Phase

Analysis Objectives

Business Value

System Planning

• Identify current workflow issues – both system and manual
• Assess potential impact of forthcoming business initiatives (e.g. consolidation of departments due to health system merger/acquisition, growth in transaction volumes due to HMO membership drive)
• Explore potential remedies and estimate resource requirements (e.g. cost, staff, time)

• Potentially avoid unnecessary investment in new system by optimizing current systems and manual processes
• Facilitate vendor search by identifying mandatory capabilities of a new system

System Selection

• Establish specific, prioritized system functionality requirements
• Identify potential functionality gaps
• Identify strong departmental resources to involve in implementation process
• Set expectations for intensity, duration of implementation effort
• Estimate (preliminary) potential benefits

• Enhance user involvement, project/system buy-in
• Develop specific, accurate system requirements

Contract Negotiation

• Quantify estimated benefits attributable to new system
• Assess system capabilities/limitations, establish contracting priorities

• Enable price negotiations based on credible knowledge of the system’s value and limitations
• Avert contractual obligation to ‘unjustifiable’ system

System Implementation

• Optimize workflows to maximize productivity
• Identify/prioritize system customization/enhancement requests
• Gain functional/workflow knowledge to develop effective training approach, materials, minimize learning curve
• Minimize work-arounds
• Update policies and procedures to reflect new system

• Accelerate ROI
• Standardize and streamline processes

Post-implementation

• Identify system and/or manual workflow impediments
• Make minor adjustments to system and/or manual processes
• Plan for and estimate cost of major modifications to system and/or manual process modifications
• Identify additional training requirements

• Increase system utilization to optimize intended benefits

Scenario

Business/IT Questions

Results

A health system acquired a nearby hospital with numerous disparate systems and differing degrees of unionization among their staffs. In order to leverage the benefits of the combined organization, it would be necessary to consolidate counterpart departments onto a single system.

• Which system should become the standard?
• What would be the costs and other implications?
• What could be done to ease the transition and improve the user buy-in and ultimate success of the consolidation?

• Analysis of manual processes and systems from both organizations yielded:
• Recommendation for long-term consolidated system decision based on relative strengths/weaknesses;
• Prioritized listing of system enhancement requests;
• Incremental process improvement recommendations;
• Valuable cross-organization participation.

A managed care organization selected an electronic claims system to improve the turnaround time and reduce the cost of processing claims. The focus in the vendor selection effort was to obtain a sufficiently robust system to accommodate all claims processing rules, effectively bypassing ‘all’ human intervention. Great – seemingly no workflow issues.

• What about the claims that would continue to be received on paper?
• What about those claims that would require intervention to resolve issues with eligibility or prior authorization – separate but related departments?

• Adoption of the new system was strong, the learning curve was abbreviated, benefits to the organization were realized significant, including:
• Electronic processing of nearly 50% of all claims;
• Reduction in claims and eligibility department FTEs;
• Increased production in authorization department.

Hoping to build upon the success of the claims automation effort, the managed care organization pursued an initiative to implement an electronic system for authorization requests and processing. Preliminary analysis revealed various significant gaps between the proposed system’s capabilities and the organization’s requirements. There was potentially some benefit from the available functionality but also considerable concern about under-utilization.

• How much should the organization be willing to pay for the system?
• At what point would it become a losing proposition?

An upstart health care information technology vendor developed, sold, and implemented an electronic medication management system. The revenue model was highly dependent on processing large volumes of prescription orders through their system. Despite considerable enthusiasm among initial physician group implementations, the vendor was not experiencing the anticipated transaction volumes.

• What was it about the product or its implementation that was constraining the adoption rate by their physician customers?

• Development plans were modified as a result of:
• Critical technology design issues (e.g. inadequate end-user and system interfaces) being identified;
• User workflows being better understood and "usability" requirements being identified and prioritized.