Straight Talk on Tech: Implementing IT in Health Care Insightful Discussions

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STRAIGHT TALK ON TECH:

IMPLEMENTING IT IN

HEALTH CARE Presenting Sponsor

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M O D E R ATO R

June 18 - July 2, 2021

DEAR READER: Atrómitos is honored to have sponsored the Insightful Discussion “Straight Talk on Tech: Implementing IT in Health Care." We are grateful to the panel that participated in this critical and timely discussion.

It is no longer enough for physicians and other health care providers to only rely on their hard-won clinical expertise and experience in delivering care. As the health care system moves (in some cases gets dragged, pushed, or pulled) towards value-based care, it is apparent that effective data aggregation and analysis (and thus technology) are essential. This means providers cannot engage in meaningful quality of care analytics, population health delivery, and value-based payment without a full informatics suite.

And while no one has “cracked this nut” yet, it is clear that there will be a divide between providers that invest in technology and those that do not. Those who invest will enjoy the benefit of maintaining their independence (from large health systems) and attain contracts with higher rates that reflect their ability to manage a population and impact outcomes.

Let’s be clear, investing in technology is not as simple as buying an off-theshelf big-name technology system. Despite what they may be telling you, the one size fits all approach often creates more challenges than opportunities. The reality is that selecting, purchasing, and implementing information technology within clinical practice is expensive, time-consuming, and requires operational and technical focus. Based on our experience, the systems in question do not (sufficiently) consider the needs and preferences of the user from the beginning.

To make informed and tailored decisions that will support your organization’s current needs while allowing you to adapt as external forces require changes, you must "know thyself." This self-awareness requires a team-based approach to identify requirements and design system specifications. Even organizations with the most significant commitment to creating a unified, interoperable system may find the cost of this too great to be feasible.

If this all feels too overwhelming, the good news is that our webinar panelists came to Straight Talk on Tech to share their essential tips and tricks to get you started and help your organization meet this challenge head-on. If you are looking for a trusted partner to guide and support you along the way, Atrómitos offers over 70 years’ collective experience in healthcare policy, regulation, management, operations, and innovation. We are passionately and fearlessly committed to helping you do big things and would be honored to support you through this time of tremendous opportunity.

Sincerely,

Michealle Gady, JD President, AtrÓmitos, LLC

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MICHEALLE GADY, JD

FOUNDER & PRESIDENT, ATRÓMITOS Founder and President of Atromitos LLC, a Wilmington-based national consulting firm dedicated to a singular mission: creating, healthier, more resilient and more equitable communities. Michealle’s career in health policy and management spans from Capitol Hill, where she served as Health Counsel to a senior Congressman during the passage of the Affordable Care Act, to Victoria, Australia, before settling in Wilmington and founding Atromitos.

TINA SIMPSON, JD MSPH, CHPC

PANELISTS

Page 2

PRINCIPAL, ATRÓMITOS Principal at Atrómitos and leads its System Integrity and Resilience practice. A former Assistant Attorney General with the North Carolina Department of Justice and a graduate UNC Gillings School of Global Public Health, Tina serves as a translator and connector across disciplines and stakeholders to provide clients with the technical resources, skills and systems to promote greater stability, security and resiliency across an organization’s operations.

LORI WRIGHT, JD

PARTNER AND CHAIR, ARNALL GOLDEN GREGORY, LLP’S TECHNOLOGY Partner and chair of Arnall Golden Gregory, LLP’s Technology practice in Atlanta, Georgia. She helps clients navigate the legal, business, and practical issues that arise in the course of the development, commercialization, procurement, and deployment of technology. Lori is a skilled drafter or all forms of technology-related contracts, and has negotiated issues surrounding, among other things, opensource software policies and licensing, appropriate security and privacy measures, complex robotic automation, and artificial intelligence (AI).

KARTHIK ADAPA, MBBS, MPH, MPP

DOCTORAL RESEARCH FELLOW, UNC HEALTH ENGINEERING DEPARTMENT Doctoral Research Fellow with the UNC Health Engineering Department within the Department of Radiation Oncology where his work focuses on evaluating usability of health technology platforms in clinical settings to reduce cognitive workload.

