Dell Executive & Patient Survey


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For both hospital executives and the patients they serve, the future of the healthcare system is clouded with uncertainty. The two groups agree the economy is the biggest issue facing the country, and the impact of healthcare reform is likely to be mixed at best.

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Dell Executive & Patient Survey

  1. 1. F U T UR E The Dell Executive & Patient Survey
  2. 2. Hospital execs and patients say post-reform future is uncertain but IT is keyF or both hospital executives before,” says Bergman, chief financial and the patients they serve, the officer (CFO) at 555-bed The Christ Hos- future of the healthcare system pital in Cincinnati. “How do we make sure is clouded with uncertainty. The there’s access for the newly insured?” two groups agree the economy Lifepoint Hospitals, headquartered inis the biggest issue facing the country, Brentwood, TN, operates 52 hospitals inand the impact of healthcare reform is 17 states. Many are the sole acute carelikely to be mixed at best. They also agree provider in their community. Sean Tuley,changes need to be made, and informa- Chris Bergman senior vice president and chief informa-tion technology (IT) will play a key role in Chief Financial Officer tion officer, says these dramatic changesmaking those changes. The Christ Hospital make for challenging times. “This industry Dell conducted a survey in the fall of has not changed so fast in its history,”2010 among 150 hospital executives and healthcare financing through Medicaid he says. “Other industries have gone309 recent hospital patients to explore and other programs. through major legislative or technologytheir attitudes toward various issues facing “My concern is that the pile of dol- changes, but healthcare is going throughthe healthcare industry. The hospital exec- lars available to pay for all healthcare is both at once. We know that the way weutives were asked how their institutions not going to get bigger, but that we’ll be deliver care will change, but we don’twere gearing up to cope with changes paying for stuff that hasn’t been covered know exactly how.”contained in both the Patient Protectionand Affordable Care Act of 2010 (health-care reform) and the American Recovery HOSPITALS FACE TECHNOLOGY CHALLENGESand Reinvestment Act of 2009 (stimulus). % RESPONDING SOMEWHAT OR VERY CONCERNEDPatients were asked what changes they Being able to afford the initial and continued technology investment 85%expect the Affordable Care Act would Training clinicians and hospital staff in order to achieve process 79%have on their healthcare and how their improvements and time savingsown involvement would change. They Maximizing your ARRA incentives payments 78% Having the ability to effectively exchangewere also asked to rate their recent experi- information through a HIE 78%ences with their healthcare providers and Achieving level 7 of HIMSS analytics EMR adoption model 73%improvements they would like to see. Ensuring your clinical systems are “always on and always available” to providers 72% Around 72% of executives and 60% Effectively using the data collected for business intelligence andof patients agree the economy is the operational improvements 71%country’s most pressing issue, with Recovering data in the event of a disaster or system failure 66%healthcare running a distant second Ensuring a secure network for sharing protected health information 66%(22% for the executives and 27% for the Adhering to HIPAA information privacy and security regulations 62%patients). When it comes to healthcare Having technology interfere with personal care giving 54%reform, the executives take a dimmerview than patients: Only 37% have an Successfully managing increase in data storage requirements 53%overall favorable opinion, compared with Providing remote access to the data 52%55% of patients. Virtually all the execu- Incorporating smart phones and other 51% devices to enhance provider mobilitytives surveyed are worried about how Survey Question: As hospitals and other caregivers begin using EMRs and other clinical systems more frequently in their everydaystates will cope with an expanded role in operations and at the point of care, what is your level of concern about each of the following challenges. 1
  3. 3. HOSPITALS INVEST IN CHANGE Patient education a tall order Establishing or offering healthcare insurance services 66% 17% 14% The majority of executives surveyed (86%) Acquisition of other hospitals 58% 17% 18% believe that hospitals should be either very involved or somewhat involved in Establishing a private HIE 38% 42% 17% educating patients about how reform will Acquisition of physician practices 27% 21% 51% change healthcare financing and delivery, Virtualization strategies or cloud based 24% 36% 30% though they have varied ideas on how to solutions to lower IT costs Build new facilities for your organization 19% 35% 46% accomplish this task. “I think you need to cast a wide net Establishing an accountable care organization 17% 56% 23% and hit on broad topics, not