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Improving IT wellness— Healthcare organizations adopt knowledge-enabled technology

By Vicki Powers

Three healthcare organizations are attaining their goals using content management and Web-based technologies. VHA, Allina Hospitals & Clinics and Highmark are succeeding at a time when healthcare technology costs are escalating faster than success.

According to Sheldon I. Dorenfest, who has followed healthcare technology for 30 years, the industry is poor at implementing technology. As a result, healthcare organizations add a variety of solutions to bandage their mix of manual and automated systems created from many years of trial and error.

"Healthcare organizations haven't lagged in [technology] spending, but they've lagged in execution," says Dorenfest, who is CEO of Dorenfest & Associates, a Chicago-based provider of health information technology market data. "The technology doesn't produce the results they want and gets more cumbersome and complex. This adds lots of cost to the healthcare delivery system and creates redundant processes. It's all very primitive right now compared with other industries."

Healthcare information technology spending is expected to grow around 9 percent per year for the next three years. to reach $30 million in 2006, according to Dorenfest. Document management systems are being purchased as one way to manage and integrate with manual systems, and Dorenfest believes buying in that area will grow rapidly.

"Every day they have to do something better than the day before," he says.

Encouraging member collaboration at VHA

It all started for VHA with just 500 content items on two healthcare topics. A member-based network, VHA has 2,200 healthcare organization members include 1,400 hospitals, 175,000 physicians and more than 1 million employees. It promotes healthcare performance improvement through better patient care, operations and supply management.

"As we began to help members make improvements, we needed a way to connect them to share their learning," says Debra Hughey, VHA's clinical knowledge management director. "We put together a Web-based application where members could post their own content and collaborate around those issues."

That member knowledge exchange, known as VHA Clinical Knowledge Management (CKM), started in 1999. VHA built the technology in-house using a Domino server and Lotus Notes from IBM Lotus. Users can access CKM from any browser and Internet connection, which physicians often do from home.

The CKM's first two topics exploded into 7,000 content items in 19 different focus areas such as patient safety, critical care, case management, clinical systems and work force strategies.

"Given the mass amounts of information available, you can't get this kind of content anywhere else," says Hughey. "There is no place to go to contribute to help your colleagues across the country, without having a review process in place."

Members post their own content, which is immediately viewable on the network—an advantage to the system. Nothing has to go through a review before it can be uploaded to the CKM. Another benefit is the amount of time members save doing their jobs. VHA members go to the CKM, click on a topic—such as patient safety—and have access to all kinds of targeted information including threaded forum discussions, related Web sites, upcoming meetings, subject matter expert materials, actual assessments and other documents shared by VHA members.

"One of the unique things about VHA is the collective strength of the alliance," says Hughey. "Members might find 10 different healthcare policies on patient safety and not have to start from scratch in their own organization."

Based on its last member survey, Hughey says VHA members value the CKM. The Web-based application averages 2,000 unique visitors per month and 5,000 total visitor sessions each month.

"Eighty percent of the survey respondents said the CKM had saved them time in their work," says Hughey. "In healthcare, our bottom line is patient care and improving patient care. Our workers are very focused on that. If I can do something to help my colleagues, that's great."

Achieving JCAHO compliance with Allina Knowledge Network

Allina Hospitals & Clinics, comprising 13 hospitals and 42 clinics in Minnesota and western Wisconsin, needed a technology system to keep its 23,000 employees current on ever-changing policies and procedures required by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO). The Allina system didn't have an intranet or content management system, so all of the policies and procedures were manually copied and replaced in manuals throughout the system.

"There was a lot of chance for error in the manual system," says Paula Maidl, IS manager at Allina Hospitals & Clinics.

Technology is critical to the healthcare industry, according to Michael Hayworth, director of industry solutions at Stellent, a provider of content management solutions. First, the industry must disseminate information throughout the organization, often to comply with JCAHO standards, such as Allina's situation. Other needs focus on providing useful information on the Web and automating paper-based processes.

Allina selected the Stellent Content Management system as a backbone and built the intranet around that adding Web-based navigation. The system, dubbed Allina Knowledge Network, helps the organization comply with JCAHO regulations by storing and tracking changes to hospital policies and procedures. The Stellent Content Server also houses all of Allina's corporate information, forms and requests.

"As more people hear about it, they are asking to use it," Maidl says. "It's now seen as a tool everyone needs to use."

Allina's IT group trained more than 100 contributors who post to a secure area via a browser. Employees access the content stored in the server through the company's intranet.

The new system required a culture change, especially for the hospital staff members who don't use a computer in their daily work. The IT department realized the challenge involved and worked with them through the transition. It gathered leaders at each hospital to serve as project champions and gave those leaders training before the system went live. Those hospital representatives, called the Health Care Initiatives Group, continue to meet each quarter to share best practices, offer feedback and share training materials. Maidl says people automatically look on the Knowledge Network now rather than calling or e-mailing other staff members for help.

Allina has achieved many benefits from its content management system, such as reduced printing costs and significantly less time spent searching for and printing forms. The greatest benefit, according to Maidl, is the ability to update documents to 23,000 employees instantly. Employees are more organized and productive, which ultimately contributes to Allina's bottom line.

Participation in the Allina Knowledge Network continues to steadily increase. In 2003, it averaged more than 1 million page views per month for a total of 11,280,679 page views from February through November.

Connecting Highmark providers with physicians

Executives at Highmark, a Pennsylvania-based non-profit providing insurance products to 23 million members in the state and across the nation, realized in 2000 that the organization needed to adopt Web-based technology to maintain its reputation for cutting-edge solutions. Highmark understood that its providers and their office staff members experienced frustration and time delays communicating with the health plan—just to complete simple tasks such as check insurance eligibility or authorize a referral.

As a result, Highmark partnered with Boston-based NaviMedix to provide an innovative application that links a provider's office to the plan. The Web-based solution, called NaviNet, speeds insurance coverage verification and facilitates referrals and other routine transactions through an Internet browser. The technology operates from NaviMedix Servers at the physician's office and the Healthcare Partner Servers that manage the partner's Web forms and business rules. A critical element was to offer tools to provider offices that would not interfere with the daily practice workflow.

Highmark and NaviMedix worked with Accenture consultants to design, develop and deploy the product. Several activities before the phased rollout helped ensure success. The organization relied on design teams to develop the nuts and bolts for the scope and design of each transaction. It also spent two months of targeted communications with providers and office managers to communicate the benefits of NaviNet and identify physician thought leaders to champion the initiative. According to August Kairys, Highmark's VP of provider relations, by the time the product was deployed to the initial sites, the "buzz was already buzzing."

Within 89 days, the organization installed NaviNet to 200 providers. Those offices conducted more than 4,000 transactions after the first week. Currently Highmark has more than 18,000 physicians tied into the system, which saves a tremendous amount of money. Officials at Highmark estimate that before NaviNet, telephone transactions cost the organization about $8 per call. Today, that figure is less than 50 cents for each electronic transaction with NaviNet.

Highmark is one of nine healthcare organizations in Pennsylvania participating in this common, Web-based connectivity platform. The result of the widespread adoption is that 25,000 physicians and more than 150 Pennsylvania hospitals use a single point of access with participating organizations. Those physicians conducted more than 2.1 million real-time, Web-based transactions, which set a new benchmark for multipayer connectivity.

Vicki Powers is a freelance writer of knowledge management and business-related articles, e-mail vpowers@houston.rr.com

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