A physician by training and a former health care administrator, Karthik’s research centers on clinician well-being, machine learning and implementation science.

VIEW THE WEBINAR Go to atromitosconsulting.com/insightful-discussionshealthcareit to watch this Insightful Discussion webinar.

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STRAIGHT TALK ON TECH:

IMPLEMENTING IT IN

HEALTH CARE

It comes as no surprise that health information technology can be a make-orbreak proposition for healthcare professionals.

Those who select and implement technologies effectively can streamline operations, reduce the burden of managing paperwork, and ultimately provide a higher level of care. But that presupposes the selection of the right platform at the right time and for the right purpose. None of those are guaranteed conditions.

The conflict between the promise of technology and the reality of the barriers to its effective deployment was the subject of a recent webinar, Straight Talk on Tech: Implementing IT in Health Care. This panel, moderated by Michealle Gady, President of Atrómitos, featured a discussion with a diverse panel of experts, including Tina Simpson, a Principal at Atrómitos who leads the firm’s System Integrity and Resilience service line, Karthik Adapa, a doctoral research fellow with the Division of Healthcare Engineering, Department

of Radiation Oncology, UNC School of Medicine, and Lori Wright, a Partner at Arnall Golden Gregory LLP and the Chair of the firm’s technology practice.

The panel represented the various skillsets and perspectives required when tackling complex integrations: from contracting considerations and best practices to data reporting functionality and user experience. The panelists provided an overview of some of the crucial issues that providers should know about regarding selecting, purchasing, and implementing health information technology.

Investing the time and resources upfront to make informed decisions and careful choices will mitigate significant expense and frustration later.

Understanding the Challenges to a Successful Integration

Moderator Michealle Gady succinctly outlined the problem from the outset: “Managing technology requires a specific set of operational and technical skills,” said Gady, “But it is also a requirement if providers are going to succeed in population health management and advanced payment models.”

In short, while healthcare providers’ formal training may not have included a background in the technical aspects of data analytics platforms or contract negotiations and data privacy, these are skills that are

increasingly indispensable to the effective operations of any clinical practice. Not least because, when investing in and implementing a technology solution - getting it wrong is expensive, not only as it relates to time and capital investment but also team fatigue.

Gady acknowledged this reality, noting the many anecdotes from friends and colleagues who are deeply dissatisfied with their current system but choose to stick with it as transitioning to a new, unknown system is too burdensome.

“Our goal here is to provide insight into steps you can take to minimize the regrets that often come after purchasing a system,” noted Gady in introducing the panel, “because we all know the cost of changing systems can not only represent an immense financial cost but an emotional one as well.”

The New Age of the Medical Arms Race: Data Analytics

As Gady pointed out, the focus on technology in healthcare is not a new one. What has changed is the function technology plays in the day-to-day operations of care delivery. “The medical arms race" once referred to acquiring the latest and greatest innovations in medical devices like MRIs to serve their patients.

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June 18 - July 2, 2021

a single network is the key to unlocking a higher level of clinical care. Here in the US, the lack of interoperability and clean data is exacerbated because the system is so fragmented. This contrasts with countries such as the United Kingdom, where the system is more centralized, and providers can begin their endeavors to improve data analytics capabilities from a more integrated starting point.

TINA SIMPSON Principal, Atrómitos

“TECHNOLOGY IS RIGHTLY BEING SEEN AS A NECESSARY LINCHPIN IN THE MOVE TO DELIVERING CARE IN A MORE COST EFFECTIVE MANNER.”

Today, however, as it relates to medical technology, there is an increasing focus on data and the capability of technology platforms to effectively capture, stratify, and analyze patient data to improve clinical outcomes.

That is because our health system is moving from a fee-for-service model to a value-based model, where providers are increasingly ‘on the hook’ for the outcomes of the care they provide. For both individual patients and across a population, clinical data are indispensable to this model of delivery. Providers cannot track and improve their patients' health without reliable data and population metrics, and payers cannot pay for outcomes. Therefore, the importance of data and the technology that enables its exchange and analysis cannot be overstated.

