Investing With Discipline: Balancing the Health IT Risk/Reward Equation

Jason Joseph, SVP/CIO, Spectrum Health Delivery System

Jason Joseph, SVP/CIO, Spectrum Health Delivery System

Every industry has a cycle of technology adoption and re-invention. For health care, the implementation of electronic health records (EHRs) has been in full swing for over a decade. As industries evolve, so does the technology that makes them operate more effectively, and health care is no exception. Although the implementation of large, integrated systems promise capabilities that will help organizations grow and transform, what is the best approach for making ongoing investment decisions regarding emerging technology? Should we stay the course and focus on adopting new capabilities from our large, integrated vendors, or consider niche solutions that come to market to solve a specific problem? How should we think about investments in AI (artificial intelligence), predictive analytics, digital automation, and consumer-facing apps that may be poised to revolutionize the experience? How should we navigate the turbulent waters of consumerism, digitization, and the next phase of technological innovation?

"With emerging technologies such as AI, predictive analytics, and consumer-facing digital tools, there are very real opportunities to optimize or transform healthcare"

While there are no easy answers to these questions, a healthy dose of common sense and a clear organizational strategy can go a long way toward charting a course forward. Too often, we start with the technology innovation or the “solution” (a.k.a. the shiny object) in mind and miss the opportunity to really crystallize the strategy or address the problem that needs to be solved. Investing with discipline starts with knowing your goals and strategy, and then looking for solutions—not the other way around. Don’t get me wrong, keeping abreast of new innovations in technology helps ensure we won’t miss opportunities to solve real problems differently. But as any good financial planner will tell you, pick the investments to match the strategy, not the other way around.

By way of example, let’s imagine your organizational strategy is focused on creating a seamless experience for consumers. Part of that strategy requires creating a “digital front door” for consumers 24x7, and enabling any number of online interactive chat functions. Although interactive chat is not a new capability overall, emerging “chat bots” leverage AI to mimic human conversation or at least get the commonly asked questions out of the way. Over time, these bots can become more intelligent and precise as they learn which responses are most appropriate for each situation. Applying a mix of human interactivity and AI can reduce the cost of this service over time, and enable extended hours at a lower cost of operation. If this capability is embedded into your EMR platform or on the vendor’s roadmap, you have an option to pursue that may have long-term benefits in the level of integration and total cost of support. Otherwise, you can do the math on the cost reduction over time (and some assumptions about how the AI bots will supplement human interaction) to determine whether the investment in another AI tool makes sense.

What if your strategy is directed toward improving the health of your at-risk population of patients? Ensuring the health of a population benefits from a focus on prevention and wellness, in addition to low-cost, high-quality care. Although there are a variety of approaches to this, consumer-facing apps provide a cost-effective way to monitor, manage, and improve health and keep people well. As part of a comprehensive program, selection and use of wellness apps ranging from activity tracking, weight management, and DNA-based programs that identify pre-disposed genetic and socio-economic risk factors can be used to proactively keep people healthy and target interventions before existing conditions become complex. Again, a business case can help guide investment decision making regarding which tools will have the greatest impact on your patient population, and determine if functionality available in the core EHR platform can meet this need effectively.

If efficiency of operations is a strategic imperative, you may be looking for ways to reduce the cost of production or improve length of stay. Traditional means of improving operational efficiency would apply, but selective use of AI can help augment manual processes and optimize the efficiency of the revenue cycle by automating routine decision making and reducing the cost (and improving performance) of coding and billing processes. Although some level of automation and improved order set management can be applied within an EMR to optimize inpatient care processes, the use of predictive algorithms can help identify opportunities to intervene in inpatient encounters sooner and improve outcomes while simultaneously reducing the cost of care. Again, where core EHR vendors have embedded this capability into existing tools, the speed to market and total cost of ownership is likely lower. A solid business case outlining the benefits and the total cost of technology can help guide the investment decision.

The key to investing with discipline in health IT starts with understanding the true total cost of ownership (inclusive of implementation, integration, hosting, support, and ongoing maintenance costs) as well as the value received from the investment. The total cost is not difficult to calculate, but is often underestimated as the ongoing costs of support, functional integration, user experience optimization, and maintenance can vary widely between specialized solutions and components of integrated platforms. The objective is to determine the true total cost of ownership and objectively evaluate the quality of the end-user experience. The value proposition must also include a quantification of the benefits and a commitment to measure these benefits over time, recognizing some benefits are less tangible but very significant (ease of use, seamless experience, etc.). Improving a process that doesn’t contribute to an improved outcome (or reduce actual cost) may not be the right place to focus. Furthermore, pursuing a specialized solution with an overall higher total cost of ownership (but with incremental benefits in functionality) may not actually contribute materially to improved outcomes when compared to an integrated (but functionally inferior) alternative.

Finally, there are times where the value achieved is unclear or not quantifiable. This is particularly true with emerging technologies. In these cases, don’t be afraid to invest in an experiment (innovation requires this), but do so diligently with a calculated investment and frequent check-points to measure the value that is being realized. Higher risk investments may yield a higher potential reward or an organizational learning benefit, but also come with the possibility that the investment will not yield outcomes as intended.

With emerging technologies such as AI, predictive analytics, and consumer-facing digital tools, there are very real opportunities to optimize or transform healthcare. Just make sure the investment approach follows the strategy, and invest with discipline.

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