© 2009 Health Care Information Consultants, LLC The Business Value of Information Technology...

© 2009 Health Care Information Consultants, LLC

The Business Value of Information Technology

Georgetown UniversityHealth Information Systems

January 20, 2011

James L. Oakes, Jr., PrincipalHealth Care Information Consultants LLC

[email protected]


James L. Oakes Thirty years in healthcare information systems and management engineering Extensive experience as an operating manager, vendor executive, and consultant Specializes in helping healthcare providers plan and optimize use of information

resources, systems, and technology to improve clinical, operational, and financial outcomes

Worked with return on investment methodologies and analysis for over 25 years and pioneered the use of healthcare-specific economic analysis of healthcare information technology, including financial, clinical, and decision support

Developed and deployed healthcare value-based planning methodology for healthcare now adopted at a 600 bed regional medical center, a nationally known pediatric referral center, etc.

Served as interim Chief Information Officer in 3 healthcare institutions in financial or operational turnarounds and provided CIO level leadership assistance and development in 12+ others

Assisted in the development of a business case and pilot methodology for a community-wide health information exchange initiative (HIE) and recently completed planning and implementation options for a statewide HIE

Co-authored the recently released book, Return on Investment for Healthcare: Maximizing the Value of Healthcare Information Technology (HIMSS 2003 book of the year) advocating the development of a disciplined business case for technology investments

Appeared on the Hospital Satellite Network and spoken at numerous professional conferences, including CPRI, HFMA, SIIM, and HIMSS on such issues as effective governance, value realization, and strategy alignment

Holds a Bachelor of Industrial Engineering and a Master of Industrial Management, both from the Georgia Institute of Technology


“The Press Can’t

Tell You What to Think, but They Can Tell You What to Think About…”

John Naisbitt


Health Care Technology in the 21st Century

• Still predominately paper based

• Systems not interoperable• Slow, expensive

implementations• Increasing public pressure to

“do something”• Continuing economic

pressures• Provisions of ARRA (Stimulus

Act) incent use of IT• Many provisions of Health

Reform depend on its use– Best practices– Information exchange– Reduction in errors– Standardization of care


Stimulus Update

• First payments made in January 2011• Implementations ratcheting up, but

slowly• Many providers waiting until 2012 for

greater clarity• Risk of losing incentive in out years if

start too soon• ONC estimates 80+% of eligible

providers will participate• CIOs estimate only 15% are ready for

“meaningful use”• Growing number of studies showing

that EHRs do (or don’t) add value• Health Reform is “elephant in the

room”


Why was the casualty rate so high in the civil war?


HIT - It is not just technology!

• It is a massive reengineering effort that converts paper processes to digital workflow

• It is about ROI or achieving the benefits from the use of technology in healthcare to gain the full value in:– Quality – Efficiency– Revenue

• Numerous studies have been published attesting of the value of health information technology

• Numerous other studies have been published finding it has little value

• Both are correct!


IT Strategy Alignment

NecessaryEvil

Cost of Doing

Business

IncreasedEfficiency

IncreasedEffectiveness

CompetitiveAdvantage


Return on Investment is Essential

Historical measurements have focused on tactical items, but should also focus on strategic goals. A broader focus: Can technology contribute to the bottom line?

$$$

$$

$

Enterprise Level Financial Strategy Marketing Strategy Business Line Strategy Customer Service Strategy

Process Level Work & Process Redesign Functional/Programmatic

Transformation

Tactical Level Incremental Improvement Automation Benefits (ie, cycle

time reduction, FTE reduction, error elimination)

Enterprise Level Financial Strategy Marketing Strategy Business Line Strategy Customer Service Strategy

Process Level Work & Process Redesign Functional/Programmatic

Transformation

Tactical Level Incremental Improvement Automation Benefits (ie, cycle

time reduction, FTE reduction, error elimination)

TraditionalHealthcareIndustryROI

The Economic Value Pathway


For Example…

• A metropolitan community hospital• Full service medical/surgical• Busy emergency services• Competitive environment• Battle for market share


Develop a vision for the future….

• Phase in applications in a logical manner• If moving towards a “core vendor” strategy, phase in as

contracts expire• Look for “quick wins” along the way• Recognize that users must see continuing benefits to

support a long term plan• Be prepared to adapt plan as circumstances dictate• Communicate, communicate, communicate!


One Organizations Portfolio – Leading to CPOE

UniversalPatient

ID

PatientDemographics

OrderManagement

IntegratedHomeHealth

Radiology LAB Pharmacy

Ad-HOCReporting

Dictation/Transcription

Bar Code SchedulingPhysicianRemoteAccess

ElectronicEKG

Results

ClinicalAlerts

CaseMgmt.

