ecommerce - amazon s3 · ehealth, ecommerce …where’s the beef? himss conference 2002 mark l....

eHealtheHealth,, eCommerceeCommerce…Where’s the Beef?…Where’s the Beef?

HIMSS Conference 2002Mark L. Andersen, CIO / Sr. Vice President, [email protected] New Haven Health System

2 HIMSS 2002 - eHealth, eCommerce…Where’s the Beef?

Yale New Haven Health SystemYale New Haven Health System

◆◆ Presently includes:Presently includes:–– MembersMembers

•• YaleYale--New Haven HospitalNew Haven Hospital•• Bridgeport HospitalBridgeport Hospital•• Greenwich HospitalGreenwich Hospital

–– Network ParticipantsNetwork Participants•• Westerly HospitalWesterly Hospital

◆◆ Affiliated with the Yale School of MedicineAffiliated with the Yale School of Medicine◆◆ Approximately 10,000 employeesApproximately 10,000 employees◆◆ Third largest nonThird largest non--governmental employer in the state governmental employer in the state ◆◆ 18.4% of the state’s inpatient market18.4% of the state’s inpatient market

–– 72,799 inpatient discharges/1.33 million outpatient visits 72,799 inpatient discharges/1.33 million outpatient visits ◆◆ $1.5 billion in total assets$1.5 billion in total assets◆◆ FY01 net revenue of approximately $1 billion FY01 net revenue of approximately $1 billion


Key YNHHS FY 2001 InitiativesKey YNHHS FY 2001 Initiatives

◆◆ Patient safety Patient safety ◆◆ Patient satisfactionPatient satisfaction◆◆ Clinical quality initiativesClinical quality initiatives◆◆ Clinical service expansionClinical service expansion◆◆ HIPAA HIPAA ◆◆ Revenue enhancement Revenue enhancement ◆◆ Cost SavingsCost Savings◆◆ ehealthehealth strategystrategy


Background: Major IS ProjectsBackground: Major IS Projects

◆◆ SystemSystem--wide Lawson MM/AP/GL/HR/Payroll wide Lawson MM/AP/GL/HR/Payroll ImplementationImplementation

◆◆ Eclipsys’ Eclipsys’ PFM product installed at 2 hospitalsPFM product installed at 2 hospitals◆◆ SystemSystem--wide PACs evaluationwide PACs evaluation◆◆ Eclipsys’Eclipsys’ EPI Project across the systemEPI Project across the system◆◆ SystemSystem--wide Interface Enginewide Interface Engine◆◆ Improvements in the technical infrastructure to facilitate Improvements in the technical infrastructure to facilitate

communications across the systemcommunications across the system◆◆ SystemSystem--wide upgrades to the wide upgrades to the Eclipsys Eclipsys DSM productDSM product


Issues that drove us to “Issues that drove us to “eCommerceeCommerce””

◆◆ Patient CarePatient Care–– Challenges in disseminating vital patient information to cliniciChallenges in disseminating vital patient information to clinicians at ans at

the point of carethe point of care–– HIPAA HIPAA -- the need to do things in a more standard, secure, an the need to do things in a more standard, secure, an

confidential wayconfidential way–– Need to seek out creative ways to improve the quality of patientNeed to seek out creative ways to improve the quality of patient

care and to improve patient safetycare and to improve patient safety–– Impending demands for patient management of health records, Impending demands for patient management of health records,

communications with physicians, etc.communications with physicians, etc.–– Hope that with new technology, patients and caregivers can do Hope that with new technology, patients and caregivers can do

more with less supportmore with less support

◆◆ GeneralGeneral–– Needed to “pull together” our various web initiatives into a Needed to “pull together” our various web initiatives into a planplan to to

ensure that the initiatives meet our corporate objectivesensure that the initiatives meet our corporate objectives–– A hope that by being more efficient, we may reduce some costsA hope that by being more efficient, we may reduce some costs


Issues that drove us to “Issues that drove us to “eCommerceeCommerce””

◆◆ eBusinesseBusiness–– Need to streamline EDI, Supply Chain Management, and claims Need to streamline EDI, Supply Chain Management, and claims

processingprocessing–– Revenue enhancement processesRevenue enhancement processes–– Our Lawson implementationOur Lawson implementation–– Access to / availability of new vendors that facilitateAccess to / availability of new vendors that facilitate

eCommerceeCommerce//eHealtheHealth transactionstransactions

◆◆ Consumer Outreach / MarketingConsumer Outreach / Marketing–– Consumer demand to do more on the WebConsumer demand to do more on the Web–– Need to creatively seek ways to build relationships with our Need to creatively seek ways to build relationships with our

consumers and extend brand equityconsumers and extend brand equity–– Ongoing interest in enhancing market image and positionOngoing interest in enhancing market image and position–– Efforts to promote direct contact and interaction with consumersEfforts to promote direct contact and interaction with consumers

and employees (selfand employees (self--service)service)


YNHHSYNHHS eHealtheHealth Position StatementPosition Statement

◆◆ The Internet is intended to serve and support the business stratThe Internet is intended to serve and support the business strategy of egy of the organization. the organization.

