Feature / US study tour: Electronic records - a competitive edge

The focus in healthcare is shifting from delivering volume to delivering value or outcomes, writes Sue Jacques. One of the clear roles for the finance profession in this is to contribute to the development of meaningful outcome measures and look for ways to link funding to the delivery of these outcomes.

This is as important for governments in charge of policy as it is for commissioners, insurers and providers of healthcare, and quantification of such complex measures is reliant on effective data capture.

The importance has been underscored in the US with the introduction of federal incentives for the meaningful use of electronic patient records (EPRs) – this if nothing else has resulted in more widespread use of EPRs.

Four sites visited by the HFMA/ACCA study tour – Geisinger Health System, VA Philadelphia, New York Presbyterian and United Hospital System Kenosha – were very different in nature. But all four had forms of EPRs that were part of a strategic approach to securing and maintaining competitive advantage in a changing environment. EPRs were being exploited in three areas:

1. Decision support As medicine becomes more specialised and evidence-based, organisations are introducing pathways to ensure consistency in process and quality. But pathways can become disjointed, interrupted and even ignored – a result of non-elective pressures, for instance, resulting in patients being put into surgical beds, or staff shift patterns or increasing clinical policies.

The EPR systems in use could not only document events relating to a patient, but also prompt the clinician to do tasks. Where appropriate, the records even prohibited clinicians carrying out further action until they had done so. Any deviation was reportable in real time, enabling it to be reviewed by a senior decision maker. Clinicians will always need to be able to exercise judgement, but the EPR system’s decision support functionality can support safer care.

2. Connecting with the customer – personalisation To the horror of my teenage daughters, I have no Facebook page, nor have I ever tweeted. Despite this, I wouldn’t consider arranging my car insurance without going online to compare offers, nor would I restrict myself to the inconvenience of high-street banking. The organisations dealing with me online know a lot about me and use it to tailor their offerings to my needs. In return, I reward them with my business.

The power of this approach in healthcare was most evident at Geisinger. Members of its health plan, whether existing patients or not, have an account allowing them to transact with Geisinger online in a simple, personalised way, simplifying everything from booking an appointment to checking the results of a test.

As well as providing patient benefits, this approach to business creates exit barriers – if it’s straightforward to deal with Geisinger, if GHS already knows everything about my health issues and allows these details to be shared (with my permission) between hospital and community health providers, why leave?

3. Patient centred costing The EPR system also provides the building blocks to allow finance leaders to shift from a cost-centred analysis of their business to a patient-centred analysis, broadening thinking about ways to streamline processes, improve care and save money.

Imagine being able to more accurately share variation in practice and cost with clinicians, linked directly to outcomes. Then imagine clinicians being able to do this for themselves, adjusting their practice in real time as needed. EPR supports patient level costing, enhancing cost attribution. US evidence shows they give:

• Access to richer and meaningful clinical, operational and financial data
• A common language and metrics for success across multiple clinical areas
• Stronger clinical accountability
• More ready identification of opportunities for improvement
• The ability to monitor progress and fine tune processes to drive success.

All of this would be helpful to us in the English NHS right now. And it will become even more vital when faced with the challenge of agreeing the cost of designated services and their inter relationships with the cost structures of other services.

In the US, business cases for EPR were rare – their introduction was a strategic top-level command, with operational return often not quantified.  It was seen as a way to secure competitive advantage, at least in the short term, and had become mission critical.

In the NHS, the Department of Health, realising the power of the EPR, established the National Programme for IT and Connecting for Health.

Arguably such a centralist approach, at a time where the provider landscape was increasingly populated by more independent commercial orientated foundation trusts,

had the potential to misfire. We now find ourselves (at least in the foundation trust sector) freer to do what we believe is right, constrained only by our imagination and the investment we can raise. Some will ask whether they can afford to invest in an EPR, others whether they can afford not to. As finance professionals we must help our

organisations get that choice right. So where will your imagination take you? n

• Sue Jacques is director of finance and deputy chief executive at County Durham and Darlington NHS FT