necessarily Business intelligence 44% 39% 15% focusing on individual groups or the nitty- Advancing healthcare community alignment strategies 10% 52% 34% gritty of the reform,” says one respondent. Health informatics 9% 44% 46% “We should provide a listing of chang- ICD-10 preparations 8% 56% 34% es, restrictions, and limitations in services that are a direct result of reform,” says Creating improved patient interactions 7% 45% 47% another. “We must be extremely specific.” Medical archiving and storage 5% 23% 71% Hospitals have their work cut out for Patient care coordination 5% 47% 48% them: 68% of patients surveyed classify Physician alignment 5% 37% 56% themselves as not knowledgeable about Increased privacy and security processes and safeguards 4% healthcare reform. Despite their lack of 33% 63% familiarity with the new law, 55% of then Have not invested in this and do not plan to n Planning to implement but have not yet started n Currently investing in thisSurvey Question: In which of the following categories is your hospital currently investing or planning on investing? survey respondents either somewhat or strongly agree that it will provide health- care coverage for nearly every U.S. citizen, 43% think it will provide more options for Install ancillaries (lab, radiology, pharmacy) 2%9% 26% 63% healthcare consumers, and 40% think it Select the EMR technology that will % 15% 45% 38% achieve meaningful use criteria will reduce personal healthcare spending. Create an online physician portal 4% 9% 28% 30% Only a third of patients surveyed Update/improve core IT infrastructure systems % 18% 52% 29% expect healthcare reform to improve to support advanced clinicals Disaster recovery and Business Continuity % 19% 51% 28% coordination of care, improve quality, or reduce overall spending. Complete EMR installation 2% 23% 57% 17% Data warehousing/business intelligence/analytics 7% 30% 50% 12% Accountable care: Participate in a local, regional, or state HIE 9% 54% 26% 9% Uncertainties abound Improve alignment strategies with doctors using EMRs % 37% 52% 9% Accountable care organizations, a key 34% 7% provision of the reform bill, are supposed Enhance your telemedicine capabilities 17% 41% to accomplish all three of those things, Implementing your own private HIE 29% 40% 21% 6% by forming providers into a continuum of Create patient information and check 34% 49% 9% 5% in kiosks for admissions care that works with patients to prevent Providing patient access to records via an online portal 19% 62% 13% 5% illness as well as to treat it. Electronically share medical records with patients 16% 62% 16% 5% “Accountable care organizations are the next new thing,” says Harry Greens-n Have not invested in this and do not plan to n Planning to implement but have not yet startedn Partially implemented n Fully implemented pun, MD, chief medical officer of DellSurvey Question: Please indicate to what extent your hospital has implemented each of the following initiatives. Healthcare and Life Sciences Services. 2
  4. 4. HOSPITALS REACH OUT TO PATIENTS Tuley says his hospitals will have to % RESPONDING STRONGLY AGREE adapt to a variety of new roles under an Enabling physicians to increase their 50% accountable care structure. “In a small patient contact and involvementCreating technology tools that can measure and share the community, we know all the providers quality of care your organization is providing patients 48% and can serve as a hub to execute those Ensuring information security and adhering to state and federal privacy laws 44% kinds of arrangements, but there are cer- Educating patients about how health care reform affects them 37% tain services we don’t provide, so we will Expanding the use of home health monitoring 36% need tertiary care partners that might be systems for managing chronic diseases two or three hours away. We’ll be both a Creating patient information portals 33% Enabling patients to conduct more business with the hub and a spoke.” 32% hospital over the Internet and through its website The Christ Hospital in Cincinnati is Establishing self-help, self check-in information and admissions kiosks 19% identifying likely partners for an account- Enabling advanced treatment regimes to be able care organization and already has conducted in the home, such as IV drips 18% Enhancing the hospital room-based entertainment 15% a solid local network and a loyal patient options available to patients and visitorsSurvey Question: As the use of technology continues to advance in healthcare, please indicate whether you agree or disagree base, but it’s not making firm plans untilwith the following ways technology could be used to enhance patient involvement in the health care process. certain aspects of the new law are clari- fied, says Bergman. “We can do a better“In macroeconomic terms, the longer To manage chronic illnesses, 37% job with the continuum of care, but if it’speople live, the more healthcare they of patients want “an organization that a total transference of risk to the hospital,consume, and the right direction is to specializes in treating the illness you that’s