What Makes Healthcare Unique?
I am "going home", returning to my roots as it were. For the past 12 years I have been engulfed in the financial services industry. It has been extremely rewarding—personally and professionally. I have played several roles in IT, Strategic Planning and Program Management including the development of a new records management program for an international firm. But now my attention has been drawn to healthcare…right where I was before I entered the financial services arena.
I had my trepidations to be sure. Certainly much had changed in my absence. Why back in my day, I was developing the systems for Blue Cross Blue Shield's new offering called "managed care" with their first HMO and helping them implement DRGs based on something call ICD-9 codes. Certainly they must be up to ICD-99 by now I figured. Why, we were even working with doctors' offices to get them off of paper-based systems. I could hardly wait to see how far into the 21st century these highly educated professionals had advanced.
Well, you can imagine my surprise. One of the largest healthcare efforts underway is a national migration from ICD-9 to ICD-10 with an implementation date of October 1, 2013. Doctors have adopted technology for medical applications, but have been slow to automate administrative functions. And hospitals, while much more automated, still have hybrid systems of paper and electronic records and their automated systems are not fully integrated internally or with outside parties.
I started drawing contrasts between the healthcare and financial services industries. For starters, there is currently a big push for something called the Personal Health Record. This is based on the idea that an individual should have the ability to possess and maintain their own pertinent health information electronically and share it with providers as they deem appropriate. I suggest that you visit your bank or brokerage website and I am sure that you will see the ability to aggregate financial information from various other accounts including credit cards, mortgages, car loans and more. This consolidation of assets and ability to pay bills from a central source is a level of customer service that we've come to expect.
Electronic Health Records (EHR) and Electronic Medical Records (EMR) serve a similar purpose at the institutional level. Some use them interchangeably while others refer to EHR as a more general term that encompasses the exchange of information between institutions and EMR as the localized instance of a record within an institution. In any case, the efficient interoperability of information across systems within and between institutions remains elusive in healthcare. I contrast this with the efficiency of the automated stock exchanges around the world, intra-day bank lending, and portfolio systems trade consolidations all of which use standardized accounting principles and the electronic exchange of information to "net" financial transactions reducing the need to physically transfer funds between financial institutions. Are there problems…certainly, but even with the current state of affairs, the financial markets are universally regarded as efficient and trustworthy in the exchange of Electronically Stored Information (ESI).
So what are the differences between the financial services and healthcare industries that have slowed the adoption and efficient exchange of ESI? One difference is funding. Many of the hospitals in the country are not-for-profit. This doesn't mean that they can't operate in the black, but they have to reinvest their profits back into the hospital to improve goods and services. The problem is that many of them operate on very thin margins at best and don't have the funds for large information systems investments. The same is true for physicians. Certainly private hospital groups have grown over the last decade and physician groups have merged or been purchased by hospital groups, but that consolidation is not of the same scale of the financial services industry. I am not aware of a hospital group with the capital available to brokerage firm that has trillions of dollars in assets under management.
Another significant industry difference is the sheer number parties involved. Whether you compare hospitals to banks, skilled nursing facilities and labs to brokerage firms, or doctors and nurses to registered investment advisors the numbers are overwhelming in healthcare. We can even look at the customers. Whether you use the figure of 56 million individuals without healthcare (calculated by including anyone who has been without healthcare coverage at any point within the last 12 months) or the figure of 18 million (representing the number without healthcare coverage at any snapshot in time), there are certainly far more men, women and children who have healthcare than have bank or brokerage accounts. Add to that the number of individuals who receive healthcare in emergency rooms even though they have no healthcare coverage and clearly you can see that there are far more healthcare customers than financial services customers.
These challenges of investment dollars and complexity due to volume are being addressed today. Already more than $30 billion has been committed to healthcare automation by ARRA, the stimulus bill passed earlier this year. Additionally, groups such as Health Level Seven (HL7) and NIST are working to develop and implement standards to simplify the interaction between healthcare partners. Changes won't happen overnight, but clearly the movement towards electronic records management in healthcare is gaining speed and irreversible.
Can the same principles that the financial services industry uses to manage ESI be applied to healthcare? Records and Information Management (RIM) all hinges on information lifecycle management (ILM). Information is created or captured, distributed to those who need it (relying on information security and privacy rules), used in the course of business (standard definitions ensure interoperability), maintained (rules may apply to the classification, storage, retention and integrity of the information), and ultimately disposed of or preserved long-term (disposition can be interrupted by hold orders).
It seems that these same ILM and RIM principles would apply to information in both industries. However, the cynics would point out that the devil is in the details. For instance, the data is different, the regulators and regulations are different, the business partners are different, the terminology is different, the systems are different, etc. All of this is true. However, all of these are different between financial services and manufacturing; between manufacturing and pharmaceutical; between pharmaceutical and government; and so on. Yet all of these industries have adopted the same RIM principles in managing the ILM for ESI.
I suggest that those of us entering (or re-entering) the healthcare industry have our work cut out for us. We need to understand the data, systems, regulations, terminology, interaction between business partners and all of the other aspects of healthcare ESI. It is imperative in order to communicate effectively and apply the general principles of RIM and ILM to ESI. At the same time, those in the healthcare industry would be wise to leverage those with experience in other industries in order to limit the growing pains suffered along the way.
Bill is responsible for advancing records management and eDiscovery knowledge through RIM Education on behalf of Cohasset Associates. Prior to joining Cohasset, Bill was Vice President of Records Management and Litigation Support at Fidelity Investments and has several years of experience as a corporate executive and management consultant. Bill is also a member of the Industry’s 2009-2010 EDRM (Electronic Discovery Reference Model) team leading a project to develop a Healthcare Information Management Reference Model.
