Cutting Edge Issues

eHealth:
Towards A New World of Communications in Medicine

Case Study: Overlake Hospital Medical Center

Information on Demand: Consumer-Controlled Medical Records

Finding Leaders for Internet Health Care

Building the Security-Capable Enterprise

Planning Business Strategies with Internet Support

Internet Use as a Survival Strategy

Case Study Zone

Who is eMed?

Internet Use as a Survival Strategy

Part 2

THE INTERNET ON-RAMP

Our e-commerce effort began in 1998, when we initiated the development that has been the road to the Internet for us. E-commerce and ehealth are now very much a part to of the everyday lexicon within Hill Physicians and within the management team. We are very much focused on improving data systems and work flows, as well as on extensive data warehousing. Our data warehousing started in 1996. We purposely chose not to begin as many other organizations did; we avoided starting with the electronic medical record. It is difficult enough to convert work processes and data on which everyone has a fair amount of agreement. Where the electronic medical record is concerned, there is very little agreement. Debate continues regarding how it should look, what should go into it, who should use it, and how to use it.

Instead of tackling such thorny issues, we started with something that could only be considered exciting in an industry as prosaic as health care: claims. Automating claims had, as its objective, streamlining the handling of the largest amount of paper that is involved in running a physician’s office (particularly in managed-care settings). Unlike approximately 80% of managed care organizations in the United States, we do not use capitated payments for primary care physicians (and have never done so). Our contention is that primary care is most of the care that most people need, most of the time. For this reason, primary care physicians should be given productivity incentives. Second, capitating individual primary care physicians not only provides an obviously perverse incentive to withhold care, but also keeps them segregated.

One of the main missions of Hill Physicians is integrating physicians, bringing them together to build teams. We have organized our primary care physicians in pods . They are profiled in pods, so they actually have fairly deep profiles comparing them with the people with whom they work on a daily basis, but they are paid on a fee-for-service basis. Because we have fee-for-service claims for primary care and most specialty care, we have a major claims-processing function. The objective of the e-commerce project was to process claims in a way that created a user-friendly environment and built trust in the system. Many of those who grew up during the period when computers often failed have not wanted to give up their parallel paper-based systems; this is how physicians are acting today. They must rely on their patient data, so they are very reluctant to give up the paper-based system unless they have absolute faith in the automated system to which they are converting.

Starting with claims seemed, to us, to be the best way to build the trust necessary for that conversion. The claims processing system is well known to most physicians in the United States, so we could establish standards, define processes clearly, and convert those processes for use in an electronic environment.