–– To be successful To be successful -- integrate these Internet initiatives into the fabric of the integrate these Internet initiatives into the fabric of the business strategy. business strategy.

–– Incorporate advanced technology to support, enhance and complemeIncorporate advanced technology to support, enhance and complement nt our core business our core business –– providing health care services. providing health care services.

◆◆ By speeding up access to and increasing the availability of By speeding up access to and increasing the availability of information, the Internet will significantly improve our businesinformation, the Internet will significantly improve our business s processes and outcomes.processes and outcomes.

◆◆ YNHHS will be an early adopter of solutions provided by commerciYNHHS will be an early adopter of solutions provided by commercial al vendors. vendors.

•• purchase turnkey applications from commercial organizations, or purchase turnkey applications from commercial organizations, or •• become development partners with commercial organizations become development partners with commercial organizations

–– Enables YNHHS to more effectively leverage and utilize InternetEnables YNHHS to more effectively leverage and utilize Internet--based based solutions to accomplish our business strategy and stay current isolutions to accomplish our business strategy and stay current in a rapidly n a rapidly changing technological environment.changing technological environment.


Revenue EnhancementEligibility Comm.Utilization ReviewPatient DataClaim/StatusHIPAA EDIReferral Process

BanksPayment AdvicePayment Notices

eSupply ChainNeoformaLawsonOrganizationOwens & Minor

EmployeesEnrollmentSelf-ServiceIntranet

PhysiciansClinical WorkflowPatient CommunicationOrdersResultsImagesReferral Process

Medical InformationServicesPublicationsResearchHealth BulletinMedical KnowledgeClinical Trials

Inpatient CliniciansSCM (Web)Clinical WorkstationWireless TechnologiesPACs Web Viewers

Patients/ConsumersPublic Web SitesPersonal Health RecordsPhysician Office Communications

eCommerce eCommerce / / eHealtheHealth at YNHHSat YNHHS

Health CareHealth CareSystemSystem


What is Electronic Commerce?What is Electronic Commerce?

Is a dynamic set of technologies,applications and business processes that

link enterprises, consumers andcommunities through the electronic

exchange of goods, services, transactions and information…

ORACLE


Success Factors for TransitionSuccess Factors for Transition

Supply Chain Enhancement through Supply Chain Enhancement through eCommerceeCommerce


* Source:Efficient Consumer Healthcare Response report, 1997

Current State: Health Care Supply ChainCurrent State: Health Care Supply Chain

◆◆ Health care industry spends upwards of $200 billion on products,Health care industry spends upwards of $200 billion on products,services and processes associated with the supply chainservices and processes associated with the supply chain

◆◆ Process of moving purchased goods and services into and around Process of moving purchased goods and services into and around hospitals costs as much as $23 billion nationhospitals costs as much as $23 billion nation--wide*wide*

◆◆ Opportunity to save $11 billion on this “processOpportunity to save $11 billion on this “process--side”alone, when side”alone, when considering the procurement, receipt, and distribution of purchaconsidering the procurement, receipt, and distribution of purchased sed goods and servicesgoods and services

◆◆ Materials Management department is responsible for less than 20%Materials Management department is responsible for less than 20% of of the total inventorythe total inventory

◆◆ There is significant opportunity for providers to engage in valuThere is significant opportunity for providers to engage in valuee--added added strategicstrategic sourcingsourcing initiativesinitiatives

◆◆ Typically, providers are information poor; there is little reliaTypically, providers are information poor; there is little reliable ble information about purchases, prices or utilizationinformation about purchases, prices or utilization


Potential Future State/GrowthPotential Future State/Growth


The The eCommerceeCommerce SolutionSolution

(s)


eCommerce eCommerce will...will...

◆◆ Cure world hungerCure world hunger◆◆ Create world peaceCreate world peace◆◆ Make you a billionaireMake you a billionaire◆◆ Make nurses love material managersMake nurses love material managers


eCommerceeCommerce should...should...

