Powering Community Health: Transformation to 2030

Executive Summary

This white paper explores the challenges and opportunities faced by Community Health Organizations (CHOs) in adopting technology to improve service delivery and patient care. It outlines a strategic roadmap for CHOs to navigate the evolving healthcare landscape leading to 2030.

Key Points:

Recommendations:

Introduction

Powering Community Health: Transformation to 2030

Community Health Organizations (CHOs) face a pivotal moment. The healthcare sector is transforming quickly, with technology and patient demands leading the change.

This shift requires CHOs to boost their IT investment by 50-100% by 2030. This white paper explores the tech trends defining CHOs’ future and presents a clear strategy to navigate these changes.

We use Highlands Health (an amalgam of CHOs we’ve studied) to tell the story of this transformation, and to discuss the challenges and solutions.

Located in Washington State, Highlands is a leader in community health. Known for its comprehensive and patient-focused care, it offers a range of services addressing physical, mental, and social health. With a commitment to inclusivity and innovation, Highlands provides high-quality care to all, making it a benchmark for community healthcare across the nation.

The Situation

Challenges and the Call for Transformation

Highlands Health, despite its achievements in holistic healthcare, faces hurdles in IT infrastructure and strategic implementation.

Highlands embraces innovation, and has brave ideas to improve metrics like ‘proof of problem solved’ across its clinics. But its ambitions are often stalled by an IT system that lags, with resources stretched thin and IT delivery falling short of expectations. This creates a cycle of constant problem-solving, making it hard to keep skilled staff and focus on long-term goals. Daily IT struggles limit the organization’s ability to innovate and grow, highlighting the critical need for an IT and strategic makeover.

Highlands must find the right IT budget to remain competitive without straying from its mission. The goal is to provide the best possible multi-modal care across a diverse population, while budgeting within the means set by funding sources. Highlands aims to not just meet industry standards but to lead the industry in providing value to the community through passion and innovation.

What we observed

Thin teams with a big appetite for innovation

Observations of Highlands’ IT ecosystem, focusing on clinical workflows, Agile delivery processes, staffing levels, and the impact of EHR Software as a Service (SaaS) platforms on innovation.

We conducted in-depth interviews with frontline staff, IT personnel, and management. Additionally, we reviewed system usage data, workflow diagrams, industry feedback¹, and project documentation to identify inefficiencies and gaps.

Our approach emphasized understanding the real-world challenges faced by healthcare professionals and the IT team, aligning our insights with the organization’s goal to deliver the most value possible to the members of the community. Through this multifaceted evaluation, we identified key areas for improvement and innovation potential.

Inefficient, frustrating clinical workflows

The clinical workflows within the system are full of operational hurdles. Key issues include:

Redundant Data Entry: Clinical staff and patients frequently encounter requests to input information that the system has previously captured, leading to frustration and inefficiency.

Navigational Complexity: Staff must navigate through an excessive number of steps, often requiring 10-15 clicks, simply to transition between views or compare data points, significantly slowing down their workflow.

Manual Data Transfer: Clinic personnel often find themselves acting as the manual link between various Software as a Service (SaaS) platforms used by the clinic. This involves a tedious process of copying and pasting data from one application to another, indicating a lack of integration and automation in the system.

Delivery process has Agile gaps

Our evaluation showed gaps in the solution delivery process at Highlands Health, particularly in adopting modern delivery methodologies. The process lacked essential steps such as contextual analysis for feature requests, decomposition into Agile stories, creation of acceptance criteria, and conducting demos and retrospectives. This gap underscores a broader issue: the absence of a unified view on priorities and strategic direction, leading to a daily focus on firefighting and minor tasks without considering their overall additive impact to patient care. IT workers are resolving tickets when they should be solving problems.

The bottom line: motivated caregivers slog through
endless workflows, acting as ‘meat glue’ between system silos, when they should be focused on patient care.

