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Health care economist: Time studies could make ACO implementation tick

Don Fluckinger, News Director

WALTHAM, Mass. -- Adam Powell, economist and Northeastern University health care informatics professor, believes there are two main areas CIOs must focus in implementing a successful accountable care organization: collecting the right clinical data

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Doing that could employ a 19th-century idea espoused by Frederick Winslow Taylor, one of the earliest industrial efficiency theoreticians: time studies, or counting the minutes each employee spends accomplishing each task in their workday. In a health care environment, Powell thinks, time studies can determine more exact costs -- including precise overhead allocation -- than present health care accounting methods can.

When a hospital can determine just how much time a particular episode of care consumes, Powell's theory goes, the better it can adjust its workflow for capitated accountable care organization (ACO) payments. Among provider teams, this can range from a simple wound stitching in the emergency department to the complex patient testing and recovery involved with an organ transplant.

Time studies involve five steps, Powell said in a presentation at the Massachusetts Health Data Consortium's "Using Analytics to Thrive in an ACO World" conference, one of a series of HIT-related events the group regularly hosts on topics as diverse as payment reform, mHealth and meaningful use compliance. The five steps include defining the method, dividing a task into work elements, timing those elements, benchmarking to determine a worker's pace as slower or faster than normal, and applying an "allowance" to the normal time that factors in such between-task activities as getting to a room, recovering from fatigue, and so forth.

If you have an EHR that just records when the physician started writing the progress report and maybe when they completed it a few hours later, that doesn't give you very much information.

Alec McLure,
medical informatics director, Verisk Health Inc.

The sum of normal time plus allowances equals "standard time," which gets counted toward the payment for a task. "Once you have this information," Powell said in his presentation, "you can make better staffing decisions."

Getting the data for ACO implementation not so simple

Health IT's 21st-century twist to old-style time studies? Software analytics to determine which providers are investing how much time treating which patients. These applications could shift care to lower-cost alternatives, such as physician assistants, nurse practitioners or even physicians who simply work faster. Time studies also could help route patients to more economical suburban community hospitals instead of high-rent city facilities when it made sense, Powell said.

The problem is, some attendees pointed out, present-day electronic health record (EHR) systems might timestamp procedures, but they can't easily collect and aggregate the data needed to feed such analytics systems. That's because EHRs are set up to capture billable charges and not analyze time spent on tasks, Alec McLure, medical informatics director for data analytics vendor Verisk Health Inc., told SearchHealthIT.

"Some of the EHRs I've worked with are very process-oriented -- [for outpatient treatment they can timestamp] when the patient checked in, when the patient got to the room. If they're well-integrated, you actually have this kind of timestamping," said McLure, who added that he found the notion of time studies interesting. "If you have an EHR that just records when the physician started writing the progress report and maybe when they completed it a few hours later, that doesn't give you very much information."

Powell and another attendee, Yogendra Jain -- medication-adherence hardware vendor SentiCare Inc.'s founder -- agreed, however, that such detailed analysis of health care workflows will become an emerging tech trend as health care moves toward ACO implementation and other similar, capitated, quality-based payment programs over the next few years.

While EHRs might not be able to capture start-and-stop times to feed analytics systems downstream presently, customers will push EHR vendors to build in these features, Powell and Jain believe. Vendors that don't will risk losing customers looking to do an ACO implementation to more accommodating software companies.

"I'm guessing, over time, it will be built into the [health IT] infrastructure itself," Powell told SearchHealthIT. "People don't want to be disturbed. To the extent that pushing a switch on a machine creates some sort of timestamp -- or logging into the system -- that you can figure out who's doing what, when and where ... I think that's what will power it."

Editor’s Note: Alec McLure’s name was misspelled in the original story; it has been updated to reflect his correct name.

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.


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