The Top Three Things Healthcare Can Learn from Other Industries

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1 The Top Three Things Healthcare Can Learn from Other Industries ABSTRACT Advanced technology is being used in many industries (and by a few innovative healthcare providers) to engage consumers, adapt to changes in their behavior, predict business (or clinical) outcomes, and improve utilization of scarce resources. These capabilities are leading to lowered costs and higher quality outcomes and can be applied to healthcare delivery without sacrificing the personal nature of patient care. Healthcare delivery organizations (HDOs) can learn from successes in other industries and skip the learning and investment steps, if they are open to changing the context, defining new processes, and tying it all together with advanced technology. Healthcare delivery and reimbursement in this country is changing quickly, and the ability to rapidly and efficiently respond to these changes can be a key differentiator. The adoption of advanced information technology in healthcare has generally lagged other industries for many reasons; Therefore, the associated productivity and quality gains have not been fully realized. For those provider organizations willing to think differently, there is a competitive advantage to be gained.

2 WHITEPAPER 2 INTRODUCTION Healthcare IT is at least 10 years behind other industries in terms of philosophy, sophistication, and deployment of advanced technologies. We have all heard some form of that statement and maybe even used it ourselves. Is it true? If so, what are some of the reasons? In what ways are other industries leveraging new ideas and technology? Other industries have invested significant time, effort, and money to get to their current level of sophistication. How can healthcare organizations leverage this learning and investment to leapfrog their competition? Only about a decade ago, India and China made leaps and bounds in opening their societies to the western world. Instead of telephone poles and landlines, companies met 21st century challenges head-on by manufacturing mobile phones and deploying mobile apps. Every industry faces challenges in keeping up with ever-improving technology. The healthcare industry has the opportunity to leapfrog to 21st century information technology solutions and relieve itself of trying to solve today s problems with yesterday s technology. There are three practices that healthcare can adopt to do what other industries have done: reframe conversations, improve processes, and leverage technology. These practices are interconnected, a package deal that offers greater efficiency. The processes have been proven in other industries, the technology is available to healthcare, and the industry has the power to innovate like never before. CHANGING THE CONTEXT What is interesting is how other industries relate to consumers. It is inherent in the terminology. In retail, consumers are referred to as customers or even fans, but in healthcare, insurance companies are payers, and consumers are patients. Currently there is apathy, but healthcare has the potential to do what retail has done in turning customers into fans by creating personal relationships. Instead of limited or one-size-fits-all styles of communication, technology can provide contextual information, individualized experiences, and help develop personal, trusted, relationships with consumers of care delivery services. DEFINING NEW PROCESSES When it comes to ensuring that processes are efficient and well managed, best practices are key to healthcare s potential advancements. In terms of security and risk management, all industries hope to have their consumers information secured. In the financial industry, people increasingly use mobile and online banking because the technology is trustworthy. The financial industry not only makes bank data readily available and secure, for effective risk management, it also makes available data tailored to each customer. In contrast, a 2012 survey indicated that 85% of Americans have expressed anxiety over the transmission and maintenance of electronic medical records. Doctors, nurses, and healthcare professionals do their best to ensure their patients receive the best care. The industry itself can do the same by using technology to ensure processes are the as efficient and effective as possible.

