January/February 2019

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Can Tech Revolutionize Medicine?

TO SOLVE A COMPLEX HEALTHCARE CHALLENGE, FOCUS ON YOUR MISSION Larry Ozeran, MD What is your mission? Do you know your mission, personally or professionally? My personal mission is to do well by doing good. My corporate mission is to promote optimal computer use in clinical practice. Your mission matters when used in day-to-day choices as well as strategic initiatives. My personal mission guides me every day and helps me make difficult decisions, such as where to practice when I finished surgical training. Rather than staying in Beverly Hills after finishing residency, I moved to a rural community in Northern California because they had a desperate need for surgeons. My income was lower but my scope of practice expanded to fill the void of cardiac, oncologic, and thoracic surgeons. I lived a mission-driven practice I loved.

How does a mission-driven process help manage more complex decisions?

When evaluating a complex challenge, first consider your mission, then your values, objectives, and goals. Create a needs assessment, a laundry list of what you need to meet your objectives and goals while honoring your values and focusing on your mission. Create a gap analysis that maps a path from where you are to where you want to be. Together, these efforts will define the products and services you need to be mission-driven.

Mission defines the context for managing your challenge.

How might this work? Imagine it is 2011 and your health system is looking fearfully at ARRA legislation that included $38 billion in incentive payments for adoption of Electronic Health Records (EHRs) and penalties of up to 3% of Medicare revenues starting in 2017 if you don’t adopt a certified EHR. To approach this complex issue focused on mission, first ask “How can we integrate this new requirement into our mission-driven activities?” In this story, your mission is some form of “We value our patients and give them the best care at an affordable price.” Your mission says that you value 3 things: 1) patients, 2) quality of care, and 3) cost. In my 2011 HIMSS podcast [https://www.himss.org/ episode-34-impact-arra-incentives-and-ehr-adoption], I focused on cost. I encouraged healthcare leaders to apply 18

SAN FRANCISCO MARIN MEDICINE JANUARY/FEBRUARY 2019

for the incentive payments if they were already on the path to EHR adoption. Otherwise, I urged careful consideration of the Return on Investment (ROI) before automatically responding to the legislation by adopting an EHR. I think that few healthcare leaders and organizations fully considered how the costs of the Meaningful Use program, both financial and human, might impact their mission. Not only were huge sums of money spent, clinical workflow was seriously modified. In some cases patients were harmed, and in some cases financial ruin befell the organization. One hospital was reportedly bankrupted by their EHR purchase. A focus on mission might have avoided these serious negative outcomes. Continuing the example, let us consider an imaginary heath health system that is focused on its mission. In 2010, Focused Health: • generated $6 billion in annual revenue,

• collected 30% of its revenue from Medicare (though 50% of its patients were Medicare beneficiaries), and

• faced a penalty of 3% of Medicare revenue starting in 2017 for not implementing an EHR.

The Focused Health mission valued patients, quality and cost. In the context of its mission, its leadership created a broadly representative multi-stakeholder team to develop a needs assessment and gap analysis. The team reported that there were EHRs with beneficial features, but no existing EHR would meet all of their needs and major workarounds would be needed. What should they do? Before describing what Focused Health did, recall that an EHR is a tool. Workarounds are an indicator that either the wrong tool has been selected or the tool is being used in the wrong way. Imagine that you need to insert a nail into wood and the only tools available are a dictionary and a small, flimsy piece of sheet metal. What do you do? You can create a workaround, wrapping the sheet metal around the book. You can search for more traditional tools. You can step back and ask, do we need to insert the nail? Without the context for this generic need, options are limited. WWW.SFMMS.ORG


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