IT is understaffed

We observed that the IT team’s size is insufficient for an organization serving 500 employees, with its expansion not aligning with the growing IT demands. This disparity has led to the adoption of disparate tools for identical needs across teams, increasing the support burden on the already stretched IT staff. Moreover, the server infrastructure’s consolidation into a single, low-security data center poses a significant risk, highlighting a critical lack of cloud expertise and a single point of failure that could jeopardize service continuity.

Great potential for user-centered delivery

The IT team possesses a strong capability for gathering, comprehending, and defining requirements for user-centric technical solutions. Whether ‘the user’ is a patient, a caregiver, or an administrator, IT culture is deeply driven by a problem-solving ethos, with a keen desire to contribute to the organization’s primary mission of providing care for the community. However, the current challenge lies not in their willingness or ability but in the constraints of time and resources. The team finds itself spread too thin, lacking the necessary bandwidth to dedicate individual members to specific projects over extended periods. For instance, just getting in the door of Highlands Health is still a paper process. But allocating one team member to digitize the patient intake process (which would significantly reduce wait time and frustration for patients) is currently beyond their capacity.

EHR SaaS are constraining innovation across the industry

Our analysis indicates that reliance on EHR SaaS platforms, such as the one provided by companies like Ochin, can significantly hinder innovation within healthcare organizations like Highlands. These platforms often impose restrictions that limit the ability of healthcare providers to tailor the EHR system, such as Epic, to maximize its utility. For instance, making customizations to adapt to the unique workflows or to introduce new patient engagement features can be a slow and cumbersome process under the rigid frameworks of EHR SaaS providers. This sluggishness in turn delays the roll out of improvements in patient care and operational efficiency.

Many EHR systems struggle with interoperability, or the ability to exchange and make use of information across different healthcare systems and software. For example, smaller EHR vendors typically don’t support seamless data exchange with larger systems, leading to information silos.

Despite these limitations, it’s important to recognize that the staff at these EHR SaaS companies are typically focused on their product’s development and might be open to addressing a list of prioritized requests from their clients. For example, while the core functionalities might be locked down, ancillary features like patient portals (similar to MyCharts in Ochin) often offer more leeway for customization. But CHOs, without a strong user advocate, are at a loss to formulate and communicate priorities to the SaaS companies. Ochin’s heart is in the right place, but without a strong signal of priorities from the CHO, they will always be a bottleneck to innovation.

Looking beyond Ochin, providers using systems like Cerner or Allscripts also face hurdles in customization, reflecting a broader industry issue where the inflexibility of EHR systems slows or stifles technological advancement and adaptability. Healthcare organizations have found workarounds and partial solutions by integrating third-party applications where possible, but these often come with their own set of challenges, including increased complexity, high cost of maintenance, and potential security concerns.

A history and culture of firefighting

Highlands Health grew into their current problem. IT evolved initially to handle the power, phones, internet, Wifi, printers, and other physical infrastructure, which solutions are associated with trouble tickets. But when the complexity of use cases increased–for staffing apps for the clinics, for example–the service model stayed the same, and so rather than strategically leading a selection for a single staffing app to be used across all clinics, the IT group simply answered trouble tickets for the four independent solutions that were chosen by individual clinics. IT is a flat organization, with a service-oriented approach, and each person works on a dozen different things each day.

A single weather event could have the entire organization running off paper and pencil.

Heavy infrastructure investment is a liability

On-premise infrastructure promised a higher level of availability and better cost performance initially, but now it’s a liability. Touring the single Highlands data center revealed drips in the ceiling tiles from one floor up: a single weather event could have the entire organization running off paper and pencil.

Running a Community Health Organization (CHO) off a single data center poses significant risks, including a heightened vulnerability to data loss, service interruptions, and security breaches. Such a centralized infrastructure creates a single point of failure; any physical damage, cyberattack, or system failure can disrupt operations, compromise patient data, and hinder access to critical healthcare services. This lack of redundancy and resilience in the IT infrastructure can lead to prolonged downtime, potentially endangering patient health and eroding trust in the organization’s reliability and security protocols.