Similarly, the tide toward these new payment systems and delivery models should not be underestimated. As Simpson explained, “Being able to control the cost of care while expanding access has been a priority for Washington, DC for the last four to five decades," explained Simpson. "Now, there is a tremendous sense of urgency because technology is rightly seen as a necessary linchpin in delivering care more cost-effectively.”

The premise for the technology push is that technology will allow providers to serve more people at a lower price and a more cost-efficient price point while preserving or promoting the quality of care. “That’s a lot of things to do all at once,” laughed Simpson.

“A patient could walk into four different health systems with four different health records," Wright said. "To rationalize all of them into one person is a difficult task." This fragmentation is a fundamental problem that even the most sophisticated systems have not been able to solve entirely.

Recognizing that this is a universal problem and a problem that will grow in importance in a more mobile, digital world as patients move across health systems, Wright hopes that this being a shared problem will lead to progress in its resolution. Since other countries have made greater progress on this issue, globalization could help to provide a possible solution. As Adapa pointed out, the end goal is to integrate multiple data points about a patient, perform data analytics, and promote learning health systems. However, as Adapa noted, even before capturing and exchanging a comprehensive, longitudinal patient record across health systems, there remain significant blind spots within a single health system. Fragmentation of services is a feature of the American health system, and this carries over to practices within a single health system. Adapa explained that fragmentation and lack of interoperability increase because major specialties within a healthcare system often operate in siloes, looking at one specific corner of the care path and conducting analytics specific to that course of treatment or practice.

“That does not provide a comprehensive view because errors are happening across different stages, and we are not fully capturing all the data points,” said Adapa.

KARTHIK ADAPA Doctoral Research Fellow, UNC Health Engineering Department

Naturally, then, there is much variation across providers when it comes to keeping all those balls in the air simultaneously.

"In the coming years, we will see a continuing acceleration on this trajectory toward more valuebased care with a greater focus on technology,” added Simpson. "This has already been happening, but it doesn't seem like anyone has cracked the nut on how to integrate technology effectively or how to deliver population health management.”

Simpson believes a growing divergence occurs between providers who struggle with tech adoption and those who successfully navigate the process, which is understandable given the problems inherent in data based on the healthcare system as it exists today.

As Wright explained, getting reliable, ‘clean’ and nonduplicative data attributed to a single patient across

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““VERY OFTEN, THESE EHR SYSTEMS TRULY DON’T MATCH THE NEEDS OF THE END USERS.

A Closer Look at: Interoperability and Usability

All panelists agreed that, after ensuring reliable, 'clean' nonduplicative data points, the most significant challenges presented by health technology platforms were those of interoperability and usability.

Interoperability refers to the ability of different

systems to exchange data effectively. In contrast, usability reflects how effectively a given user can use a product within a given context to achieve the intended result. As it relates to both, part of the problem is that Electronic Health Records (EHRs) were initially developed around revenue management. The objective was to capture every billable activity conducted by a provider in any engagement with a patient. The transmissibility and clinical integration of the platform, while important, began as a secondary feature to what was, essentially, a billing machine. The impact of this design has been exacerbated by how EHRs are regulated: until recently, EHRs were validated based on lab results and were not tested in a clinical environment.

“Very often, these EHR systems truly don’t match the needs of the end-users,” said Adapa.

MICHEALLE GADY Founder and President, Atrómitos

“THE COST OF CHANGING SYSTEMS CAN NOT ONLY REPRESENT AN IMMENSE FINANCIAL COST, BUT AN EMOTIONAL ONE AS WELL.”

As demonstrated by Adapa's research, progress is being made related to usability. But we still have a long way to go. One pathway to improved usability, particularly as it relates to information overload, focuses on improved interoperability across systems, and that is focusing on a minimum data set.

To this end, the National Coordinator for Health Information Technology developed a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange, referred to as the United States Core Data for Interoperability (USCDI).

Simpson pointed out that this is just a mandated set of the clinical measures that EHRs have to cull and be able to exchange. "Instead of capturing every possible data point, you need a minimum data set for everything,” explained Adapa. Medical providers should partner with the tech vendor they select during the development phase to figure out what that data set needs to be.