not going to work.”keep the patients healthier. It’s hard to require treatment for,” while another 37%incentivize people to take care of them- would prefer to work with their healthselves. As a nation, that’s what we need insurance company. Technology investmentsthe healthcare system to do.” Several patients commented that a are essential Of executives responding to the Dell patient advocate or coordinator would The stimulus bill included about $20 billionsurvey, 23% say their hospital is already improve their care, perhaps dramatically. to encourage the adoption of health IT,investing in establishing an account- “They would help patients disseminate and the reform bill also included severalable care organization, and another any labs, records, or other information measures affecting IT. Slightly more than56% haven’t started but are planning to. to other providers,” says one, complain- half of the surveyed executives believeRespondents are split about who should ing that physicians refer patients to each those provisions, especially the financialspearhead the coordination of care: 77% other but rarely communicate. “In my incentives for adopting electronic healthsay the role of physicians and specialists own case, a patient advocate would save record (EHR) technology and financialshould decrease, and 69% say the role of thousands of dollars per year!” penalties for not doing so, will have ahospitals should decrease. But if they had positive effect on the healthcare industryto pick an organization to back up primary as a physicians in care coordination, “From an IT standpoint, this is the58% would choose to give the hospital most exciting decade to be in health-that responsibility. care,” says Tuley. “The industry has Patients surveyed also weren’t sure needed to change, and we finally havewho should coordinate their care. For a government mandate and somegeneral healthcare, 41% say a hospital funding that we can reinvest for morewould be the organization they want to efficient care, better patient safety, and Sean Tuleywork most closely with their primary care Senior Vice President better communication.”physician, and 36% prefer to see their and Chief Information Officer Hospitals must not only install EHRs,insurance company in that role. Lifepoint Hospitals but achieve “meaningful use” according 3
  5. 5. to specific federal standards in order Society. Bergman expects that his orga- IT benefits patients andto collect their incentive payments. nization will also qualify for full governmentSome Lifepoint hospitals will be able EHR incentive payments. organizationsto show meaningful use in 2011, and Three out of four executives surveyed Executives see multiple promising ave-Tuley’s goal is to have them all at that say their organizations have partly or nues for expanding hospital use of IT topoint by 2013 in order to receive the fully implemented EHRs of some sort, engage patients in the healthcare pro-maximum payments. and 83% have either selected or imple- cess. Of those surveyed, 87% think it The Christ Hospital in Cincinnati has mented an EHR that can fulfill federal would be helpful to create tools to mea-already made major IT investments, says meaningful use requirements. A third of sure and share the quality of care in theirBergman. When it separated a few years respondents are participating in some organizations, and 84% think IT can helpago from a larger system, its use of com- form of local, regional, or state health their physicians increase their patientputers was at a very low level, but cur- information exchange (HIE), which allows contact and involvement. Direct patientrently the hospital is in the top 2% of EHR multiple providers to have access to the contact with the hospital, through portalsusers nationwide according to the EHR same patient data. Another 54% are plan- and other ways to do business online,adoption scale used by HIMSS Analyt- ning to participate in an HIE. Almost 70% draws favorable reactions from 83% ofics, the consulting arm of the Healthcare have partly or fully implemented an online respondents. Though only 18% have par-Information and Management Systems physician portal. tially or fully implemented a patient portal, another 62% are planning one. WHAT PATIENTS THINK Hospitals themselves will reap strate- gic benefits from having electronic access % RESPONDING STRONGLY AGREE to clinical information, says Tuley. Tech-The quality and treatment I received at this hospital will have an 45% nology will make it relatively easy to put impact on my decision to use this facility in the future The hospital provided me with the information and directions I together a handful of vital measures that needed to recuperate successfully at home 33% I felt like the hospital staff had enough information will tell his organization’s management regarding my condition, my medical history, and 30% what it needs to know. the treatments I was undergoing while in the hospital to make informed decisions about my care “The big challenge when you’re dealing My physician played an important role in selecting the hospital I used for my treatment 30% with business