100%Codified

MedicalNecessity

OutpatientAssessments

DocumentImaging

ElectronicSignature

Vital SignsI/O’s

IntegratedMonitors

NursingAssessments

ProblemLists

Today

18 + Months

18 Months

OperatingRoomMgmt.

OnlineMAR

CommonOrderSets

Care Plans

CPOE

OnlineResults


System Operational

Patient-Centric Information Systems

February 2007

Sequenced orSimultaneousInstallations

Orange Indicates

FY 08Emphasis

1. Business Continuity Plans that provide for Redundant Storage and Communications to ensure constant availability of the systems

2. An adequate number of appropriate user devices connected to a Robust Infrastructure that provides data that is shared (interfaced or integrated) across the continuum of care

3. Common Identification of the Patient across the continuum of care

4. Adequate Technical Support to ensure continuous operation.

Clinics/Ambulatory/Physician

NTierprise PMHealthmaticsEMR

Home HealthHomeworks

TransitionalCare

AccuCare

Home MedicalEquipmentMestaMed

CodingQuantim Coding*

Homeworks

Medical RecordManagement

Affinity*MRI*, MRA*, MRC*

MedicalNecessity

CaremedicLMRP

Billing & Collections

Affinity*, SSI, Medifax MestaMed, Homeworks,

Medware, Zirmed

MaterialsManagementDimension21

PatientRegistrationAffinity Reg*

NTierpriseHomeWorks, Mestamed

OBQS Sentinel

Order Mgt.Viewable Results

Common Order SetsOrder Mgmt*

PathologyMediSolutions AP

RadiologyRMS

LabMedilab

Pharmacy Affinity Pharmacy*

Etreby

ManagementAd-HOC ReportingCrystal Reports

Dictation/Transcription

Precyse Solutions HealthNotes*, SpeechQ

CaseManagement

MIDAS+

Utilization ReviewMIDAS+

OR ManagementORSOS

ElectronicEKG Results

Pyramis

ElectronicSignature**

Quantim e-Sig**

Document Imaging/Storage

EDM*

ED Documentation

& TrackingT-System EV

Picture Archiving& Communication

System (PACS)

McKesson HMINursing

Assessments**Vital Signs

I/O**

Care PlansProblem Lists**

OutpatientAssessments**

ClinicalAlerts**

OnlineMedication

AdministrationRecord**

Integrated PatientMonitors**

(OB, ICU, ER, Telemetry)

Web-basedPhysician

Remote Access**

ElectronicScheduling**

Web-basedViewable Results**

Computerized Provider

Order Entry**

ElectronicMedicalRecord

System yet to be Installed

Legend

The FOUNDATION REQUIRED to make these components into a Fully Functional Electronic Medical Record includes the following:

* Installed Quadramed Product

**Planned Quadramed Product


What Value does the system bring?

ValueAnalysis

Costs• Direct, one-time• Direct, ongoing• IndirectBenefits• Level I• Level II• Level III


Benefits

• For the CFO– Capital Avoidance– Efficiency

Improvements– Reduced A/R– Denials Reduction– Paper Storage

elimination– Etc.

“Its got room for the kids”

• For the CMO– Improved Registration

Process– Decreased Turnaround

Time– Streamlined Coding– Increased Customer

Satisfaction– Physician Satisfaction– Etc.

“Its got a Hemi”


Should we invest in this technology?4 Useful Calculations

• Benefit-Cost Ratio• Payback Period • Net Present Value• Internal Rate of Return


Benefit-Cost Ratio vs. Payback Period vs. NPV vs. IRR

• Measures are complementary• Intended to guide, rather than substitute for,

decision making• None of these measures attempt to account

for intangibles• Particularly useful in comparing alternative

investment opportunities• Never assume that just because numbers are

in a spreadsheet, they are necessarily accurate


Investment Analysis Example

• Proposed acquisition of a Document Imaging System

• System hardware and software will cost $250,000

• Use of the system will lead to greater efficiencies in the HIM department

• Should we approve the purchase?


Costs:

Annual Maintenance (3% inflation)

$30,000

None identified

Direct, one time (negotiated with vendor):

Hardware/Peripherals $100,000

Software $150,000

Training $35,000

First Year Maintenance $15,000

Direct, Ongoing (negotiated with vendor):

Indirect:


Projected Benefits: Level 1

Year 0 1 2 3 4 5

Microfilm Equipment $ -

$ 100,000

Microfilm Supplies -

15,000 15,450 15,914

16,391

16,883

Copier Costs -

5,000 5,150 5,305

5,464

5,628

ED Printing Costs -

500 515 530

546

563

HIM ED Postage -

7,500 7,725 7,957

8,195

8,441

Marginal Facility Costs

- 17,500 36,050 54,075

72,100

74,263

Autoindexing 36,000 37,080 38,192

39,338

40,518

Total Benefits $ -

$ 181,500 $ 101,970

$ 121,973

$ 142,035

$ 146,296


Cash Flow - Level I benefits only

($400,000)