Industry wide, CHOs that do have multiple data centers in general don’t have automation or tested plans in place for failing over to it. There are real costs and effort to build out that automation, to test it, and to keep it ready at all times.

Federal oversight trend toward more competition, innovation

In its Federal Health IT Strategic Plan² (draft for comment), the US Department of Health and Human Services introduces and reinforces a theme of greater competition among Federally Qualified Health Centers, with the multiple goals of expanded access, cost reductions, and more innovative solutions. Leading up to 2030, CHOs will be expected to share data on underserved populations with health researchers and federal agencies, while enhancing data security and privacy for the members.

The goals expressed in the draft document  mean that CHOs need to

1. implement new patient management software, telehealth platforms, and other digital tools that facilitate improved patient engagement

2. invest in technologies that enhance service delivery to remote or marginalized populations, such as mobile health units or community-based health IT centers

3. expand their IT departments, hiring individuals with expertise in the latest healthcare technologies and data management

What we recommended

Staff up strategically, and get in the cloud

Competition among Community Health Organizations (CHO) unfolds over an extended period. Patients typically do not switch providers based on the introduction of new features, such as SMS messaging, by a neighboring provider. However, a culture of continuous improvement significantly impacts patient perception and loyalty.

This attribute is notably observable and valued by patients, making it a key factor in retaining them over time. One of the most straightforward strategies to demonstrate an organization’s commitment to continuous improvement is through the timely adoption of technological solutions. This not only showcases an organization’s agility but also its dedication to addressing the evolving needs of the community it serves.

In addressing Highlands’ challenges, we recommend a strategic and structural transformation of its IT and development practices. First, formalizing the tech program across value streams will enable focused and efficient delivery of services.

This involves hiring skilled personnel to ensure each value stream is self-sufficient and can manage its commitments independently. Adopting Kanban for portfolio management and Kanban or Scrum for stream teams will introduce a structured yet flexible workflow, facilitating regular demos, retrospectives, and planning sessions.

Reset your roadmap

We believe that you have to have stability before you can make transformational changes. A crucial first step is resetting the delivery roadmap: re-prioritizing current projects and aligning the work in progress with the available staff. At the same time, it’s a good idea to determine where paying down technical debt would help you move forward on your roadmap, and prioritize that along with other items.

Bring in new IT Roles

The current support ratio of 1:100 is inadequate; doubling the IT staff to meet the healthcare industry standard of 1:50 is imperative for maintaining quality and supporting growth. Specific hires should include roles such as a fractional CIO/CDO/CTO, program manager, IT managers/leads for each value stream, an enterprise architect, EHR systems analyst for customization and training, among others. Considering a partnership with a local IT vendor for the Infrastructure stream could further alleviate internal pressures.

Align IT budget with the future

In our analysis of resource allocation strategies, we also explored budgeting considerations. While the typical knowledge industry spend on IT ranges from 4% to 8% of revenue³, our findings suggest that leading Community Health Organizations (CHOs) should consider allocating 10% or more of revenue towards their IT budgets over the next six years. This recommendation is driven by the recognition of significant advantages that early adoption of IT solutions can offer in a competitive landscape:

Meeting 340B Program Challenges: Managing contracts, tracking program purchases, monitoring compliance and performing audits are more than just check-off items in a matrix: each one is implemented in system software that has to be trained, tested and maintained to deliver the promise.

Remote Patient Monitoring, Telepresence and Personalized Medicine: These areas are increasingly becoming essential for providers committed to long-term success, requiring substantial investment in IT infrastructure and software.

