing system, there is tremendous reluctance to remove a successful solution that everyone knows how to use. Because the major technology providers in the healthcare space act as a "One Stop Shop", they spend most of their time working on integrating in their own product suite with little to no regard to other programs. Subsequently, they find themselves trapped: they have to position all products/modules to maintain the accessibility and integrity of their data. This really is problematic for the hospital that is trying to solve one problem but then must purchase additional solutions to apply to areas that are not damaged, just to be able to integrate information. That is like going to the hardware store for a screwdriver and coming back with a 112 piece device set with a rolling, 4 foot cart built for NASCAR. You will probably never use 90+% of those tools and will not be able to park in your own garage because the new tool box takes up too much space!

IT resources - including people instructions must be utilized. In today's economy, leveraging internal IT staff to administer a solution post-deployment is a given. If those THIS resources do not feel comfortable in supporting the integration plan, then status quo will be justified. This is the "anti" approach to providing remedies in the healthcare industry: the sales leaders from Big Box technology firms want their sales people in front of the business part of the organization and to stop selling to IT. While this is a common sense approach, the economy in 2010 mandates that IT has to a minimum of validate their ability to administer new technology solutions. The prospect of long-term professional consulting engagements to follow post installation continues to be shrinking at the same rate as healthcare organizations profit margins.

Empowering the healthcare organization to utilize its existing IT staff members to administer and develop with the new products is not part of the business plan when Big Box players market to the industry. It is the precise opposite - recurring revenue from lengthy, and sometimes permanent, professional services consulting engagements is part of the overall focus on. The initial price quote for a Big Box solution is scary enough, but the fact remains that it is still not representative of the particular ongoing cost to maintain through consulting arrangements. This is a variable cost, which is difficult to predict, and drives finance administrators and executives crazy.

Solving the Dilemma - A Better Solution through a New Approach at a Fraction of the Cost

Whenever Healthcare Business Experts combine talents with Technology Architects, EIM Solutions cost drop dramatically. This is the New Method of Healthcare EIM, providing the way health organizations will be able to provide successful solutions at significantly reduced costs - starting the door for health systems of all sizes.

The EIM Firm (using the New Approach) versus Big Box Healthcare Technologies Providers:

Smaller, more agile firms bring many benefits to Healthcare Organizations of any size. The benefits:

1 . They may be focused on specific verticals - just like the Big Box Health Technology providers. Subject Matter Experts (SME) in the smaller firms usually are industry veterans with years of experience and success in their approach who see their resume as a support offering better utilized when they are able to apply their methods for successful strategy planning as opposed to learning the methods of a Home supply player. Their income is better since their revenue is applied into a smaller operating cost, extending lower prices for solutions that are MORE EFFECTIVE and offering stronger client/vendor relationships as the SME limits themselves to a certain number of customers.

2 . Solutions built on proven approaches and strategies. Again, the firm's SMEs are able to define a methodology which can be re-used or re-configured in each client instance. This saves time and money for the client as delivery is more rapid and the cost of architecting is eliminated.

3. The firms themselves develop solutions and methodologies agnostically. Their knowledge of the diversity of systems that exist in the technology of a healthcare organization allows them to not only develop adaptable alternatives but also add a Business Process Management Plan (BPM). The BPM will define for the organization EXACTLY how information is actually received, processed, cleansed, stored, shared and accessed. It also will define an action plan for training IT for management and support as well as end users at all levels on how they will leverage it going forward. BPM planning in a healthcare business is a low six figure investment with an outside consulting group. The EIM firms will include it in the cost of the answer. Basically, it is the difference in being told what is wrong and here are the recommendations to fix it versus here is what is wrong which is how it will be fixed with the new solution.

What is a typical EIM Firm solution?

1 . Solution Assessment, observing the current systems, data sources and methods of sharing information as well as business processes, key personnel identification that are door keepers if information, timeliness of providing information and overall effectiveness in leveraging enterprise information for proper business planning. See figures 1 for an example of the information process flow visual component of an actual assessment.

2 . EIM solution that contains an integration engine that accesses all data sources - reading and writing back to the database or even application, providing data quality services and maintaining HIPAA as well as HL7 requirements. See Figure 2 for a picture.