($300,000)

($200,000)

($100,000)

$0

$100,000

$200,000

$300,000

Year 0 Year 1 Year 2 Year 3 Year 4 Year 5

Cash Flow

Cumulative Cash Flow


Net Present Value and Internal Rate of Return – Level I Benefits only


Level II Benefits

• Process Redesign Across Departments and Functions– IT Enabled Registration and Scheduling:

• Inpatient Registration Process• Outpatient Registration Process• ED Registration Process• Satellite facilities Registration Process

– Document Retrieval Process


Level III Benefits

• Revenue Cycle– Reduction in unbilled $– Reduction of days in AR– Reduction of denials

• Customer Satisfaction– Faster, more user friendly patient registration– Faster access to billing and payment

information– Increased market share


Cash Flow - With Level I, II, III Benefits

($500,000)

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000


Cash Flow

Cumulative Cash Flow


Net Present Value and Internal Rate of Return – Level I, II and III Benefits

($500,000)

$0

$500,000

$1,000,000

$1,500,000

$2,000,000


Ne

t P

res

en

t V

alu

e

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

Inte

rna

l Ra

te o

f R

etu

rn

Net Present Value

Internal Rate of Return


Comparison of Benefits: Level I, II and III

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

Year 1 Year 2 Year 3 Year 4 Year 5

Level III

Level II

Level I


Intangible Benefits

• Brand Advantage • Competitive Advantage • Management Information • “Catch-Up” To Standard Practice • Stakeholder Satisfaction


EHR Return on Investment Analysis Example

• Methodology– Interview based approach– Combines industry experience with client specific

environment– Utilizes information gained from multiple sources

• Vendor Claims• Prior studies• Literature review (including Davies Award submittals)• Consultant experience

• Benefits Identified in Four Categories– Revenue– Hard dollar savings – Soft dollar savings– New opportunities


ROI Analysis – Benefits

Benefit Category FY 07 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 TotalRevenueReduced ER Walkouts 93,562$ 190,866$ 194,683$ 198,577$ 202,548$ 206,599$ 210,731$ 1,297,567$ Reduced Denials 125,000$ 255,000$ 260,100$ 265,302$ 270,608$ 276,020$ 281,541$ 1,733,571$ Reduced DNFB 126,891$ 258,857$ 264,034$ 269,314$ 274,701$ 280,195$ 285,799$ 1,759,789$ Copay Collection 250,000$ 500,000$ 510,000$ 520,200$ 530,604$ 541,216$ 552,040$ 3,404,060$ Total Revenue -$ 595,452$ 1,204,723$ 1,228,817$ 1,253,393$ 1,278,461$ 1,304,030$ 1,330,111$ 8,194,988$

Hard Cost ReductionForms reduction 12,857$ 26,228$ 26,753$ 27,288$ 27,834$ 28,391$ 28,958$ 178,310$ SCC Maintenance 40,000$ 81,600$ 83,232$ 84,897$ 86,595$ 88,326$ 90,093$ 554,743$ Logicare Maintenance 16,000$ 32,000$ 32,640$ 33,293$ 33,959$ 34,638$ 35,331$ 217,860$ Keane Maintenance 77,500$ 155,000$ 158,100$ 161,262$ 164,487$ 167,777$ 171,133$ 1,055,259$ Avoided Capital Expense - Dictaphone 275,000$ -$ 275,000$ Total Hard Cost Reduction 645,000$ 335,675$ 995,436$ 1,181,065$ 1,385,226$ 1,412,931$ 1,441,189$ 1,470,013$ 8,866,534$

Soft Cost ReductionReduced RN Charting time 514,239$ 1,049,048$ 1,070,029$ 1,091,430$ 1,113,258$ 1,135,524$ 1,158,234$ 7,131,763$ Reduced RN turnover 39,780$ 40,576$ 41,387$ 42,215$ 43,059$ 43,920$ 250,937$ Reduced infection rate -$ Reduce ADEs -$ Reduced malpractice insurance -$ Pharmacist time (tracking down MD) 59,363$ 121,101$ 123,523$ 125,993$ 128,513$ 131,084$ 133,705$ 823,283$ Total Soft Cost Reduction -$ 573,603$ 1,209,929$ 1,234,128$ 1,258,810$ 1,283,987$ 1,309,666$ 1,335,860$ 8,205,983$

New OpportunitiesIncreased Lab Outreach 137,500$ 280,500$ 286,110$ 291,832$ 297,669$ 303,622$ 309,695$ 1,906,928$ Total New Opportunities 137,500$ 280,500$ 286,110$ 291,832$ 297,669$ 303,622$ 309,695$ 1,906,928$