Artificial Intelligence and Data Analytics: Adopting Artificial Intelligence (AI) and data analytics is crucial for improving patient outcomes, operational efficiency, and research capabilities. Given the transformative impact of AI across various sectors, accurately predicting its specific influence on community health remains challenging. Therefore, it’s likely that current spending on AI and analytics may not fully meet the needs of the sector.

Cybersecurity: Given the healthcare sector’s vulnerability to cyber threats, robust investment in cybersecurity measures is imperative to safeguard patient data.

Regulatory and HRSA Program Compliance: Adapting to evolving healthcare regulations, including HIPAA and mandates on EHRs and patient data interoperability, demands sustained investment in IT to maintain compliance. These are health industry table stakes. For CHOs, adapting and maintaining records in accordance with UDS and emerging metrics requires constant attention.

Operational Efficiency: Continuous efforts to enhance operational efficiency, reduce costs, and elevate care quality will drive CHOs toward investing in EHR systems, patient management software, and billing and coding technologies.

Revenue Optimization: Reducing manual payments keeps administrative overhead low, decreases compliance risk, and makes more data available for real time analysis. In addition, automatic insurance verification and authorization reduces denied claims and payment delays. Upgrading to a modern payments system accomplishes both.

This strategic increase in IT expenditure is not merely about keeping pace but positioning CHOs at the forefront of healthcare innovation and service delivery. By comparison, the revenues in financial services are higher than in healthcare, and the IT spend as a percentage of revenue is already over 11% for the top quartile of financial services firms.⁴

Implement Kanban and Agile ceremonies

Adopt Kanban and traditional Agile methodologies to enhance IT’s agility and efficiency. Kanban enables teams to remain flexible, adapting quickly to evolving stakeholder needs by providing visibility into workflow bottlenecks and preventing task overload, ensuring continuous delivery of services.

Meanwhile, ceremonies like maintaining a backlog, organizing work into sprints, and demo-ing work on a regular basis help teams to concentrate their efforts on value-driven work completion. It fosters collaboration among cross-functional teams, uniting them around shared objectives within a common framework for problem-solving. Furthermore, Agile practices enhance team dynamics, independence, and productivity through regular retrospective meetings, solidifying a culture of continuous improvement.

For what it costs to build a truly redundant data center, you could migrate everything to the cloud and realize substantial additional benefits into the bargain.

Head for the cloud

Transitioning technology implementations to the cloud is not just beneficial but essential for future resilience and service excellence. The cloud offers unparalleled advantages, including scalability, cost-efficiency, and enhanced security, which are critical for CHOs to adapt to the rapidly changing healthcare landscape.

By moving to the cloud, CHOs can ensure that their IT infrastructure can expand or contract as needed without the upfront costs associated with physical servers and data centers. This flexibility is crucial for supporting fluctuating demand, introducing new services, and managing data more effectively.

Moreover, cloud platforms provide advanced security features that help protect sensitive patient data against cyber threats, an increasingly important consideration in today’s digital age. Implementing cloud-based solutions also facilitates easier integration with emerging technologies and data analytics tools, enabling CHOs to gain insights into patient care and operational efficiency.

Last, migration to the cloud can be accomplished as easily as implementing a truly reliable failover mechanism from one physical data center to another. For what it costs to build a truly redundant data center, you could migrate everything to the cloud and realize substantial additional benefits into the bargain.

Team-centered tools

Embracing a cloud-first strategy for backups and new development will mitigate single points of failure and modernize the infrastructure. Aligning on tooling, exploring alternatives and enhancements to EHR SaaS systems, and standardizing processes with tools like Epic, Figma, Jira, Teams or Slack, and expanding patient engagement tools (such as MyChart for Ochin) will significantly enhance operational efficiency and patient experience.

These comprehensive steps will position Highlands Health to not only
navigate its current challenges but also pave the way for sustainable growth and innovation.