3 WHITEPAPER 3 USING TECHNOLOGY TO TIE IT ALL TOGETHER Information technology is not a zero sum game as every industry can improve if it leverages technological advancement. Healthcare is more than capable of doing what the transportation and logistics industries have done in getting a complete view of an organization and giving people the right information at the right time. By utilizing online bookings, airport kiosks, reservation centers, and baggage tracking devices, airlines have cut costs and increased profits. Moreover, they have made the traveling experience more enjoyable. Just as a consumer can check the delivery status of their package, if they want to know the status of an insurance claim or outcome of a treatment or surgery, that information should be available. Websites that provide information on treatment options and outcomes should be designed for a consumer layperson s understanding. Automation, data analytics, and collaboration tools are all available for improving healthcare supply chain operations. For collaborative inventory planning and order forecasting, many industries have created an integrated supply-chain network so that everyone has the right information when they need it and can make decisions. In all three areas context, processes, and technology it is evident that healthcare is more than capable of doing what other industries have done to improve. The more information that is available, the more technology is applied, and the more healthcare continues to innovate, the better the diagnoses, treatments, and care. PROBLEM DEFINITION Advanced technology is being used today by many industries (and a few innovative healthcare providers) to engage consumers, adapt to changes in their behavior, predict business (or clinical) outcomes, and manage perishable inventory. These capabilities are leading to lowered costs and higher quality outcomes. The drive to improve financial performance through lowered costs, new revenue streams, and higher productivity while maintaining or improving quality is nothing new. All industries and businesses strive to achieve these things. What is different is how some industries have been able to derive additional value from their technology investments by thinking about the business in new ways. They were able to develop a new perspective on the business and use advanced technology as an enabler. Is healthcare different? If so, how? Healthcare has for many years functioned in a fee-for-service model; the more services provided, the more reimbursement received. The HITECH Act, Affordable Care Act, and other market dynamics are starting to change this. The marketplace is evolving towards a shared risk or accountability model in which providers and payers must cooperate to keep a certain population healthy. While there will certainly be challenges during the transition as both systems will likely co-exist for a time, it is clear that healthcare organizations must engage patients/members in new ways. They must think less about traditional acute care and ambulatory care silos and more about the number and type of resources and how they can be used differently. The traditional thinking has been that healthcare delivery is different, that treating patients is part art and part science, and that rules and processes that work in other industries just don t apply in healthcare. Resources that are leveraged in the care delivery process will have to be viewed differently. How can inpatient census be optimized across multiple facilities? How can staffing be managed in real time and linked closely with acuity? Are three CT scanners really required, or are there ways to more efficiently schedule two scanners while proactively managing preventative maintenance to assure maximum up-time?

4 WHITEPAPER 4 There are many reasons for the delayed adoption of advanced technology in healthcare. Among them: Penalties for PHI breaches, as well as potential for damage to brand or reputation, have in many ways kept healthcare providers from sharing data more freely and across traditional boundaries. Close ties and reliance on traditional EMR vendors and HIT providers for very important functions, including support for regulatory initiatives like Meaningful Use and ICD-10. Unfortunately, as much as EMR vendors would like to think they can cover all HDO needs, it is still a very heterogeneous vendor and technology environment. The lack of integration between key platforms continues to inhibit more thorough use of real-time events and data. In some cases, there is a general lack of standards to adequately define and support interoperability. More often though, standards exist but there is lack of adoption (or incomplete adoption) by many provider and payer organizations. Resistance to change, with some common recurring themes, such as: That s the way we ve always done it, or Healthcare is different, or Healthcare is more art than science, or I don t want a computer telling me how to practice medicine. Of course there is some truth in all of these and other industries are not immune to the fear of change, either which points to the very real need to aggressively manage change at an enterprise level. The ultimate goal is getting and keeping the patient well; Therefore, it will be important to ensure that the doctor-patient relationship and trust remain intact. Most HDOs are still very siloed with respect to delivery of healthcare. Workflows, if they exist, are departmental or vertical in nature. Very rarely does the organization take a holistic, horizontal, patient-centric view of processes that cut across departments or silos. Real-time or event-specific information is used mainly to populate applications (which is appropriate to support specific functions), but the event (something that occurred at a specific point in time) in the context of time is lost. For all of the challenges being experienced in the healthcare industry, there are surprisingly few that are specific to the delivery of patient care, which means, all things considered, that healthcare is really not that different. The list above is certainly not exhaustive but illustrative of the need to change the context, think differently about processes, and tie everything together. Other industries have successfully made this transition through investment in process and organizational redesign, investment in the right technologies, and implementation of change management. This is good news for healthcare providers since they can immediately benefit by adopting similar philosophies and technology. Let s see what this would look like. SOLUTIONS IN OTHER INDUSTRIES Leading organizations in other industries such as transportation, energy, retail, finance, and telecommunications have long used comprehensive, integrated, event-enabled platforms to deliver consistently better results. These platforms allow them to harvest their data to enhance operational predictability, synchronize and control processes, and simultaneously personalize their customer experience. Achieving this has required them to think about their business differently in term of processes (both macro and micro) and data. Big data is being turned into Fast Data as the data in motion and data at rest worlds collide. Healthcare is a very data- and event-rich environment, but much of the information remains isolated in databases that lack real-time connectivity and the context of real-time events. As a result, it is information poor.

