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January 01, 2006

The more I learn about problems with technology adoption in behavioral health, the more I'm sure it's a marketing issue. That's right—marketing.

Follow my logic. Behavioral health provider organizations’ rate of adoption of electronic medical record (EMR) systems (and other technology) is spectacularly low, even for healthcare. My interviews with executive teams about their current state of “wiredness” reveal fairly common reasons for limited technologic functionality: not sure what the future holds in terms of payer technology demands and standards, not enough money available to pay for new or upgraded systems, lack of certainty about achieving a return on their technology investment, and competing organizational priorities for available money and resources.

You might say that this sounds like a financial issue. I would, in turn, say that all financial issues are marketing issues. So, let's go down the marketing path with this one. First, there is the customer issue, as in, “Who are they?” Customers are those who use, pay for, or influence the purchase of behavioral health services. For behavioral health providers, customers include both consumers (and their families) who use services and payers (and their intermediary managers) who purchase our services.

So what do customers want? Payers want the providers they work with to have technology systems that capture a wide range of data in transportable standard formats that help both to reduce system transaction costs and to permit more accurate management of consumer care. Consumers want providers who have technology that permits knowledge of available service options and their efficacy, easy online access to personal health information, convenient scheduling, and streamlined communication with the professionals within the provider organization.

Given the chasm between these two sets of functionality, you would think this is an easy choice—go with the money and give payers what they want. But this is probably a good choice only if you think: (1) Payers really are at a point where they know what they want and need for their systems management in the long run, and (2) payers have a great influence on consumer selection of your program.

That being said, it's easy to see why payers want providers to have systems that gather all clinical information in an electronic record and can integrate with regional health networks. Almost all analysts agree that EMRs would save lots of money in the delivery of healthcare. But I'm not so sure consumers care.

Where are the provider organizations in this cost equation? According to RAND Corp. Senior Management Scientist Richard J. Hillestad, PhD, the disjointed nature of funding in U.S. healthcare results in the majority of technology benefits accruing to payers, rather than to the provider organizations that pay for systems.

Thus, savings from “more efficient” care have different consequences for different stakeholders. The cost of systems, with a limited share of system savings and razor-thin margins, makes it difficult for many organizations to accumulate the capital needed for a technology investment. And concerns about payer paperwork, compliance, reporting, and licensure requirements make providers question whether they will achieve the administrative ROI savings. This is the basic value-chain/supply-chain practice in the market.

Last, but not least, let's address the issue of competing priorities for available resources. David Garvin, a prolific author on market-related issues, has written about strategic quality as a means to compete on the eight dimensions of customer quality differentiation. The strategic quality framework is based on the notion that if our market position is clearly based on one (or more) of the eight customer-focused quality dimensions, that positioning will drive our prioritization of organizational resources. Simply, know (and quantify) what your customers want to make your resource-allocation decisions. Not so simply, provider organizations have two distinct customers with two distinct sets of technology-related requirements.

The challenge of applying the strategic quality model for resource prioritization is that the market has not sorted out if the next wave of healthcare is based on consumer-directed tenets or pay-for-performance disease management models. It's difficult to know whether the most strategic use of resources is online personal health records, Web-based patient self-scheduling, technology-enabled consumer care, decision-support tools for disease management, or electronic record-keeping systems.

So, providers have two options: Wait until we have all the market data and then make technology decisions, or make an informed and well-researched decision on the future of your particular market and proceed at a reasonable pace. The former will never happen—or will happen too late for most organizations. The latter is why they pay the leaders the big bucks.

Monica E. Oss, Editor Emeritus of Behavioral Healthcare, is CEO of OPEN MINDS, a research and management consulting firm for the behavioral health and social services field.
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