◆◆ Automate the purchasing processAutomate the purchasing process◆◆ Reduce Procurement costsReduce Procurement costs◆◆ Reduce errors and paperworkReduce errors and paperwork◆◆ Aggregate purchases for many suppliers on one Purchase Aggregate purchases for many suppliers on one Purchase

OrderOrder◆◆ Reduce price discrepancies on nonReduce price discrepancies on non--contract itemscontract items◆◆ Eliminate “maverick buying”Eliminate “maverick buying”◆◆ Provide online access to multiple suppliersProvide online access to multiple suppliers◆◆ Provide the Buyer all the above in a “seamless” mannerProvide the Buyer all the above in a “seamless” manner


Provider

Source: Andersen/VHA, Industry Study Report, June 2001

Why eWhy e--Supply Chain Solutions?Supply Chain Solutions?

◆◆ It’s the thing to do It’s the thing to do -- It’s contemporaryIt’s contemporary◆◆ Manage offManage off--contract “maverick” purchasingcontract “maverick” purchasing◆◆ Reduce nonReduce non--productive time in purchasing/APproductive time in purchasing/AP◆◆ Expand pool of qualified suppliersExpand pool of qualified suppliers◆◆ Save time and increase efficiencySave time and increase efficiency◆◆ Reduce pricing disparityReduce pricing disparity◆◆ Make better decisions based on better, more accurateMake better decisions based on better, more accurate

sourcingsourcing informationinformation◆◆ Obtain more accurate and timely information to manage Obtain more accurate and timely information to manage

utilizationutilization


ProviderWhy eWhy e--Supply Chain Solutions?Supply Chain Solutions?

◆◆ Value can be created in the range of 1% to 3% of total Value can be created in the range of 1% to 3% of total provider supply costs by fully utilizingprovider supply costs by fully utilizing eCommerceeCommercecapabilitiescapabilities

◆◆ Current use of electronic data interchange (EDI), Current use of electronic data interchange (EDI), represents about 31% of total eligible transactionsrepresents about 31% of total eligible transactions

◆◆ An integrated eAn integrated e--Commerce solution can reduce the rework Commerce solution can reduce the rework related to processing errors by as much as 52%related to processing errors by as much as 52%

◆◆ Providers can overpay suppliers from 2% to 7% for Providers can overpay suppliers from 2% to 7% for contracted medicalcontracted medical--surgical suppliessurgical supplies

◆◆ As much as 40% of buyer time and 88% of accounts As much as 40% of buyer time and 88% of accounts payable time is dedicated to the manual processing of payable time is dedicated to the manual processing of transactionstransactions


Source: Andersen/VHA, Industry Study Report, June 2001

Why eWhy e--Supply Chain Solutions?Supply Chain Solutions?

◆◆ Manufacturer Manufacturer –– A fully integrated eA fully integrated e--Commerce solution can lead to revenue increases of 1% to Commerce solution can lead to revenue increases of 1% to

14% for early adopters. 14% for early adopters. •• Minimizing rework and eliminating nonMinimizing rework and eliminating non--value activities by sales representatives who spend value activities by sales representatives who spend

25% to 49% of their time on administrative tasks25% to 49% of their time on administrative tasks–– Increase in net operating margin potential ranges from 2%to 57% Increase in net operating margin potential ranges from 2%to 57% varying varying

dramatically depending on the type of manufacturer, current techdramatically depending on the type of manufacturer, current technology state and nology state and level of elevel of e--Commerce implementationCommerce implementation

–– Fill rates can be improved if suppliers and manufacturers are abFill rates can be improved if suppliers and manufacturers are able to track le to track transactions throughout the supply chaintransactions throughout the supply chain

◆◆ DistributerDistributer–– A fully integrated eA fully integrated e--Commerce solution can help benefit distributors from 1% to Commerce solution can help benefit distributors from 1% to

10% of Selling, General and Administrative (SG&A) expenses10% of Selling, General and Administrative (SG&A) expenses–– MedicalMedical--Surgical distributors sales forces spend only 14% of their time Surgical distributors sales forces spend only 14% of their time selling selling

products or educating customers, as a majority of their time is products or educating customers, as a majority of their time is consumed by consumed by customer service related issuescustomer service related issues

–– Although automation of contracts, pricing and rebates have contiAlthough automation of contracts, pricing and rebates have continued to increase, nued to increase, 2% of SG&A is spent on personnel to ensure pricing accuracy.2% of SG&A is spent on personnel to ensure pricing accuracy.

