Implementation best practices: Ringing up success with finance IT

Five experts in financial information systems offer insights and tips for launching technology to help drive cost efficiencies and boost hospital bottom lines.
By Bill Siwicki
03:04 PM
Implementation best practices: Ringing up success with finance IT

Clinical information systems help keep patients healthy and safe, but financial information systems help keep healthcare provider organizations up and running. There is no underestimating the importance of finance IT.

This is why implementing it correctly, and getting it right the first time, is so important. Poorly implemented financial information systems can negatively impact payments, analytics and any number of factors in the daily operation of healthcare organizations.

Here, five professionals with deep expertise in financial information systems offer their best practices for launching finance IT at a healthcare provider organization. These suggestions are aimed at healthcare CIOs, CFOs, and other IT and finance staff.

Key first questions: the what and the how

Before even selecting a finance system, it is vital that a provider organization has clearly defined a roadmap to answer the what and the how: What it hopes to achieve, and how it plans to achieve it, said Dr. Kaveh Safavi, senior managing director of consulting giant Accenture's global health practice.

"With sharp clarity on the objective and path forward, an organization is better equipped to apply operations and processes so that the new tools are used in the most effective way possible," Safavi explained. "Only with a clearly defined roadmap can an organization succeed in seamless system integration, ensuring its new financial system is fully integrated with the systems it is using for clinical and business functions."

Being able to integrate a new financial system in this way eliminates a tremendous amount of redundancy, ultimately saving time and resources by removing issues stemming from reconciliation and data sharing across separate systems, Safavi added.

"My second-best practice when implementing new finance technology is for organizations to recognize that, while the new technology being implemented may serve as the company's financial backbone, the organization will need to ensure that the right skills, people and business processes are in place to use the technology effectively," Safavi said.

When implementing the new system, organizations have the choice to either hire talent that already has experience in using these digital technologies, or to reskill their existing employees, Safavi stated.

"The success of any new technology, overlay or organizational initiative often depends on its ability to play well with the health system's EHR."

Kent Ivanoff, VisitPay

"I often suggest organizations create an implementation team, which designates a group of employees to lead and manage the process, and to champion the new system with colleagues," Safavi explained. "This can alleviate a lot of confusion, as they serve as the point of contact for any questions posed to the organization or vendor."

New financial technology can transform operations, but only if the organization invests in talent and ensures it's being used by people with the appropriate skills, Safavi added.

Effective systems integration is essential

Elsewhere in the finance IT implementation arena, if a healthcare CIO is planning to implement a financial system, it is important for him or her to understand that integration with third-party systems will be a large portion of the effort, said Joseph Clemons, director, advisory services, at Pivot Point Consulting.

Integrations are complex, require a very specific skill-set, and will make or break the implementation, he said. A CIO can mitigate risk, he advised, by considering the following:

  • Start planning for the third-party system integrations on Day One, particularly those that transmit data to financial institutions and regulatory bodies.
  • Start interviewing and secure professionals to lead the integration component of the implementation as soon as possible.
  • And most important, develop a strategy to transfer the knowledge of that expert team one hired to those who will maintain the integrations.

"Implementations where integrations are considered later in the project schedule and that are not properly transitioned to an operational model all too often run over schedule, over budget, and lead to risk that could have been easily mitigated with the right amount of planning and management," Clemons explained.

What's the problem?

The first priority – and the most essential – is understanding the problem the technology is intended to solve, said Kent Ivanoff, CEO and co-founder of VisitPay. This may sound obvious, but challenges defined by assumptions often lead to the wrong conclusions and an ineffective solution, he said.

"For example, on the financial side of healthcare, there are few challenges as systemic and widespread as patient billing," he stated. "For many large hospitals and health systems, patient payments can comprise more than 20 percent of a health system's revenue – and it's growing every year. On the surface, this look like a collections challenge, but a deeper look reveals a more complicated story about patient experience."

Most patients want to pay what they owe for the care they need, but the typical healthcare financing system is designed to manage billing as a series of business-to-business transactions across large, complex organizations, rather than accommodating the needs and preferences of individual patients, Ivanoff said.

"From this more complex perspective, it's clear that a collection-driven technology is poorly suited to meet the true nature of the problem – providing consumers with the tools to confidently meet the complexities of healthcare billing. As a result, patients are forced to accept the outcomes of a system designed for centralization and control."

"Organizations can take advantage of technology to identify the care a patient will likely receive earlier on in the process, provide the patient with a better cost estimate, and collect upfront for that anticipated care."

Scott Herbst, Availity

However, a CIO who understands the true nature of the challenge will evaluate technologies that enable the consumer to have transparency, trust and control in the financial relationship, and then use smart analytics to understand consumers' ability to pay, propensity to pay and behavioral characteristics in order to drive meaningful experiences and engagement on the consumers' terms, he contended.

"What many health system CIOs are coming to understand is that clinical and financial experiences are no longer mutually exclusive; patients increasingly view them as a single experience," he added.

Understand the overall ecosystem

Sonal Owings, vice president of customer experience at Patientco, offers two implementation best practices for financial information systems. First, it is critical that healthcare CIOs understand the overall ecosystem that new finance tech will impact, she said.

"This involves researching integration points, considering the impacts to banking and accounting systems, how these systems will impact workflows, and, ultimately, the patient financial experience," she said. "Regardless of the technology, managing internal change created by shifting technology is also critical. Keeping a pulse on how the organization is handling the transition is important – particularly if there is a change to individual staff roles and responsibilities."

The regulatory environment related to financing technology shifts frequently, she added.