5 WHITEPAPER 5 As you read through the following short vignettes from other industries, think about how these concepts can be leveraged in healthcare. A large retailer can recognize a customer s buying patterns in real time and make customer-specific discount offers at the point of sale. For example, a customer purchasing two dress shirts has not bought any ties for two years. How about a 25% discount on three ties? In terms of changing the context in healthcare, a similar story could be told about a member of a large health plan being sent a free gym membership when they schedule a checkup and it is recognized that their weight and blood pressure have both increased significantly over a certain period of time. The concept of investing to help healthcare consumers stay well is certainly a new context and counterintuitive in the old fee-for-service world. In the airline industry, when baggage has been rerouted and is not on the same aircraft as the passenger, software can send a text message or to passengers mobile phones, alerting them to the situation and providing a toll-free number to call at the destination airport. Also provided is a special identification code used to track the baggage. By communicating this way, the airline saves the passenger time finding out something the airline already knows. As a result, ill-will is reduced and passenger loyalty is bolstered. At most airlines, baggage handling had traditionally been considered an internal function, and until recently, very little thought was given to engaging consumers in the process. Healthcare organizations that think about processes holistically or cross-organizationally can gain advantages in areas like chronic disease management and patient satisfaction. Again from the airline industry, an event that frequently causes delays is a passenger who has checked bags and received a boarding pass, but fails to show up by the last boarding call. What should be done? Normally, the best course of action would be decided by the gate manager in consultation with others, including the pilot. However, a complex event processing (CEP) system can analyze the possible solutions in real time and take into account several variables given real-time data: the length of time before the departure slot is lost, the amount of time required to off-load the baggage based on historical data and data from other gates earlier in the day, the effect of waiting longer or removing the luggage in light of emerging weather patterns along the flight route, and the passenger s loyalty-program status. These results can be matched with flight crew constraints, ATC flow control, noise-curfew rules, and additional factors. Rather than having the gate managers examine the various factors and sort them into a priority scheme based on previous experience (which depending on the individuals might lead to conflicting solutions), CEP software can factor the various scenarios using real-time data, identify the options with the fewest drawbacks, and help the person in charge make a better decision. The translation of this scenario to healthcare is not difficult. Healthcare has silos of operational data and processes that are not well coordinated today. The ability to tie all this together and provide visibility into what is happening in real time is the key difference.

6 WHITEPAPER 6 One can easily imagine the plethora of seemingly unrelated health-related events being correlated in real time to orchestrate and optimize macro and micro processes, such as pre-admission, admission, or discharge. Applying technology to the discharge process alone could result in savings in terms of reduced length of stay, cost, or penalty avoidance due to reduced numbers of readmissions and improvement in patient satisfaction and engagement. For example, The Hospitalist reported that the University of Michigan improved discharge time by 54% simply by realizing that there were tasks in their process that were handled serially that could easily be run in parallel. All it took to achieve this major improvement was looking at their process differently and implementing one paper form. Imagine what they could do by managing bottlenecks in real time. Things really get interesting when you think about using technology to present clinicians with real-time, evidence-based choices. Many innovative healthcare organizations are already applying this kind of advanced technology to create possibilities like prediction and prevention of sepsis, real-time cardiac risk assessment, and potentially, heart attack prevention. WHAT HEALTHCARE DELIVERY SYSTEMS NEED TO DO EMRs are only part of the answer. Despite our best efforts to facilitate workflow for orders in Epic, we have errors everyday with release of orders too soon, too late, or not at all.... When orders aren t present when the patients arrive to be prepped for surgery, it results in a flurry of calls and pages, and ultimately a case delay, and everyone is unhappy, reports a leader in an Illinois healthcare organization. Problems like these occur because we are humans! Humans react to events and not very well to preset workflows. Just as we try to impose some sense of order in our lives as we react to events, we similarly try to optimize hospital operations. However, as a HIT professional, you know there are many variables that influence our ability to fulfill our mission: staffing shortages, emergencies, patient coding, and so on. These are all events we need to react to. Recognizing that these are events meaningful business and clinical events we must change our context. When these events occur, an efficient workflow should recognize them, enable us to react to them, and help move us back to standard work. This is a LEAN principle; Getting back to the mudda (daily ritual) requires that we detect and anticipate issues and resolve them so we can get back to standard work. Traditional solutions for integrating data in hospitals have relied on point-topoint integrations. This model breaks down over time with growth in demand for data and the reality of the n2 or n(n-1) connections rule: Point-to-point connections of n systems requires that almost n squared connections will need to be maintained. To better understand and utilize data being generated in healthcare, we need the ability to capture and consume event-based real-time data and correlate it to create continuous intelligence about our patients. We need to create a platform that can facilitate predictive analytics while simultaneously addressing the need to increase speed to market for system integration initiatives. The solution is to implement an enterprise service bus (ESB) that eliminates the need for point-to-point interfaces. An interface should be written once and reused for all future systems that need the same data. Additionally, each message should be able to be opened in real time to understand the event(s) being represented by the message. These are the business events we care about, and they should be directly available for analytics.