•• The lack of standards in the pricing process continues to impedeThe lack of standards in the pricing process continues to impede the reduction of the reduction of resourcesresources


YNHHS Supply Chain MissionYNHHS Supply Chain Mission

To support operations and quality patient care To support operations and quality patient care through the cost effective and efficient through the cost effective and efficient

provision of supplies, capital equipment, and provision of supplies, capital equipment, and related services in partnership with the related services in partnership with the

employees, staff, and physicians of Yale New employees, staff, and physicians of Yale New Haven Health SystemHaven Health System


YNHHS Strategic ObjectivesYNHHS Strategic Objectives

◆◆ Corporate Materials Management StructureCorporate Materials Management Structure◆◆ One Business Information System across the Health One Business Information System across the Health

SystemSystem◆◆ Identification of $8.8M potential annual savings after 3 Identification of $8.8M potential annual savings after 3

yearsyears


Cost Savings OpportunitiesCost Savings Opportunities

Ensuring that you pay the best price for supplies commonly used will provide a first round of savings.

The progression of savings starts with paying the best

price and ultimately optimizing utilization.

Standardizing across your institution will provide a second tier of savings.

Focusing on proper supply selection and utilization will generate the most sustained savings opportunities.


YNHHS StrategiesYNHHS Strategies

◆◆ Overall goal is to manage quality and reduce cost through Overall goal is to manage quality and reduce cost through rational supply selection and utilization.rational supply selection and utilization.

◆◆ An interdisciplinary approach provides for input from the An interdisciplinary approach provides for input from the array of experts available in the facility.array of experts available in the facility.

◆◆ Product selection is based on establishing objective Product selection is based on establishing objective clinical specifications forming the basis to minimize clinical specifications forming the basis to minimize redundancy.redundancy.

◆◆ The clinicallyThe clinically--indicated needs of any particular patient will indicated needs of any particular patient will always take priority over the preferred formulary product.always take priority over the preferred formulary product.


Supply Chain Management ProcessSupply Chain Management Process

◆◆ Establish Clinical Evaluation Committees (CEC)Establish Clinical Evaluation Committees (CEC)

TOTAL MEMBERSHIP TOTAL MEMBERSHIP -- 77 members77 members

◆◆ Price ParityPrice Parity◆◆ Standard Information SystemStandard Information System◆◆ Product StandardizationProduct Standardization◆◆ UtilizationUtilization

◆◆ Medical/SurgicalMedical/Surgical◆◆ Operating Room Operating Room ◆◆ Pharmacy Pharmacy ◆◆ Facilities Evaluation Committee Facilities Evaluation Committee

◆◆ CardiacCardiac CathCath◆◆ Clinical Laboratories Clinical Laboratories ◆◆ Diagnostic ImagingDiagnostic Imaging


Gathering, Correlating and Disseminating InformationGathering, Correlating and Disseminating Information

◆◆ Legacy MIS systemsLegacy MIS systems◆◆ Wisdom I & II, Owens and MinorWisdom I & II, Owens and Minor◆◆ LawsonLawson◆◆ Manufacturer purchasing histories Manufacturer purchasing histories -- derived from derived from

manufacturers / latemanufacturers / late◆◆ ee--telligence telligence -- Allegiance (evaluating)Allegiance (evaluating)◆◆ Distributor reportsDistributor reports◆◆ NovationNovation compliance reportscompliance reports

◆◆ Enable improvementsEnable improvements


eCommerce eCommerce at YNHHSat YNHHS

◆◆ Lawson provides significant advancements in eLawson provides significant advancements in e--capabilities.capabilities.◆◆ The market is offering opportunities to use new entities as a clThe market is offering opportunities to use new entities as a clearinghouse for earinghouse for

all purchasing transactions.all purchasing transactions.◆◆ Pro’s:Pro’s:

–– One stop shopping (faster access to vast supply formularies).One stop shopping (faster access to vast supply formularies).–– Simplifies the number of (electronic) links needed to be maintaiSimplifies the number of (electronic) links needed to be maintained with various ned with various

vendorsvendors–– Simplifies the addition of new vendors.Simplifies the addition of new vendors.–– Alignment and synching of contracts and pricing on a more timelyAlignment and synching of contracts and pricing on a more timely and global scale.and global scale.

◆◆ Con’s:Con’s:–– All of our data in the hands of one vendor (potential security iAll of our data in the hands of one vendor (potential security issues).ssues).–– Cannot replace our existing Materials I.S. Potential for duplicaCannot replace our existing Materials I.S. Potential for duplication of system tion of system

functionality.functionality.–– Most of the vital links(I.e. GL/AP) needed to make eMost of the vital links(I.e. GL/AP) needed to make e--commerce work as advertised commerce work as advertised

without Materials System are still “Vaporware.”without Materials System are still “Vaporware.”–– Additional “middle man” functions of most EAdditional “middle man” functions of most E--Commerce are already available Commerce are already available

through YNHHS’ Lawson MMIS.through YNHHS’ Lawson MMIS.


