In the two previous posts I reported (vented, some might say) on the lack of attention to productivity as we spend billions on health care information systems. In Part 1 I pointed to the Bipartisan Policy Center Task Force on Delivery System Reform and Health IT as a major culprit, and then in Part 2, I acknowledged the difficulties the health care industry has in identifying and adopting change. This time let's look at specifics.

Over the past two years, the big health care I.T. failure was spending billions switching from paper to electronic health records without ensuring that the costs were economically justified.  Furthermore, what seems to be universally missing from managing our health care system is a rigorous cost analysis on the provider side of the system -- just what does all this electronic paperwork and wasted time cost?  Is the workload apportioned properly to reduce real and hidden costs?  Is anyone tracking and analyzing all this? The answer seems to be no.

We see absolutely nothing in most current EHR products, despite all the money spent on then, that take even baby steps toward making sure that doctors are optimally utilized from a productivity perspective. In fact, there is a good argument (I have made it in previous posts) that EHRs actually are productivity killers for doctors.  But on the other hand, it does not take a rocket scientist (maybe it does) to see that the introduction of EHRs could include readily available technology to address at least four specific productivity sinkholes in the way medicine is practiced.  

Fortunately, the Bipartisan Policy Center Task Force and the government in general, and the current health care I.T. vendor establishment, are not the only contributors, thinkers and innovators in the information technology market. Lately a few new commercial organizations are beginning to identify, address and subsequently close the productivity gap. It’s also encouraging that a few health care providers are beginning to think about the problem and look for solutions.

Let’s look at specific productivity gaps and how to close them.

First, in any business, or economic activity, eliminating or reducing time and effort spent on uncompensated products or services is the easiest way to increase productivity.

Second, make sure you actually charge for the chargeable services you provide. 

Third, make sure you prioritize the work based on critical success factors--economics being one of them.

Fourth, if you do not measure it you cannot improve it; and conversely if you DO measure it you cannot help BUT to improve it.

Fifth, if a computer can do it cheaper, faster and more accurate, let the computer do it.

Sixth, if a computer cannot do it make sure you detail the costs (real, hidden, and opportunity) when you choose who does it.

That said, here are specific improvements to health care I.T.—specifically electronic records--that will help close the productivity gap:

 Reduce uncompensated time.  A doctor gets paid for diagnosis and treatments--fee for service OR managed care—and not for screwing around doing keyboard data entry into the EHR. So anything that does electronic data capture into an EHR is worth spending money on. Technologies to reduce or eliminate manual data entry are widely available and used by other industries. The EHR vendors are the laggards here.

Make sure all billable activity is actually billed for in an accurate and timely fashion. Opportunities to computerize billing abound.  Some of it is computer-generated coding, but there is more to it including mapping to insurance criteria and managing self-pay at time of service.  Again these have to be features of economically justifiable EHR platforms.

Schedule the provider’s time with consideration to provider compensation. This is standard applied computer science (queuing and basic analytics) used in almost every other industry. The concept in health care is to use familiar triage techniques with a financial input --of course in the software--as a front end to patient scheduling. Some of the Internet-based physician scheduling sites popping up look to be going in the wrong direction by offering  brain dead scheduling algorithms that are counter-productive by the measure outlined above.

Implement productivity performance feedback mechanisms.  Many industries use relatively simple and mature business intelligence dashboards to give workers simple metrics and key performance indicators to allow these workers a regular graphical picture of their overall productivity. Tie compensation to productivity and stand back.

These are just a few steps that could be taken to improve productivity of health care by relatively minor additions to the EHR platform (which is beginning to take on the role of information hub).  I am not saying that these are the only four. There are plenty of other proven techniques available to reduce costs without negatively impacting effectiveness or efficiency.



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