Partner for services platforms: Ochin as example

Prioritizing feature requests to make Ochin (or any comprehensive healthcare IT platform like Epic, which Ochin hosts for many community health organizations) easier to customize involves focusing on areas that can significantly enhance operational efficiency, user experience, and patient care. Here is a ranked list of feature request areas that CHOs (as customers and stakeholders) should prioritize:

Modular Customization Capabilities: Allowing organizations to customize and configure modules without needing deep technical changes. This could include user interface adjustments, workflow configurations, and report formats to better meet the specific needs of different departments.

Enhanced API Access: Improving access to application programming interfaces (APIs) would enable easier integration with third-party applications and services. This can broaden the ecosystem of tools available to healthcare providers, such as specialized analytics platforms or new patient engagement solutions.

Self-service Configuration Tools: Developing tools that empower non-technical staff to make changes to the system, such as form updates, notification settings, and simple workflow modifications. This reduces dependency on IT staff for minor changes and accelerates implementation.

Secure SMS and Email: Raise the bar for standard of care for underserved populations: a large percentage of the CHO population uses mobile exclusively for communication with care providers, scheduling appointments, and seeking critical information.

Incremental AI: Streamline administrative processes, allowing healthcare providers to spend more time on direct patient care. AI can analyze vast amounts of data to identify at-risk patients, enabling early intervention and personalized care plans. Additionally, AI-powered chatbots provide 24/7 responses to patient inquiries, improving access to information and freeing up staff for more complex tasks associated with direct patient care.

Faster Deployment of Custom Features: Streamlining the process for developing and deploying custom features, including a more agile approval process for customizations that do not impact the core system stability
or security.

Training and Support for Customization: Offering specialized training programs and dedicated support for organizations looking to customize their SaaS-hosted systems. This support could include access to expert consultants and technical resources.

Enhanced Data Customization and Reporting Tools: Expanding the capabilities for customizing data fields, forms, and reports to better reflect the unique information needs and workflows of different healthcare providers.

Community Collaboration Platform: Creating a forum where platform users can share their customizations, insights, and best practices with each other. This collaborative environment would encourage innovation and allow users to learn from each other’s experiences.

By focusing on specific feature requests, Highlands becomes an empowered stakeholder and a better technology partner.

Leading the Transformation

The IT delivery transformation of a Community Health Organization (CHO) should ideally be spearheaded by a neutral third party, reporting directly to the CEO, COO, or CFO.

This recommendation draws inspiration from the tech startup scene, where transformative shifts often necessitate external expertise.

Despite the competence of in-house IT leaders in managing day-to-day operations and their confidence in their performance, there’s a notable gap in innovation, which internal teams and leaders may not fully acknowledge
or address.

While the current IT leader might agree with the need for transformation and believe in their ability to lead it, history and data suggest that actual innovation rarely happens without an external, objective perspective.

An external consultant provides the necessary
neutral viewpoint, and informed leadership;
unencumbered by internal politics or past failures,
they drive meaningful change.

Conclusion

Community Health Organizations (CHOs) face a critical moment.

In search of better clinical metrics and patient retention, the need to boost IT budgets and embrace new tech is clearer than ever.

Today’s challenges, from teams stretched too thin maintaining physical infrastructure, to bottlenecked EHR implementations, highlight the need for change.

By adding the right people, updating plans, using Agile methods, and moving to the cloud, CHOs can overcome these hurdles.

This white paper offers a path forward, showing how technology can support, not hinder, their goals. Looking ahead to 2030, the success of CHOs will depend on their ability to adapt and use technology to deliver more value than ever to their communities.

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1.  https://www.nachc.org/conference-page/financial-operations-management-information-technology-fom-it-conference-expo/sponsorships-exhibits/
2. https://www.nachc.org/conference-page/financial-operations-management-information-technology-fom-it-conference-expo/sponsorships-exhibits/
3. https://www.statista.com/statistics/1105798/it-spending-share-revenue-by-industry/
4. ​https://avasant.com/research/it-spending-and-staffing-study/
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