What has What has eCommerce eCommerce Done for YNHHS?Done for YNHHS?

◆◆ Controlled offControlled off--contract purchasescontract purchases–– TemplatesTemplates–– Online ContractsOnline Contracts

◆◆ Reduced pricing disparitiesReduced pricing disparities–– ContractsContracts

◆◆ Better decisionsBetter decisions–– Reports from LawsonReports from Lawson

◆◆ Productivity improvementsProductivity improvements


eCommerceeCommerce at YNHHSat YNHHS

Lawson Marketplace@novation

ServiceVendor

Distr.

MFG

EDI

YNHHS ERP (Formulary,Item Master

Contract Mgmt etc)

MFG

b2b Product

Info Exchange

“Unaligned” vendors

“Aligned”partners

(Ideally the majority of YNHHS Vendors)

Wisdom II(Decision support &

analytics)

AllegienceOwens & Minor

PDADSUnitsORDI

Cath Lab



➊➊ Order EntryOrder Entry–– OnlineOnline

•• Web Web ReqsReqs•• Lawson (LID)Lawson (LID)•• Internet Link for Office SuppliesInternet Link for Office Supplies

–– Internet Internet SourcingSourcing•• Shopping (business only)Shopping (business only)

➋➋ LawsonLawson–– Single Item MasterSingle Item Master–– Vendor masterVendor master–– ContractsContracts–– DBDB/Reporting/Reporting–– EDI/FaxEDI/Fax



➌➌ B2BB2B–– Neoforma Neoforma / Marketplace@/ Marketplace@NovationNovation

•• Started 4/01Started 4/01•• $25MM annual rate$25MM annual rate•• 60 POs per day60 POs per day•• Good reportingGood reporting•• Limited vendorsLimited vendors

–– Owens & MinorOwens & Minor–– AllegianceAllegiance–– OtherOther

–– GHXGHX•• Manufacturer / specialty itemsManufacturer / specialty items•• Recent partnership with Marketplace@Recent partnership with Marketplace@NovationNovation•• Still waiting...Still waiting...



◆◆ Hoped for results…Hoped for results…–– Reduce paper (Reduce paper (autofaxautofax/receipt)/receipt)–– Tracking ordersTracking orders–– Access to Info for decisionAccess to Info for decision--makingmaking

Net Result is better service at a lower costNet Result is better service at a lower cost


Marketplace@Marketplace@Novation Novation ActivityActivity

◆◆ YNHH ranks 6th in total transactions out of 178 YNHH ranks 6th in total transactions out of 178 organizationsorganizations

◆◆ YNHHS ranks 4th in total transactionsYNHHS ranks 4th in total transactions◆◆ YNHHS averages 65 Purchase orders per dayYNHHS averages 65 Purchase orders per day◆◆ YNHHS average transaction time is 120 seconds from YNHHS average transaction time is 120 seconds from

YNHHS to supplierYNHHS to supplier


Marketplace@Marketplace@Novation Novation Next StepsNext Steps

◆◆ Connect Greenwich HospitalConnect Greenwich Hospital◆◆ Utilize Marketplace Release 2.4Utilize Marketplace Release 2.4

–– Order Manager, Report Manager, Links to CISOrder Manager, Report Manager, Links to CIS

◆◆ Convert manual suppliers to EDIConvert manual suppliers to EDI–– EM Parker, EM Parker, Dade BehringDade Behring, , Sims PortexSims Portex, , RocheRoche, , NycomedNycomed

◆◆ Continue to participate in Task ForcesContinue to participate in Task Forces–– Formal feedback and input into MPFormal feedback and input into MP

◆◆ Volunteer to partner in Beta ReviewsVolunteer to partner in Beta Reviews–– Reporting and Reporting and AnalyticsAnalytics, Contract Manager, Price Collaboration, Contract Manager, Price Collaboration

◆◆ Leverage Leverage eCommerceeCommerce–– Reduce reReduce re--work, minimize price discrepancies/overpaymentwork, minimize price discrepancies/overpayment

◆◆ Promote Marketplace@Promote Marketplace@NovationNovation–– More suppliers and more membersMore suppliers and more members


PitfallsPitfalls

◆◆ More vendors in Marketplace@More vendors in Marketplace@Novation Novation / GHX/ GHX–– User Task ForceUser Task Force

◆◆ User training in previously lowUser training in previously low--tech areas (receiving, tech areas (receiving, distribution)distribution)

