Strategy and Information

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Strategy and Information

• Jan Probst, PhD
• HSPM J713
• 2006

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Additional comments

• By Sam Baker, Ph.D., Fall 2008

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High hopes

• The public has high expectations about
  information technology in health services.

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Patients want information
5
Public approves of HIT
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Potential not being met

• IT has not kept up with
• Complexity of system
• Division of labor

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Information gaffes

• Administrative cost of provider-insurer-patient
  interaction
• Care problems
• Lost and repeated tests
• Wrong drug or wrong dosage
• Surgery on wrong body or part

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Falling behind other countries

• http//content.healthaffairs.org/cgi/content/full/
  25/3/819?ijkey9mznvmXKaxoykkeytyperefsiteidhe
  althaff

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Avoidance is not an option

• Executive Order 13335. Incentives for the use of
  Health Information Technology
• The National Coordinator shall develop,
  maintain, and direct the implementation of a
  strategic plan to guide the nationwide
  implementation of interoperable health
  information technology in both the public and
  private health care sectors .

http//www.whitehouse.gov/news/releases/2004/04/20
040427-4.html
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The need

• Get good information
• To the right person
• At the right time

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Health information technology spending

• 23.6B 2003
• Projected 30.5B 2006
• 9 growth per year

Dornfest.com, press release 2/2004
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Newer estimates of government health IT spending

• State and local
• Federal

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Topics for this afternoon

• Purpose of HMIS
• How to think about information

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Purpose of HMIS

• Improve health better outcomes
• Improve organization lower cost
• Requirements
• Good organizations
• Good information
• Systems for linking information and action

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Good management information

• Information
• Relevant
• Sensitive
• Unbiased
• Comprehensive
• Timely

• Action-oriented
• Uniform
• Performance targeted
• Cost effective

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First lesson for tonight

• What you ask matters
• Whom you tell matters
• Getting either of those wrong is a short-cut to
  disaster

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Information is...

• A key organizational resource
• The central unit in medicine
• Vital to ALL management

So it must be strategically planned developed
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Case

• A weekend counselor at a home for mentally ill
  teens takes the entire cottage of 15 children to
  the movies. One girl, a recent admission, runs
  away. This childs medical record flagged her as
  a flight risk.
• Whose fault?

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Case

• A weekend counselor at a home for mentally ill
  teens takes the entire cottage of 15 children to
  the movies. One girl, a recent admission, runs
  away. This childs medical record flagged her as
  a flight risk. Medical records are locked in a
  central office and not available to weekend
  staff.
• Whose fault?

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Thinking about medicine information

• The product is intangible application of
  knowledge
• Knowledge about the patient must be shared
• Patient record is usual communication vehicle

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Themes for tonight

• Intangible product gt compete on service
• Quality gt compete on work process
• Service process gt information dependent

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Services

• Intangible
• Produced and consumed simultaneously
• Involve the customer in production and delivery

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Fun facts about service

• For every complaint received, 26 customers with
  problems.
• Of customers who complain, 54 - 70 percent will
  return ... if their complaint is resolved.
• The average customer with a problem tells 9 or 10
  people. 13, gt 20.
• Customers with complaints satisfactorily resolved
  tell an average of 5 people .

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About patients with a problem

• 47 "wanted to say something but rarely did"
• 41 said something to friends and relatives
• 33 ... to the receptionist
• 2 ... to a nurse
• 2 ... to the physician

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More perspective

• Patients
• Physicians

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What patients want

• Improved well being
• Interpersonal psychological need fulfillment
• Reduced uncertainty
• Control
• Convenience
• Time conservation

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Or..

• Service
• Consideration
• Access
• Price

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Or..

• Caring
• Professionalism
• Competence

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What referring physicians want

• Individualized patient management and care
• Convenience to the patient
• Patient preferences met
• Communication
• Support for the referring physician

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Visualizing the Value Chain

• Every step in a process is documented
• What value is received at each?
• How can value be added?

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Attempting a picture
Make appmt
Leave work
Call office
2 weeks
Park at MD
Enter building
Locate office
30 mins
Exam room
Sign in
ETC
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• Just as all patients have a clinical
  diagnosis requiring technical expertise, they
  also have a customer service diagnosis requiring
  caring competence, compassion, and service
  excellence skills.

Mayer Cates, JAMA 1999 2821281-1283
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Medicine and the undistinguished middle

• True efficiency comes from top quality care
• Medicine is information
• Bad information management is bad medicine

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Systems

• The best systems help people do well.
• Run, dont walk, from someone who says that the
  system is perfect but the people arent good
  enough for it.