“It’s incumbent on the vendor and their customer success team to design a solution with the end goal in mind," said Wright. It starts with getting all of the necessary constituents in the room, so a list of the desired requirements can be created, and the technology can be customized to those needs.

“Then, the lawyers can come in and document that in the context of acceptance criteria,” added Wright.

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about how these systems work. "You may not need this person all day, every day for 10 years. But you certainly need them as you’re architecting and designing the solution,” noted Wright.

LORI WRIGHT Partner and Chair, Arnall Golden Gregory, LLP’s Technology

“YOU NEED TO SOMEWHAT HOLD YOUR VENDOR’S FEET TO THE FIRE AND ALSO HAVE REMEDIES BEYOND JUST TERMINATING THE CONTRACT.”

“The conversations have to start long before the legal paper passes.”

No Blind Faith — Test and Verify Providers need to be wary of inflated promises from any sales team, particularly regarding technology.

In many cases, the sales team does not possess an in-depth knowledge of how the technology works.

"From the beginning, you need to have internal expertise on your contract needs, and it’s important not to rely on vendor assurances,” noted Simpson.

Wright, who built her law practice around complex contract negotiations for Software as a Service, noted that timing is critical. Setting clear expectations in the negotiation phase as far as establishing acceptance criteria, project planning, and requirements gathering are paramount. "But you lose all your leverage once you've signed the contract," advised Wright. This means that providers need to push back on vendors that want to establish these critical elements after the contract is signed but before a project plan is developed.

More specifically, after a contract is signed, medical providers likely have limited recourse if their purchased technology does not align with expectations.

Regardless of what a salesperson may have said as a part of the sales cycle, their opinion about the core functionality of what technology is supposed to do is meaningless unless explicitly stated in the contract.

“It’s vital to slow down and take the time to really think through the requirements,” explained Wright.

It is also critical to understand that outsourcing a technology solution does not equate to outsourcing risk or responsibility.

Tackling Security Issues

Finally, assuming you have found a platform that meets your specifications, that doesn’t mean it is clear sailing. Understanding your risk profile and the shared responsibility related to data privacy and security when you purchase a platform is also essential.

Again, an ounce of prevention is worth a pound of cure. During negotiations, have a person on hand who understands encryption and can ask the hard questions

This vigilance and responsibility don't end once a platform or process is implemented.

As Gady noted, "In 2021, around 50 million healthcare records in the United States were breached." Data breaches through ransomware attacks and other incursions present a significant operational and financial risk and threat to an organization's reputation and credibility.

And this is a risk that is increasing in scope, frequency, and severity. Providers must adapt to this changing digital and regulatory environment, requiring a culture shift across practices.

Many providers do not have an IT security expert on staff, or IT is focused primarily on maintenance and operational support and not on proactive cyber defense. While understandable, given the narrowing margins in healthcare, it is a mistake. Providers cannot avoid liability by stating the vendor said the system is HIPAA compliant and therefore secure; instead, they need someone to vet adequately the claims put out by the vendor.

“You can’t just outsource this; you need to conduct your own risk assessments and have a trusted adviser, someone who knows what you don’t know,” explained Simpson.

The Bottom Line

The key takeaway from this discussion is that there is no one-size-fits-all approach to managing or implementing healthcare information technology. Still, the potential benefits from taking the necessary steps could be substantial. Providers should begin with reasonable expectations about the process and functionality and a clear understanding of how the technology should work after it is implemented. Finally, providers need to enlist the required expertise to identify internal needs, evaluate vendors and platforms, contract successfully, design and implement the technology, and ensure appropriate ongoing maintenance and security.

HOW ATRÓMITOS CAN HELP TECHNOLOGY COMPANIES IDENTIFY NEW MARKETS Suppose your growth strategy includes expanding services either into new geographies or in support of new lines of business (and it should). In that case, we can help you identify opportunities and remove obstacles. Our extensive regulatory and practical industry experience will help clarify which service areas align best with your operational model. If entering the public payor market (e.g., Medicaid, Medicare, Marketplace) is part of your growth strategy, we can easily catch your team up-to-speed on how these programs function, the challenges to be aware of, and how to best address those challenges.