–– Key IssueKey Issue

◆◆ Transition to new system required significant increase in Transition to new system required significant increase in data requirements data requirements

–– Leading to no transaction efficiencyLeading to no transaction efficiency

◆◆ More structured approachMore structured approach–– Less ways to get around the systemLess ways to get around the system


SavingsSavings

◆◆ PharmacyPharmacy◆◆ CathCath Lab Lab ◆◆ LinenLinen◆◆ Document CenterDocument Center◆◆ PCsPCs


Or … Lessons Learned

I Wish I Knew These Things Before I Got Into the Business

◆◆ Aggregated purchasing without compliance saves very Aggregated purchasing without compliance saves very littlelittle

◆◆ Unmanaged offUnmanaged off--contract purchasing is very expensivecontract purchasing is very expensive◆◆ Trading partners must reduce low and/or no value Trading partners must reduce low and/or no value

processes in order to saveprocesses in order to save◆◆ “He who dies with the most information wins!”“He who dies with the most information wins!”


Things to do DifferentlyThings to do Differently

◆◆ TrainingTraining◆◆ Manage Expectations Manage Expectations -- Up and DownUp and Down◆◆ Reporting Limitations in LawsonReporting Limitations in Lawson

–– Wisdom IIWisdom II–– CrystalCrystal

Revenue EnhancementRevenue Enhancement


PrePre--eCommerceeCommerce

AM/PFM

Payor

Payor

Payor

Payor

NEIC

Payor

Mail

Payor

Payor

Payor

� Manual Eligibility verification (i.e. telephone)

� Multiple non-standard methods and formats of Claimsubmission:� Limited Electronic EDI - 837� Electronic Print image (NEIC Clearing house)� Paper bills via US Mail

� Multiple non-standard methods and formats of Remittance� Limited Electronic EDI-835� Electronic non-ANSI� Paper reports via US Mail -manual posting

� Secondary Billing:� Manual recording of Coins/Deductibles� Manual EOB generation.

� Multiple contact points and systems for bill and remittanceprocessing.

Eligibility VerificationClaims SubmissionRemittance

Mail


Enhancing Revenue through Enhancing Revenue through eCommerceeCommerce

AM/PFM

Payor

Payor

Payor

Payor

Medi.com

Payor

Payor

Payor

PayorMail

Payor

� Automated Electronic Eligibility verification.

� Limited & standard method and format of Claimsubmission:� Increased % of Electronic EDI - 837� Paper bills via US Mail

� Limited & standard method and format of Remittance� Electronic EDI-835� Paper reports via US Mail -manual posting

� Automated Secondary Billing,� Automated recording of Coins/Deductibles.� Automated EOB generation.

� Limited contact points and systems for bill andremittance processing (Clearinghouses canconsolidate diverse transactions).

� Additional functionality.� Electronic claims tracking.� Electronic claim status inquiry and response.

Eligibility VerificationClaims Submission Remittance Verification, Claims &Remittances

2001/20012001/2001


BenefitsBenefits

Lower days in AR, due to:Lower days in AR, due to:◆◆ Eligibility Verification Eligibility Verification ◆◆ Electronic billingElectronic billing◆◆ Electronic RemittanceElectronic Remittance◆◆ Claim status & prioritizationClaim status & prioritization

Lower Staffing Requirements, due to:Lower Staffing Requirements, due to:◆◆ Automated Eligibility VerificationAutomated Eligibility Verification◆◆ Standardization of BillsStandardization of Bills◆◆ Standardization of RemittancesStandardization of Remittances◆◆ Fewer points of contactFewer points of contact

Additional Benefits:Additional Benefits:◆◆ Lower maintenance costsLower maintenance costs◆◆ Mandatory availability ofMandatory availability of payorpayor direct electronic connectionsdirect electronic connections

eHealtheHealth


IntranetIntranet

✔ Departmental Customization✔ Internal Recruitment Process✔ Customized Views by User

✔ Employee Directory ✔ Document Management (currently ltd.)

