The Health Care IT Triple Aim

Written by on February 3, 2012 in Research & Technology - No comments

By Robert C. Tennant

In terms of information technology (IT) advancement, when compared to the airline and banking industries, health care often comes up short (although I, a traveler, might contend that the airline industry is a formidable challenger). While health care’s complexities and challenges are unmatched by either other industries, no one would disagree that our industry needs to make better use of IT. The success of health care IT projects depends on their ability to deliver on three main objectives: improving care, reducing costs and enhancing the worker experience, Health Care IT Triple Aim. By adopting the Triple Aim, we can ensure that IT solutions have a positive impact and advance health care’s stature with regard to leveraging IT. The following are five keys to hitting the technology Triple Aim.

Technology is the Enabler, not the Driver

Improving care, reducing costs and enhancing the worker experience produce the demand of IT solutions. The Triple Aim is the driver and technology is the enabler, not the other way around. Remembering this is critical to success, but is often easier said than done. Technology implementations are complex and sometimes develop a life form of their own, and before we know it, assume the role of driver. Another challenge is that IT departments often end up driving the implementation of IT solutions, which is not the best approach. Solutions should be driven largely by stakeholders and users who will benefit from the solution. IT departments are not necessarily to blame for assuming control as they often end up filling a void created by the lack of leadership. Hitting the Triple Aim requires viewing technology as the enabler along with active involvement from key stakeholders.

Trust the Technology

Remember when eCommerce came into being? One of the key issues was consumer trust in these new, Internet-based technologies that a user could not touch, talk to or see. Fear of stolen identity, financial loss and general mistrust of this new, technologically advanced way of doing things slowed adoption. We are in a similar place today with health care technology. Physicians, hospitals and patients are being asked to be more transparent and share information. We are entering a world where electronic visits and remote health monitoring are moving toward the norm. Health care providers are being asked to look at and respond to clinical and financial performance data, and are being told that their income will depend on that data. Like it or not, health care is fueled by data, and there is likely no escape. The best option is to learn to trust and embrace the changes. Validate it, challenging its accuracy when necessary and get comfortable with the technology: use it to affect change. New technology will perform tasks for us that we once did for ourselves, and we will be asked to trust the technology to guide and do support work for us. If the IT solution successfully performs tasks it will improve care, reduce costs and enhance work experience; hopefully allowing health care workers to realize rewarding roles requiring new levels of human interaction, observation and judgment.

Pay Attention to the Often Overlooked Driver

Of the Triple Aim objectives, improving the health care worker experience is the one most often overlooked. Technology projects are usually born out of a desire to save money and decrease risk exposure thereby improving quality of care. Some electronic health record (EHR) projects were started with the notion that they would make a physician’s job easier. However, EHR implementations, in general, have not delivered on that objective; in fact, most have had the opposite effect. If technology doesn’t simplify a job, the job may not get done; or if the job does get done, it will be done at the high cost of lost productivity and worker dissatisfaction – negatively impacting the quality and cost of care. A first step toward improved worker satisfaction is embracing it as a core objective. If we don’t believe in it, we won’t likely achieve it. Studies have shown that patients who have a good experience are more compliant to treatment plans. Does it naturally follow that health care workers whose experience is enhanced will be better performers? I believe it, do you? Once convinced, key stakeholders and users will need to stay attentive to the often overlooked driver of health care worker satisfaction.

Measure It

Is our technology improving care? Reducing costs? Enhancing worker satisfaction? If so, how and to what degree? These are questions that should be asked and measured specifically and quantifiably. Create key performance indicators (KPI) detailing the goals that support the overarching Triple Aim objectives. Items to be measured will vary by worker group. For example, physicians, nurses, schedulers, billers and administrators should all have unique KPI dashboard measures related to their specific objectives, and their capacity to impact care and cost. In addition, they should have their worker satisfaction evaluated on a regular basis. KPI’s may also vary depending on what issues the technology solution is intended to address but could include:

  • patient waiting time
  • gaps in care
  • patient satisfaction surveys
  • number of visits per day
  • number of same day visits
  • worker satisfaction surveys
  • hours required to wrap up the day after the last patient visit
  • traditional billing and financial measures.

As the axiom goes, if it’s not measured, (with results in front of you daily or weekly) it won’t improve.

Improve It

Improvement naturally follows measurement. With regard to IT improvements, there are two important things to keep in mind: 1) Today’s solution may not suffice tomorrow, and if we think it will, we’ll get left in the dust. 2) The complexity of health care’s issues require adjusting on the fly. If we wait for the perfect roadmap, the project will never get off the ground. Complex implementations such as ambulatory EHR solutions leave users feeling like overwhelmed. Likewise, data intensive accountable care models are complicated and not fully defined, requiring a lot of discovery and invention along the way. There is no linear path; missteps and rabbit trails will be the norm, not the exception. Many consulting firms and health system IT departments have assembled EHR optimization teams that follow implementation by 90 or more days, and work to improve processes of adoption after everything has settled. Technology optimization initiatives that involve a systematic plan of reviewing and responding to performance metrics should be widely used.

Seasoned veterans know that the devil is in the details when it comes to applying IT solutions to the complex issues of health care. Sometimes the biggest challenge is getting the proper stakeholders to spell out objectives and play a key role in the execution of the project to ensure that they are met. If you are considering a new technology implementation or find yourself in the throws of adversity from a previous implementation, it’s not too late to revisit the project and align with the Triple Aim objectives.

Robert C. Tennant is a Managing Associate with Health Directions, a national healthcare consulting firm. He has more than twenty years of experience leading business development software and IT infrastructure deployments, and has dedicated ten years exclusively to healthcare information technology and health information exchange in the physician practice, hospital and payer settings.

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