CONTRACT NEGOTIATIONS Sustainable, mutually beneficial contracts that create the opportunity for growth of both parties are an integral component of any growth strategy.

We not only have years of experience negotiating complex contracts, but we also have deep knowledge of the stakeholders' priorities and pain points. We help ensure the contracts you get are necessary to support your business' growth.

PARTNER IDENTIFICATION Identifying and securing the right partner for your growth strategy is imperative. Atrómitos can help you evaluate your potential collaborators, including engaging key stakeholders to understand better how your platform can and should operate within a given partnership.

REGULATORY COMPLIANCE The regulations governing the health care industry are extensive, complex, and intersect with your operational model at multiple points. We support your team by auditing your compliance with any market's regulations and legislation, including those you are already in and expansion markets. And we will leave you with a roadmap of changes your company must make to abide by all relevant policies.

SECURITY BY DESIGN Atrómitos is an SBA-certified woman-owned business headquartered in Wilmington, NC. The Atrómitos team has expertise in strategy, innovation, and change management; policy and research; operations and contracting; and technology, security, and compliance.

Atrómitos works with small to mid-sized organizations in the health and human services sector. Through their work, their mission is to help create healthier, more resilience, and more equitable communities.

You are only as strong as your weakest link. Planning for and building security and privacy controls is an essential determining factor for the scalability and application of your platform. Being “HIPAA Compliant” is not enough (or an actual designation) – you need a system and controls to implement and operationalize your privacy and security policies actively. In collaboration with our strategic partners, we stress test your platform, conduct threat modeling, and help you to implement a plan to monitor and defend your organization and platform.

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TOP 5 WAYS ATRÓMITOS CAN SUPPORT PROVIDERS IMPLEMENTING TECHNOLOGY SOLUTIONS

OPERATIONAL IMPLEMENTATION AND CHANGE MANAGEMENT

PLATFORM AND VENDOR EVALUATION STRATEGIC PLANNING AND PARTNERSHIP DEVELOPMENT CONTRACT NEGOTIATIONS

COMPLIANCE AND SECURITY EVALUATIONS

ATRÓMITOS TEAM

MICHEALLE GADY, JD

SARAH JAGGER, JD, MPH

PRESIDENT

VICE PRESIDENT OF OPERATIONS

• 20 years of experience in health law and policy, program design and implementation, value-based care, and change management.

• As former Health Counsel to a senior member of the US House of Representative's Ways and Means Committee, Michealle was intimately involved in creating and passing significant health care legislation, including the Affordable Care Act. • Ample experience evaluating, selecting, and contracting population health management and care management platforms.

• Former Director of Policy for Indiana Office of Medicaid Policy and Planning, Sarah has expertise in long-term services and supports and identifies, implements, and manages traditional and non-traditional partnerships across healthcare stakeholders.

• More than a decade’s experience working with health plans, providers, and community-based organizations to assess readiness for program changes and implement processes and procedures to achieve program goals.

TINA SIMPSON, JD, MSPH

PETER FREEMAN, MPH PRINCIPAL

PRINCIPAL

• Leads Atrómitos' System Integrity and Resilience service line, providing technology evaluation, contracting, security, and compliance services to healthcare clients.

• Former Chief Compliance Officer of a population health company focused on supporting North Carolina providers under the Advanced Medical Home model. Tina has expertise in programmatic reporting requirements, platform functionalities, and the effective implementation of technology solutions.

• Former Executive Director of the Carolina Medical Home Network, an ACO comprised of Community Health Centers, Peter offers over a decade of experience interpreting data to inform program design and effectively implementing quality improvement and operational changes across organizations.

• Over 10 years of experience supporting clinical care teams, Boards of Directors, and volunteer communities to establish more efficient operational infrastructures and effectively implement change.

• Over 15 years of experience in health law and policy and as a Certified Healthcare Privacy Compliance Professional (CHPC), Tina is proficient in strategically aligning legal and business risks.

If we can meet any of your needs, send us an email to info@AtrómitosConsulting.com. We also offer free, 30-minute consultations. Visit us here at www.AtrómitosConsulting.com/Contact-Us/Free-Consultation to schedule your free consultation.

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