✔ Form Maker✔ Clinical Protocols✔ Employee Self Service

✔ Access from anywhere (Extranet)✔ Roles Based Authentication✔ Interactive Project Management

Tools (Healthflash)

✔ Employee Health

✔ FAQ’s✔ Advanced

Searching

Core Functionality

Priority One Functionality

Priority Two Functionality

Priority Three Functionality

Priority Four Functionality

✔ CBT’s✔ Content Management✔ Executive Information

System/Balanced Scorecard

Current Sites:• System and Hospital

Intranet• Clinical Workstation• Healthflash


Public Web SitesPublic Web Sites

◆◆ System ApproachSystem Approach◆◆ Objectives are:Objectives are:

–– Lower CostsLower Costs–– Increased interactive functionalityIncreased interactive functionality-- (personalization, nursery, calendar…)(personalization, nursery, calendar…)–– Reduced burden on multiple hosting companiesReduced burden on multiple hosting companies–– Continue to strengthen the brand that we have already establisheContinue to strengthen the brand that we have already establishedd

◆◆ Shared functionality such as calendar, employment, physician refShared functionality such as calendar, employment, physician referral (by erral (by area), etc.area), etc.

–– Calendar of events to be Calendar of events to be initiallyinitially displayed with “initiating” hospital’s informationdisplayed with “initiating” hospital’s information–– Physician Referral by Zip Code. Will take feeds from Call CentePhysician Referral by Zip Code. Will take feeds from Call Center.r.

◆◆ Important that we do not lose functionality that we currently haImportant that we do not lose functionality that we currently haveve

Yale New Haven Health

Design of New System

Identity

Greenwich Hospital

Bridgeport Hospital

Yale-New Haven

Hospital

Now Dec 01 Mar 02 Jun 02 Sept 02 LIVE!


Physician PortalPhysician Portal

True Web Integration & Patient Interaction

EMR Functionality

Billing

Connectivity to Hospital Systems

✔ Remote Access to Hospital Clinical Information System✔ Reference Materials - MDConsult and Dxplain✔ Access to Envoy for Eligibility and Referral Management✔ Secure eMail Messaging

✔ Interfaces to/from current hospital systems for results to be displayed using a web browser

✔ Drug/drug/allergy alerting ✔ PDA Downloads✔ Structured Messaging - prescriptions, appts✔ Patient Interaction ✔ Practice Mgmt Integration ($$)

✔ End of visit doc, annotated results, clinical decision support, super bill templates

✔ Patient entered clinical data and health maintenance alerts

✔ E&M Coding

Guiding Principles:• Single view of clinical

data across the system• Secure• Integrates into MD and

Office workflow• Easy access

MDlink


eHealth eHealth at YNHHSat YNHHSPhysician/Patient StrategyPhysician/Patient Strategy

IntegratedIntegratedContentContent

HealthHealthContentContent

Tools &Tools &Resources Resources InteractivityInteractivity

PhysicianPhysicianReferenceReferenceContentContent

IntegratedIntegratedClinicalClinicalContentContent

Tools &Tools &ResourcesResources

InteractivityInteractivity

Physician

Physician

PhysicianPhysicianWorkflowWorkflow

ClinicalClinicalMessagingMessaging

PhysicianPhysicianPatientPatient

InteractionInteraction

Secure Interactive

Secure Interactive

Patient Care

Patient Care

✇ Lab ✇ Diagnostic Imaging✇ ADT✇ Pathology

✇ Envoy✇ PHO Site✇ Structured Messaging✇ Prescription Writing

✇ YSM Resources

✇ MDconsult

✇ Current Web Sites

✇ LaurusHealth

✇ MyHealthRecord✇ Calendars✇ Pre-Reg Forms

Consumer

Consumer ✇ Prescription Refills✇ Appt Requests✇ Ask a Nurse

yalenewhavenhealthyalenewhavenhealth.org.org

www.www.ynhhsynhhs--mdlinkmdlink.org.org

The Real Action!The Real Action!

* Adapted HEALTHvisio

Business Case Analysis: Physician StrategyBusiness Case Analysis: Physician Strategy


Why a Business Case?Why a Business Case?

◆◆ We needed to We needed to –– evaluate how opportunity and risk were balanced in this initiatievaluate how opportunity and risk were balanced in this initiativeve–– clearly identify the benefits and how it helps us to achieve ourclearly identify the benefits and how it helps us to achieve our

strategic objectivesstrategic objectives–– evaluate whether potential Return on Investment could help to evaluate whether potential Return on Investment could help to

fund some of the costsfund some of the costs–– achieve buy in achieve buy in fromfrom the hospitals andthe hospitals and SrSr. Management. Management

◆◆ ROI ProcessROI Process–– Developed teams for evaluating each areaDeveloped teams for evaluating each area–– Analyzed Return on Investment and Soft BenefitsAnalyzed Return on Investment and Soft Benefits–– Held facilitated focus groups with physicians and their office Held facilitated focus groups with physicians and their office

managersmanagers


Qualitative BenefitsQualitative BenefitsImprove

relationships with the

physicians and patients

Improve quality of care and patient safety (reduce adverse drug

events)

Be ready to support the demand for patient

interactivity / patient management of medical records

Provide secure, accurate, and timely clinical information to

physicians at the point of care

What are our competitors doing to attract doctors? attract patients?