intelligence is defining exact- I felt confident that my treatment information was effectively ly what you need,” Tuley says. “It’s much communicated between each care provider during shift changes 27% and new treatment courses like being a pilot: There are an overwhelm-When I checked into the hospital, I was pleased to learn that mymedical history and information was already available to my care 27% ing number of dials and switches, but if you providers at the hospital I felt safe from treatment mistakes caused by ask a pilot they look at five things. The rest miscommunication between my care providers 25% are important, but only five are essential.”My transition to my home after my stay at the hospital was very smooth because of the help my hospital provided 25%The hospital provided me with strong after-stay information and care options The overall comfort of my stay with regards to room amenities, 22% Tech adoption entertainment options, and general staff hospitality will be themost important things I consider when recommending this hospital 21% is dauntingI was required to provide my medical information multiple times during the same hospital stay 17% Despite the prospect of at least partial The invoice and correspondence I received from my insurance federal reimbursement, 85% of exec- company was easy to understand and made it clear what they 15% would pay versus what I needed to pay utives are worried about how they’re The hospital’s billing and invoice process was convenient and easy to understand 13% going to afford the initial investment and My physician should have provided more ongoing cost of EHRs. They’re ambiva- follow-up regarding my care 12% My insurance company played an important role in helping me lent about how widespread adoption will get the best treatment possible and in coordinating my care 10% among various providers affect individual segments of the industry: Only 47% say the change will be positive Survey Question: As you think about your recent hospital stay, please indicate whether you agree or disagree with the following statements. for hospitals, and only 37% think it will be 4
  6. 6. WHAT PATIENTS WANT % RESPONDING SOMEWHAT OR STRONGLY AGREE Electronic access to information about a hospital (medical expertise, physician experience, insurance acceptance, etc) to 81% help you determine which hospital to visit Electronic prescription processing to allow health care providers and pharmacies to communicate without paper 76% Making it possible for EHRs to be shared between your physician, hospital, rehab center, laboratory, etc. 74% Harry Greenspun, MD Providing more information electronically, such as access to 73% discharge and follow-up care instructions after a hospital stay Chief Medical Officer Dell Healthcare and Life Sciences Services Email access to your doctor so you can ask questions and discuss your health via electronic mail 71%positive for physicians. Almost 80% are Implementing EHRs 69%apprehensive about the prospect of train- Hospitals and physicians publishing their quality rankings on 67%ing their clinicians and hospital staff to use their website for your review and considerationthe new technology. Independent third-party internet portals where patients can rate their experiences with doctors, hospitals and clinics (not 65% Dell’s Greenspun believes at least some sponsored by a physician or physician’s office)of that apprehension may be misplaced. New technologies that enable your physician“The new generation of doctors and nurses to remotely monitor your wellness, by checking your vital statistics and treatment response (e.g., blood 64%has grown up with these technologies, and pressure) from a device you use in your homeyou can hand them a smartphone with an Introducing more tele-medicine capabilities so that you canRFID tag and they’ll know how to use it,” he meet with your physician to discuss health issues over the 62% Internet or telephonesays. “They want to work in an industry thatuses these tools.” Providing access to your personal health records through an 61% Internet portal or private website Providing check-in or admission kiosks at 60% Patients embrace tech hospital and physician facilities Technologies that allow your insurance company to remotelyPatients like the idea of advanced health track vital statistics and treatment response to help you man- 48%IT as well, even though they worry a little age your prescriptions and help you manage a chronic diseaseabout the security of their data. Survey Survey Question: As you consider how care providers help you manage your personal wellness and care, do you agree or disagreerespondents were asked to list the one that each of the following new capabilities or tools should be implemented to improve your patient experience?change they wanted to see their hospitalmake. Amid predictable calls for lowercosts, better food, and more nurses, WHAT PATIENTS WORRY ABOUTthere were many requests for better com- % RESPONDING SOMEWHAT OR VERY CONCERNEDmunication and recordkeeping. Your health data being safely and securely stored 69% “A data bank with all my records thatcould be accessed by all hospitals would Your health data being transmitted over the internet 66% Hospitals and providers adhering tobe very helpful,” says one. privacy laws (such as HIPAA) 60% “At least agree on an areawide system Your health data being compared to others to determine 46% effectiveness of treatmentsso that all area hospitals could accessthe same patient information to include Your health data being shared between hospitals 45%test and procedure results as well as cur- Your health data being shared between physicians 37%rent med lists,” says another. “Providers Survey Question: As hospitals and other caregivers begin using EHRs more frequently, what is your level ofdo NOT have time to talk to each other, concern about each of the following issues? 5
