By Joe Naughton-Travers, Ed.M.
With my work at OPEN MINDS, I’m often asked by my specialty health care provider organization clients which type of technology is the most important. My answer is always the same: it’s not about the individual technology itself, it’s about how all of the technology platforms come together and “play nice” to manage and optimize overall clinical and financial performance. Without the integration across all platforms, each are merely working in silos without the ability to use each platform’s data as decision-making guides for the organization.
In response, I’ve worked with our team of senior advisors to develop a technology platform framework for specialty provider organizations to aid in planning technology needed for the future. This framework has six domains:
#1 Electronic Health Record & Billing System — The functionality of a comprehensive electronic health record (EHR) software application.
#2 Human Resource Information System & Financial/General Ledger System — These are the two other key software applications for administrative operations. The Human Resource Information System (HRIS) is the software that maintains, manages, and processes detailed employee information and human resources-related policies and procedures. The Financial/General Ledger System is the software that tracks all financial transactions and is used to generate a company’s financial statements.
#3 Hybrid & Community Based Service Delivery Platform — Technology tools that support virtual and community-based service delivery.
#4 Consumer Experience & Engagement Platform — Technologies for enhancing consumer engagement in the health care experience and optimizing consumers’ experience with the system of care.
#5 Value-Based / Risk-Based Reimbursement Platform — Technology capabilities that support measuring value in terms of customer experience and engagement and of the cost and quality of services.
#6 Integrated Analytics & Service Performance Optimization — Software applications for aggregating and analyzing the data from all the other software systems and databases to manage and optimize clinical and financial performance.
Domain #1: A Whole Person Care Record: Comprehensive EHR Software
The first requirement is a comprehensive EHR software application for all the consumers your organization serves, and all the service lines delivered. The EHR must record the demographic and clinical data for consumers, the services they receive, and the corresponding clinical documentation. Additionally, the EHR must:
- Document all referrals and referral dispositions
- Support tracking performance and clinical quality metrics
- Include standard functionality for medical services (e.g., e-prescribing, laboratory orders, and electronic medication administration records)
- Provide support for the delivery of routine primary care services
Mobile access to the EHR (both on- and off-line) is a must, and clinical decision support for medical necessity, clinical appropriateness for care, evidence-based practices, and payer-mandated clinical pathways is highly desirable. The EHR should be interoperable with the EHRs of other provider organizations to facilitate care coordination. Lastly, the software must handle all of your organization’s billing and accounts receivable operations (including fee-for-service, bundled, case rate, and VBR payment models) and have tools for maximizing revenue collection.
That covers the technical details—the functionality of a good electronic health record. The essential questions to ask about any EHR system are:
- Does the EHR help you manage whole person care for the consumers you serve?
- Does it have functionality to monitor physical and behavioral health as well as social determinants of health (SDoH)?
- Does it aid in care coordination with other provider organizations to achieve the best health outcomes?
If your EHR software application is not addressing these key service management functions, it is time to consider a change.
Domain #2: Managing Administrative Functions: Human Resource & Financial Management Software
The second domain helps provider organizations ensure that key administrative operations—human resources and finance—have the right software applications to meet your organization’s needs. The HRIS (human resource information system) must do more than track employees, salaries, and benefits. The HRIS also should include functionality for job applicant tracking and position control, time and attendance tracking, employee self-service capabilities, and a learning management system. A final requirement is comprehensive support for employee appraisals and development plans.
The financial management software (sometimes called the general ledger or accounting system) should have all the basic capabilities: budgeting, financial reporting, payroll, accounts payable, and fixed asset management. To support VBR contracts, the financial management software also needs to have the capability to aid in the management of the cost-of-service delivery—overall—and for individual health plan contracts. (It will need access to the service delivery data in the EHR to do this.) Lastly, this software application should have functionality for monitoring and managing health plan contracts and other payer contracts.
Domain #3: Delivering Care Conveniently: Hybrid & Community-Based Service Delivery Capabilities
This domain is more than just the telehealth services that your organization has become proficient at delivering during the COVID-19 pandemic. It includes other technologies that support and enhance your community- and home-based care delivery. Telehealth capabilities must be integrated into the EHR itself and should also be available on mobile devices so that community-based staff can bring in additional staff virtually when needed. Electronic visit verification (EVV) is needed to report that staff were physically present at consumer service delivery sites during community-based care. Smart home and remote health monitoring technologies can be used to ensure the health and safety of consumers. Secure communication between staff and consumers should be available in multiple formats (text, email, telephone, and video). Ideally, you would also have technologies that aid in route optimization for staff travel in the community as well as tools for managing these field and remote-based staff.
Domain #4: A Focus On Customer Service: Consumer Experience & Engagement Tools
Technology in this fourth domain is new to many specialty provider organizations. Consumer experience is the subjective response consumers have with any contact with your organization. Questions you might consider when evaluating for consumer experience include:
- Are your services convenient and easy to access?
- Are communication and other interactions smooth and painless?
- Is there a personal touch to service delivery and an impression of quality?
Consumer engagement is when individuals take action to become more informed and more proactively involved in his or her health and the health care services received. There are numerous technology tools to help with both consumer experience and engagement, including:
- 24/7 centralized access to care
- An easy to navigate website with the ability to access care and schedule appointments
- A consumer portal for communication, bill payment, and health record access
- Web- and app-based self-directed consumer health and well-being technologies
- Enhanced social media presence
- Net promoter scoring integrated into all aspects of care delivery
- Appointment and health check-in reminders via telephone, text, and email
As provider organizations expand their focus on consumer experience and engagement, a key focus is to determine which technology tools they may already have to support these efforts and which they will need to acquire and implement.