"That means it's essential for CIOs to understand how regulations – such as FinCen and PCI compliance requirements – may impact their approach for implementing new technologies," she said. "Additionally, some regulations may require specific information from the health system to support a successful and compliant implementation."

Owings' second best practice notes that regardless of what type of technology an organization is adopting or implementing, establishing a charter for the implementation, along with an internal governance structure that includes key stakeholders, is highly recommended.

"To successfully implement technology within an organization, everyone must be aligned on the purpose of the implementation and those key stakeholders must stay informed," she said. "From identifying the scope of the project to establishing key metrics of success, assign appropriate resources to the project and create communication pathways to keep everyone on the same page, as well as escalation pathways for when issues need to be addressed."

Keep an eye on workflows

On another front, healthcare CIOs should beware workflows. While 70 percent of hospitals have adopted revenue cycle management technology, many use EHRs combined with multiple RCM vendors, which can cause significant interoperability and workflow issues, as well as data silos, said Scott Herbst, senior vice president and general manager of provider solutions at Availity.

"Better workflows can also improve upfront collections," he said. "Organizations can take advantage of technology to identify the care a patient will likely receive earlier on in the process, provide the patient with a better cost estimate, and collect upfront for that anticipated care."

"Keeping a pulse on how the organization is handling the transition is important – particularly if there is a change to individual staff roles and responsibilities."

Sonal Owings, Patientco

Healthcare providers must have one source of truth. To accomplish that, the work must be done in one system so it can be used to the maximum degree, Herbst said.

"If a correction was made outside the system, it's not efficient to import that correction manually back into the host EHR system, for example," he explained.

One of the major hurdles to attain one source of truth is the surge of mergers and acquisitions, which have left many systems with a hodge-podge of technologies that don't always talk to each other, he added.

"Revenue cycle leaders will be instrumental in making sure new entities' workflows are properly mapped to existing platforms and that the shift can be tracked and reported, and RCM partners should actively help them accomplish this task," he stated.

Another challenge: Regional or new technologies that arise often are not available immediately in the core EHR systems, he said.

"If a state or a payer comes up with a new requirement to send a claim or adds a new data field, for example, it's not readily accessible in the EHR," he explained. "Software must operate as seamlessly as possible with the host system. And whether that's communicating back into the host system – it must be able to integrate and augment those systems."

The benefits of workflow optimization can be significant, but the execution will take a lot of expertise, time, and cooperation with providers, RCM partners, and, in many cases, the EHR systems, he added. One must have a good relationship at multiple levels to get that work done, he said.

Clinical integration is important

Ivanoff of VisitPay offers another finance IT best practice: Understand how effectively new technology will play with existing IT investments and align with the overall goals of the health system.

"The electronic health record is the most significant health IT investment many health systems will make," he stated. "For this reason, most healthcare executives continually seek to maximize their platform's performance, rather than view them as a 'one-and-done' implementation."

The clinical side of healthcare has taken the ball and run with this philosophy, leveraging the EHR and third-party technologies to foster dynamic initiatives in areas like population health, care management and virtual health, he explained.

"The success of any new technology, overlay or organizational initiative often depends on its ability to play well with the health system's EHR," he said. "Well-executed interoperability makes it easy for providers to use the tool, and ultimately makes it easier for the consumer to interact with the provider."

The easier it is for the consumer to interact digitally with the hospital or health system, the easier it will be for them to ultimately resolve their financial obligations, and it will be easier for the providers to actually give them that experience, he said.

"A financial health tool that seamlessly integrates into the EHR can not only eliminate current inefficiencies, like manually entering payment information, but prevent new problems from emerging, including disrupted workflow or added administrative burdens to bridge poor interoperability," he added.

Start with the EHR

Herbst of Availity agrees that working with the EHR is crucial, and that healthcare CIOs implementing finance IT must pay a lot of attention to how things work with the EHR.

"Few health IT implementations are as expensive, complex, and involve as many stakeholders as an EHR – and it's even harder when you're up against an aggressive deadline," he said. "During an EHR build, it's natural for an organization to put considerable focus on clinical functionality. However, the line between clinical and financial data isn't as bright as it once was, and a significant indicator of a successful go-live is a provider's ability to effectively manage payments and claims."

Hospitals upgrading or embarking upon a new EHR build should make revenue cycle management a high and continuous priority in order to identify and mitigate any issues during the course of the build, he added.

"With an implementation of this scale, the impact on cash flow is always going to be a concern," he said. "New EHRs often cause changes in charge capture and billing processes, and there is the ever-present risk that something will go wrong, leaving you unable to get charges out the door."

By focusing on revenue cycle management early, providers can establish a performance baseline for claims and revenue management, and ensure that the hospital can seamlessly administer payments and claims and maintain financial performance during the transition to the new system, Herbst stated.

Have a solid testing program

Clemons of Pivot Point Consulting added that another best practice for any implementation is a good testing program, and this is especially true when implementing a financial system.

"As with any implementation, testing is the best mitigation of risk to avoid unnecessary problems," he explained. "A good mantra to channel to your team is that failure with financial data is not an option. I always tell my clients, 'Testing is confirmation of an expected outcome. If the outcome of the test is not what we expected, we still have work to do.'"

Financial system implementation plans often call for multiple iterations of tenants, or test environments, where data is slowly developed over time, tested and then moved on to the next level, he explained.

"A best practice is to insist on the folks who lead this work to be skilled with intense attention to detail, proven test plans with detailed documentation of the test result, and the resolving regression test activity," he said. "The best outcome is a failed test. The worst outcome is a failed activation. In the end, your investment in people and time will be well worth the effort."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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