  7. 7. thus they don’t and so are missing impor- to information about their hospitals and backlash when it introduced full-bodytant information.” doctors. More than 70% want to be able scanners at airport security screening “I had different nurses and doctors to e-mail their doctor, and 76% want points last year, Greenspun says. The TSAthroughout my 10-day hospital stay, and their prescriptions sent to their pharmacy communicated poorly about why it neededevery day I had to tell them what was electronically. Only 37% express concern the scanners, and allowed privacy issues togoing on because they had not com- about their health data being shared dominate the public conversation.municated with the previous nurses and among physicians, and 45% are con- Greenspun points out that becausedoctors,” complained a third. cerned about hospitals sharing their data electronic records include ways to track Many patients already use electronic (though only 17% are “very concerned”). each person who looks at them, and cantools routinely in connection with their Dell’s Greenspun believes health- easily limit access to certain portions,healthcare and will increasingly expect care providers have to get out in front they’re more secure than paper recordsthem. Three out of four survey respon- of patients’ privacy concerns, so that in many ways. “We need to let peopledents use sites like WebMD at least occa- they won’t mushroom as EHRs become know what’s being done to protect theirsionally to research their health concerns. prevalent. information, the way the finance industry Three out of four want their records “The healthcare industry should learn does. It’s important to communicate theshared electronically among their provid- a lesson from the Transportation Safety advantages before people start focusingers, and 81% want electronic access Administration [TSA],” which faced major on the potential risks.” • WHAT PATIENTS DO Use online resources like WebMD to learn about health issues 10% 16% 44% 30% Talk with your physician to make sure that your medical information is shared by the physician with other care 16% 22% 41% 22% providers and your hospital of choice Discuss with your physician how to best coordinate your care between physicians, 19% 26% 34% 21% hospitals, and other care providers Use a home health and wellness monitoring device such as a blood pressure tester, 41% 16% 23% 20% glucose monitor, or other device. Address insurance reimbursement challenges associated with care that you believe should be covered, 18% 31% 34% 17% but was not paid for by your health insurance company Research hospitals to make the best selection on where 21 31% 31% 17% to stay in case of an illness, injury or medical procedure Consider changing physicians or hospitals 16% 35% 37% 12% Use a walk-in health clinic for 30% 29% 30% 11% non-emergency care and check-ups Share information electronically with your physician or hospital 44% 25% 22% 9% Discuss with your healthcare insurance company how to best coordinate your care between physicians, hospitals, 40% 29% 25% 6% and other care providersn Never n Rarely n Sometimes n OftenSurvey Question: How often do you engage in the following activities? 6
  8. 8. A healthy communitystarts with a healthy community hospital. Mount Sinai Hospital was critical to its Chicago community. But, like many not-for-profit hospitals, it needed to improve its revenue cycle. Accounts receivables were in arrears, billing and administrative processes weren’t capturing all hospital fees and a lack of cash flow was hindering it from focusing on its primary goal: caring for the community. That’s when Mount Sinai turned to Dell Services. With extensive experience in optimizing hospital revenue cycles and preventing billing leakage, we knew just how to help: We put a revenue cycle team in place to work closely with their team. And by examining financial processes and billing systems together, we found ways to create more efficiencies and greater revenues. The result? Open accounts were reduced by 40%, incremental cash flow increased by over $29 million, and the hospital that a Chicago neighborhood counted on began operating better than ever. How can we boost your organization? After all, the future is wide open. Visit Applications Business Process Consulting Infrastructure Support Services© 2010 Dell Inc. All rights reserved.