Total Potential 645,000$ 1,642,229$ 3,690,588$ 3,930,120$ 4,189,262$ 4,273,047$ 4,358,508$ 4,445,678$ 27,174,433$

Additional FactorsMD SatisfactionPatient SatisfactionStaff SatisfactionPatient SafetyCompetitive Advantage

Inflation Rate 2%


ROI Analysis – Cost/Benefit ProjectionsFY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14

One Time CostsApplication Software 2,166,360$ 1,444,240$ 3rd Party/Operating SW 428,454$ Hardware 922,697$ 395,441$ Implementation 2,867,514$ 1,911,676$ Out of Pockets 430,127$ 286,751$ Conversions/Interfaces 295,373$ Infrastructure Costs 635,000$ Foundation Costs 155,500$ 773,500$ Total One Time 155,500$ 8,519,024$ 4,038,109$ -$ -$ -$ -$ -$ -$

Ongoing CostsSoftware Maintenance 1,500,210$ 1,530,214$ 1,560,818$ 1,592,035$ 1,623,876$ 1,656,353$ 1,689,480$ Hardware Maintenance 146,460$ 149,389$ 152,377$ 155,425$ 158,533$ 161,704$ 164,938$ Total Ongoing 1,646,670$ 1,679,603$ 1,713,195$ 1,747,459$ 1,782,409$ 1,818,057$ 1,854,418$

Grand Total Cost 155,500$ 8,519,024$ 5,684,779$ 1,679,603$ 1,713,195$ 1,747,459$ 1,782,409$ 1,818,057$ 1,854,418$ Cumulative Cost 8,674,524$ 14,359,303$ 16,038,906$ 17,752,102$ 19,499,561$ 21,281,970$ 23,100,027$ 24,954,444$

Benefits 645,000$ 1,642,229$ 3,690,588$ 3,930,120$ 4,189,262$ 4,273,047$ 4,358,508$ 4,445,678$

Cash Flow (155,500)$ (7,874,024)$ (4,042,549)$ 2,010,984$ 2,216,924$ 2,441,803$ 2,490,639$ 2,540,451$ 2,591,260$ Cumulative Cash Flow (155,500)$ (8,029,524)$ (12,072,074)$ (10,061,089)$ (7,844,165)$ (5,402,362)$ (2,911,724)$ (371,272)$ 2,219,988$

Net Present Value $17,180.07

Discount Rate 4%Inflation Rate 2%NotesHighest cost vendor assumedAssume discounts from RFP pricing as follows:Software 25%Hardware 10%Implementation 20%


Things to keep in mind….

• You can’t do everything at once• Not all applications need to be state-of-the-art• Value is in the mind of the beholder• You must decide how far out on the “bleeding

edge” your institution wants to be• A well implemented middle of the road system is

more valuable than a snazzy one that is poorly implemented

• Paper will always be with us?


Understand Your Institution’s Risk Profile

Con

servative

s

Prag

matists

Skep

tics

Inn

ovato

rs

Early A

dop

ters

Ù ChasmÚ

The Healthcare TechnologyAdoption Life Cycle

EarlyMarket

Mainstream

Market

Mainstream

Market

Con

servative

s

Prag

matists

Skep

tics

Inn

ovato

rs

Early A

dop

ters

Ù ChasmÚ

The Healthcare TechnologyAdoption Life Cycle

EarlyMarket

Mainstream

Market

Mainstream

Market

Innovators Mainstream Skeptics

TraditionalTechnology

Adoption Curve


No Longer Supported

Last Generation

State of the Art

Leading Edge

Emerging from the Lab

In the Lab

Nu

mb

er o

f In

stal

lati

on

s

Time

Credentialing

Physician OfficeManagement

Budgeting

EKG

Billing

PharmacyRadiology

EMR

Lab

RFID

PACS

AutomatedPathways

Voice Activated Systems

AI


LifeCycleSuccessPlan

Organizations tend to plan extensively for technology acquisition and the resulting implementation. Very few health care organizations plan for success of the technology throughout its entire life cycle


The IT Value Planning Process:Life Cycle Success Plan


What about Quality?

• Many processes in healthcare are quality or safety driven, not financial

• Processes may or may not be amenable to financial measurement, but are usually amenable to some form of quantification

• The more specifically a process can be quantified, the more it can be measured – and therefore analyzed and improved

• Specific tools may vary, but the underlying principles are the same

• Different constituencies will perceive value in very different ways, although they may all be looking at the same process

• Quality improvement can be achieved and expressed in a variety of ways…..


Eliminating Illegibility


“Technology is just a matter of using the right wrench to pound in the correct screw”

© 2009 Health Care Information Consultants, LLC The Business Value of Information Technology...

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