Domain #5: Managing Care & Costs: A Value-Based Reimbursement Platform
The fifth domain of the technology platform framework is technology tools for managing service performance and cost. Provider organizations should assume that most, if not all, of their health plan contracts in the future will be value-based, with both upsides and downsides in terms of payment models. You’ll need technologies that monitor clinical quality metrics in comparison to contract requirements. Will these be in your EHR? In other software applications? In analytic dashboards?
You’ll also need to monitor other contract performance metrics. Examples include metrics to monitor access to care, treatment engagement, telephone and referral response time, and other industry standard metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and Certified Community Behavioral Health Clinic (CCHBC) requirements. You may also be required to track and monitor SDOH and adherence to evidence-based practices.
Other key questions you’ll want to consider about managing care and cost include:
- What other technologies can better facilitate your ability to manage care and cost?
- Can you accomplish this with your EHR and financial management software alone?
- Do you need to invest in a better telephone system and website?
- Should you implement separate technology tools for quality and performance tracking that your EHR cannot handle?
This leads to Domain #6—does your organization need business intelligence and data analytic technologies to aggregate, analyze, and present the data in a meaningful way to your staff?
Putting It All Together With Domain #6: Analytics & Optimization
The last domain uses technology for aggregating your data in a meaningful way to proactively manage your organization. This is accomplished by utilizing business intelligence (BI) or other data analytic software applications that aggregate data for analysis and performance optimization. This is the ‘holy grail’ of performance measurement and optimization, having meaningful data to report your organization’s financial strength and operational performance and to monitor progress towards strategic objectives.
Most commonly, provider organizations begin with using these technology tools to manage and optimize clinical quality and performance metrics through reporting. The next step is to implement the use of dashboards for the board of directors, the executive team, department managers and individual staff. The most sophisticated use of BI software applications for specialty provider health care organizations is for population-health management. Here, BI software applications are used to provide the analytics to improve the health of the overall population of consumers served, to enhance consumer experience, and to reduce costs through consumer segmentation and analytics.
Where To Start In Building A “Next Generation” Technology Platform
The question is how to proceed with planning for and implementing the technology functionality needed to support future growth plans. There is a two-step process—addressing both immediate functionality needs for success in the current market and assessing the technology needed to support your strategic plan.
For the first, addressing immediate functionality needs, we have created a short assessment of ‘must have’ current tech functionality—The OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success. To see how your organization stacks up in this preliminary list, go through the checklist.
|OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success||Yes||No|| Working
|#1 Electronic Health Record & Billing System|
|Does your EHR handle all your health record documentation and billing requirements?|
|Does your EHR have the capability to share data with other provider organizations (interoperability)?|
|Does your EHR have mobile access (both on-line and off-line)?|
|#2 Human Resource Information System & Financial/General Ledger System|
|Does your HRIS include functionality for job applicant tracking, position control, and employee self-service?|
|Is your Financial/General Ledger System chart of accounts set-up so that you can report the unit cost and case costs of all the services you deliver?|
|Does your Financial/General Ledger System include contract management functionality?|
|#3 Hybrid & Community Based Service Delivery Platform|
|Do you have secure telehealth technologies in operation?|
|Do you have electronic visit verification (EVV) in operation?|
|Do you have technologies in place to monitor or report consumers’ health status (e.g. blood pressure, body mass index, lab levels, etc.)?|
|#4 Consumer Experience & Engagement Platform|
|Do you have centralized scheduling or other tools that make it easy for consumers, their families, and referral sources to access care at your organization?|
|Can consumers communicate securely with their care providers through a web portal, text, or other technologies?|
|Have you implemented net promoter scores, or a similar measure, to routinely measure consumer experience?|
|#5 Value-Based / Risk-Based Reimbursement Platform|
|Does your team have a system for reporting payer-centric and consumer-centric performance metrics?|
|Do you have technologies in place to report timely access to care and hospitalization readmission performance metrics?|
|Do you have a system to report other value-based and risk-based reimbursement contract performance measures such as follow-up after hospitalization, emergency room utilization, and use of evidence-based care protocols?|
|#6 Integrated Analytics & Service Performance Optimization|
|Do you have software technologies in place that can aggregate data from your EHR, HRIS, and Financial/General Ledger System to report on key strategy metrics?|
|Do executives and managers have access to real-time dashboards for key performance and operational metrics?|
|Does your staff know how to interpret and use the data that is available to them for performance management (data literacy)?|
This checklist provides an assessment of basic technology-enabled management capabilities. Where there are gaps in these management capabilities, management teams should develop a plan to meet these functionality basics. If there are functionality deficiencies in Domain #1 and #2 (the EHR, HRIS, and GL systems) these should be an area of immediate focus.
Beyond these basic areas of tech-enabled management capabilities, executive teams need to also crosswalk their strategic plans with the tech requirements to support those strategic initiatives. For more on that process, see From Strategic Plan To Tech Strategy: Building Your Crosswalk.
Looking ahead, every executive team member—and not just the CIO or CTO—need to focus on the coming digital transformation of the health and human service field—and the strategy and technology needed to succeed.