7 WHITEPAPER 7 One Illinois medical center has adopted this approach. While it is only partway through its journey having replaced the legacy system with an ESB and migrated over 150 interfaces to the new platform it is embarking on an exciting phase to help redefine how information technology can be used to transform care delivery. Its early efforts have produced very promising results: A CEP prototype of a proprietary algorithm it developed has been successfully predicting cardiac arrests up to three days in advance of the incident. The medical center intends to improve its patient experience by implementing an event-driven real-time analytics platform aimed at enabling continuity of care. Such a platform would notify the right departments in real time when key patient events occur. Here are a few scenarios that are being implemented: 1 Alerts could be generated from ED arrival of a recently discharged patient to engage providers and staff that previously treated that patient. 2 Inefficiencies could be reduced by prioritizing discharge activities and better facilitating care team collaboration. 3 Predictive analytics could be operationalized to forewarn of potential adverse outcomes allowing opportunity for intervention. 4 Various IS and operational processes could benefit from immediate notification and automation of activities upon detection of certain conditions. For example, unauthorized activity detection and notification and unplanned downtime alerts to specific IS on-call resources. SUMMARY Nearly everyone agrees that today s U.S. healthcare system costs too much. As reimbursement models change and new laws and regulations are implemented, healthcare delivery organizations are being challenged more than ever before to do more with less. Unless HDOs can change the context of how they think about patients, customers, members, physicians, employees, and others; look differently at processes; and achieve higher levels of data and process integration, it will be nearly impossible to thrive in the new environment. To get started, HDOs must implement an enterprise services bus and move away from traditional point-to-point integration methods and technologies. This is a foundational step that provides a platform on which all other innovations and transformations can be built. Additionally, the efficiencies gained through reduced complexity, fewer connections, and increased reuse, will allow the organization to achieve speed to value on new solutions and lower TCO. The faster HDOs pivot to a services bus and an event-enabled enterprise philosophy, the greater success they will have in the increasingly competitive market for members, patients, physicians, and a skilled workforce. HDOs can meet some of their toughest challenges by learning what other industries have already accomplished using advanced technology like that available from TIBCO Software. Additionally, organizations that look at what innovators in healthcare are doing can get a very clear glimpse of the future of event-enabled healthcare. Global Headquarters 3307 Hillview Avenue Palo Alto, CA TEL FAX TIBCO Software Inc. (NASDAQ: TIBX) is a global leader in infrastructure and business intelligence software. Whether it s optimizing inventory, cross-selling products, or averting crisis before it happens, TIBCO uniquely delivers the Two-Second Advantage the ability to capture the right information at the right time and act on it preemptively for a competitive advantage. With a broad mix of innovative products and services, customers around the world trust TIBCO as their strategic technology partner. Learn more about TIBCO at , TIBCO Software Inc. All rights reserved. TIBCO, the TIBCO logo, and TIBCO Software are trademarks or registered trademarks of TIBCO Software Inc. or its subsidiaries in the United States and/or other countries. All other product and company names and marks in this document are the property of their respective owners and mentioned for identification purposes only. 10/16/14