Meets our Objectives


The Real DollarsThe Real Dollars

◆◆ Revenue EnhancementsRevenue Enhancements$$ Volume growth Volume growth -- inpatient and outpatientinpatient and outpatient

$$ Improved billing and reduced claims denialsImproved billing and reduced claims denials

◆◆ Expense ReductionsExpense Reductions$$ Reduction in redundant proceduresReduction in redundant procedures

$$ Reduction in AR InterestReduction in AR Interest

$$ Reduction in Malpractice Suits with improved documentationReduction in Malpractice Suits with improved documentation

◆◆ Expense AvoidanceExpense Avoidance$$ Incremental costs related to increases in outpatient volume Incremental costs related to increases in outpatient volume

$$ Contribution margin related to the maintenance of inpatient Contribution margin related to the maintenance of inpatient admissionsadmissions

$$ HIPAA consulting services (ifHIPAA consulting services (if outsourcedoutsourced))


What did we get out of this?What did we get out of this?

◆◆ The process helped usThe process helped us–– Attain organizational buy in Attain organizational buy in -- including senior management as well including senior management as well

as physiciansas physicians–– Come to a better understanding of what is important to usCome to a better understanding of what is important to us–– Learn more about the Internet and how it impacts healthcareLearn more about the Internet and how it impacts healthcare–– Realize that the cost to develop a similar solution on our own Realize that the cost to develop a similar solution on our own

would be astronomical and that an ASP solution is the preferred would be astronomical and that an ASP solution is the preferred optionoption

◆◆ Value identified will be used as metrics for successValue identified will be used as metrics for success


What does it mean?What does it mean?

◆◆ Clearly, we are unable to justifyClearly, we are unable to justify eHealtheHealth initiatives with initiatives with ROI ROI alonealone

◆◆ Soft benefits must play a Soft benefits must play a significantsignificant role in the decision role in the decision making process making process

–– improved physician relationships, quality of care, and patient improved physician relationships, quality of care, and patient satisfaction may not have a satisfaction may not have a directdirect monetary benefit, but monetary benefit, but nevertheless are vital to our organizationsnevertheless are vital to our organizations

◆◆ Being an early adopter is largely a leap of faith, but due Being an early adopter is largely a leap of faith, but due diligence helps to ease the trepidationdiligence helps to ease the trepidation

◆◆ Difficult Times / Difficult DecisionsDifficult Times / Difficult Decisions–– budget constraintsbudget constraints–– increased competitionincreased competition–– higher patient and physician expectationshigher patient and physician expectations–– all leads to no all leads to no easyeasy answersanswers


Primary Inhibitors for Physician StrategyPrimary Inhibitors for Physician Strategy

◆◆ Plans to take a system approachPlans to take a system approach–– Slower decision makingSlower decision making–– Need for an Enterprise Master Person Identifier (EMPI)Need for an Enterprise Master Person Identifier (EMPI)–– Design / strategy around the conversion to standard Internet sitDesign / strategy around the conversion to standard Internet siteses

◆◆ Maturity of public sitesMaturity of public sites◆◆ SecuritySecurity

–– Challenges in incorporating security into Physicians’ workflowChallenges in incorporating security into Physicians’ workflow–– Lack of stability in the market place for security solutionsLack of stability in the market place for security solutions


General General eCommerceeCommerce BarriersBarriers

◆◆ Organizational BarriersOrganizational Barriers–– Organizational and reporting relationship structure of theOrganizational and reporting relationship structure of the eHealtheHealth

groupgroup–– Funding of initiativesFunding of initiatives–– Culture and operating orientation of the overall health care Culture and operating orientation of the overall health care

organizationorganization–– A process for approving and prioritizing initiatives according tA process for approving and prioritizing initiatives according to o

ability to support goalsability to support goals–– Need for buy in from Senior Leadership, physicians, and others aNeed for buy in from Senior Leadership, physicians, and others at t

all levels in the organizationall levels in the organization–– Uncharted territoryUncharted territory

◆◆ Technical BarriersTechnical Barriers–– SecuritySecurity–– Performance and reliabilityPerformance and reliability–– Uncharted territoryUncharted territory

Questions?Questions?

HIMSS Conference 2002Mark L. Andersen, CIO / Sr. Vice President, [email protected] New Haven Health System

ecommerce - amazon s3 · ehealth, ecommerce …where’s the beef? himss conference 2002 mark l....

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