Carol Davis-Smith 500

Carol Davis-Smith

Healthcare facilities across the country are experiencing tremendous upheaval. In order to better understand the trends driving the industry forward and how to best serve patients and clinicians in the future, it can be useful to engage in futurecasting. Futurecasting is the practice of envisioning the future of yourself, your team, your organization, or even your broader industry.

The Kaiser Permanente Clinical Technology program is in the midst of this process, and documenting it within our strategic plan. We are a community of practice consisting of seven geographic regions, a national team, and at least 10 accountable management teams reporting up through the organization in a variety of ways. Our futurecast envisions a “One ClinTech” strategy ensuring coordinated, consistent, high-quality, and affordable healthcare technology management (HTM) across the Kaiser Permanente enterprise.

Our vision is probably not unlike the vision of most HTM teams across the country. However, the complexity for all of us arises in trying to make that futurecast operational. While we are probably most comfortable tackling technological challenges, it’s more likely that people and process challenges will consume our time, energy, and creativity.

For example, we are all dealing with medical device networking, integration, and security. The technical solutions to these challenges lie in well-understood science and engineering principles. They may be complicated, but solutions exist, and more are being invented every day. However, the impact of these issues on organizational dynamics, people-based workflows, and nonexistent or poorly defined processes do not have such clearly defined solutions—or at least, not ones that are consistently agreed upon and uniformly implemented.

The reality of this scenario is apparent whether you are a single hospital or a large integrated health system like Kaiser Permanente. So what can we do? I suggest careful consideration of three challenges facing our healthcare industry at large and their specific implications for healthcare technology management.

Mergers and Acquisitions in the Medical Device Industry

Once again, we find ourselves in a period of consolidation within the medical device industry. Large corporations are acquiring or merging with other large corporations, which leads to business decisions about the future of their various product lines. Some will thrive, some will survive, and some will fade to black.

As healthcare technology management leaders, we must monitor these changes and anticipate the impact on our programs. We must be prepared to adjust our processes and methodologies for forecasting technology requirements (such as upgrades and replacements) and our technical support models in response to the medical device industry’s product line decisions. These changes may have a minimal impact if our preferred products “win” in the consolidations. However, our healthcare technology strategies may have to undergo significant changes if our preferred products “lose.”

The technological implications of these market changes are typically straightforward. However, the disruptions they might cause to clinician workflows and the financial implications could be challenging to navigate. Do we as healthcare technology managers have the skills and knowledge to support these nontechnical challenges? Do we understand the implications of medical device consolidations? Can we anticipate these changes and educate our organizations? Or are we “behind the eight ball,” in a reactive posture?

Mergers and Acquisitions Among Healthcare Delivery Providers

We are also in an era of consolidation among healthcare delivery organizations. Facilities of all sizes find themselves combining with others. Just as in the medical device industry, consolidation of these organizations requires business decisions about which “product lines” to pursue in which locations, and to what degree of complexity. Just as in the medical device industry, there will be decisions about leadership. Will your organization assume leadership, or be folded into the acquiring organization? Regardless, are HTM departments prepared to lead the merger of disparate healthcare technology management programs? Or will we wait for senior leadership to define our future?

In most cases, healthcare delivery organizations acquire or merge to achieve greater market share and improve cost efficiencies. Do we have the skills to lead and deliver value through standardization of HTM processes and capabilities? Do we understand the implications of the acquisition or merger upon our most precious resource—our staff? Do we have, or can we get, the necessary and appropriate support from senior management to make the process transitions in parallel with the people transitions?

Unprecedented Volume Growth in an Era of Affordability

Perhaps the most difficult issue to forecast is the impact of unprecedented growth. Implementation of the Affordable Care Act  has meant increased membership for nearly every health insurance plan and a greater number of clinical visits for nearly every healthcare delivery organization. Additionally, the consumerization of healthcare now means more healthcare “consumers” are educating themselves just as they would for any other purchase. As such, they have greater expectations of value: that is, what do I get for my dollar?

The healthcare delivery organizations we serve are exploring a spectrum of strategies to absorb this increased patient volume, along with the need for more locations, broader hours of operations, more complex mix of clinical services, and more integrated technologies. Are we exploring HTM strategies to support this growth, such as staffing models, skill sets, and service offerings? Are we engaged in technology planning, or are we still stuck in a fix-it mentality? As our healthcare delivery organizations revise their enterprise strategic plans, are we defining and refining our HTM strategic plans?

Embracing the Continuum of Care

To further complicate our futurecast, the healthcare industry has recognized and is beginning to seriously address the broader continuum of care. The most obvious area is the increased focus on primary care and prevention. This segment is not completely unfamiliar to HTM professionals, because many HTM programs support primary care physicians who practice in the healthcare delivery organization’s hospitals. However, the other end of the continuum—skilled nursing facilities, home health—is less familiar. Growth is increasingly taking place in these “nontraditional” venues.

As part of the consumerization of healthcare, we are also witnessing a growth in retail healthcare delivery venues. Almost every big-box store and pharmacy has, or is planning, an in-store clinic. Are our HTM programs prepared to expand into this broader continuum of care, which will require a very different operating model? Are we exploring potential strategies and comparing tactical options?

Our HTM program futurecasts must include the development of these capabilities—people, knowledge, and tools—in order for us to be trusted advisors to our organizations.

Strategies for Success

The Kaiser Permanente Clinical Technology program is using the strategic planning process to organize our thinking and document what we believe is necessary for us to be successful over the next 5 years, as well as in our current environment. We are attempting to respond to the questions above through four lenses: people, process, technology, and financial stewardship.

Currently, our community of practice is working towards consensus around the high-level vision and enterprise-applicable, “strategically tactical” actions required to achieve that vision. Our next steps will require alignment across the geographic regions and current practices of each HTM management team. Along the way, we will understand the necessary sequencing and establish timelines. Key to our success, and that of any healthcare technology management team, will be alignment with our enterprise vision and mission. That involves making sure that everything we do has “line of sight” to our most senior managers’ priorities and workstreams.

Our adaptability to an ever-changing, and sometimes ambiguous, environment is also key to success. External forces such as reimbursement and regulatory requirements are affecting our healthcare delivery organizations more than ever. Additionally, we all anticipate expansion of our healthcare delivery systems beyond hospitals and medical office buildings.

All these changes will require us to assume new HTM responsibilities without dropping our core services. Are we prepared to take on the next era of healthcare technology management? Or will we find ourselves on the sidelines? At Kaiser Permanente, the Clinical Technology program is on an exciting journey into the future. We hope you will join us and meet the challenges and opportunities that will drive higher quality affordable care for all the communities that we serve.

Carol Davis-Smith is vice president, Clinical Technology of the Kaiser Foundation Health Plan. For more information, contact editorial director John Bethune at [email protected].