3. EHR Data Warehouse. A repository to build Electronic Health Records through the integrated data flow.

4. EHR Portal for patient entry (when additional information needs to be added) via a browser.

5. Business Intelligence Dashboards for metrics, AD Hoc analysis and Performance Management Scorecards on organizational goals and objectives.

6. Onsite implementation and integration of the EIM remedy.

7. Onsite training during installation for IT and end users. Ongoing training provided via webinars, documentation and tech support team staff.

8. Relationships maintained by the Subject Matter Experts for the life of the solution.

9. Stimulus "HITECH" Act will pay $44, 000 per physician for an EHR solution implemented. The SME creates the grant request to be posted so the healthcare organization receives Stimulus funds to pay for the total EIM solution

Key Element of the Solution

Onsite Delivery as well as full time support are key. But , the most important element is training. Why? As noted earlier, it is paramount which existing IT investments, namely personnel, be able to not only administer but also conduct development as the need arises. In Medical care, CMS managed Medicare/Medicaid is already margins that are in the negative. As private payers follow suit, the number of uncollectable activities will increase, impacting current profitability models and increasing future cost for treatment. By mitigating IT costs, the Total Expense of Ownership (TCO) qualifier should actually evolve to a Return on Investment (ROI). ROI is immediate for this solution approach, however it is sustained year over year by leveraging internal IT to support and develop. Now, the Healthcare Business has eliminated costly professional service consulting engagements and re-investments into new feature licensing. This takes a adjustable cost every year and makes it a fixed, yet smaller amount - a sensible financial approach to accomplish a proven strategy.

Summary aid

Why EIM? Whether it is Omnibus, "Obama"-care or an edit (not overhaul) of the Healthcare industry, Healthcare Organizations understand these truths:

1 . Electronic Health Records are necessary for the Fraud detection unit of CMS. Each organization should comply with accessibility, HIPAA and format. Fraud reduces overall revenues for a hospital by 9% (ACFE)

2 . EHR/EHR have proven to be highly effective in eliminating internal waste, patient fraud, practice fraud and paper overhead. Vast amount of place within the facilities that had been used to store patient records in hard copy can now be utilized to provide additional services and open up new revenue streams.

3. Bad or "dirty" data in electronic or hard copy format is costly. Based on the AHA (September, 2008), the average cost of a patient record with good or accurate information is $343 annually. Typically the annual cost of a patient record with bad information is $2, 054 annually. On average, 18% of patient data within a healthcare organization is bad.

4. Strategies developed by healthcare organizations without 100% of the information they personal that is also timely and relevant are ineffective. Objectives cannot be defined, successful processes cannot be identified and enhancement plans have little to no metrics in which to determine success.

5. Stimulus/HITECH Act pays $44, 000 per physician whenever EHR is part of the EIM solution. With the smaller EIM firms, Stimulus pays for the entire solution.

Why a New Strategy EIM Firm?

1 . Subject Matter Expertise from consultants that have proven methodologies.

2 . Agility to adapt to the client require instead of the Big Box approach of the client adapting to their product limitations.

3. A Better Solution at a Fraction of the Cost. Their own solutions are based on needs and not features.

4. Relationships with the vendor, resulting in improved services, maximum values from merchant solutions and a focused approach to the client needs and goals.

5. A Return on Investment as opposed to a Total Cost of Ownership. Clients have to see solutions that immediately pay for itself and then recover lost revenue while offering channels to new profit centres.

Scott Schledwitz is a Subject Matter Expert in Healthcare Strategic Planning, Information Integration, Data Quality, and Balanced Scorecard Methodologies. He has developed solution products and practices for compliance measures, reporting and planning utilized by various agencies inside the United States on the Federal and State levels. Within healthcare, he has consulted with hospital systems ranging from 1 in order to 100 campuses, providing them assessments and solutions to improve information efficiencies, extend information across the enterprise, develop group strategies that start at the top and cascade to the individual contributor. Through a Balance Scorecard Methodology, he has advised these types of organizations on how to identify their objectives, successful processes, define projects to overcome deficiencies and view the results in a simple to understand dashboard.

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