Mike Poling is SVP/GM of healthcare for Infor of New York, NY.
Tell me about yourself and the company.
I’m general manager of healthcare at Infor. We’re a $3 billion software company. Healthcare is about $500 million of that. I came from Lawson Software and was previously at Siemens. My entire career has been in the healthcare IT industry.
As a vendor of an integration solution, what are the opportunities and challenges in an era where everybody wants interoperability?
In the world of acute care consolidation as well as extending care outside the walls of a hospital, data itself and the integration of data becomes mission critical in terms of analyzing patient outcomes married to cost. Everybody wants to understand what their cost is relative to delivering care as well as the satisfaction ratings that are wrapped around it. Data becomes the center of importance.
Does a new level of sophistication exist where health systems are aware of the incremental cost involved with delivering a particular service or a product?
Yes. There’s a need for healthcare to report on lines of business — both in terms of profitability, revenue as well as cost — because of where the industry is in terms of the switch from fee-for-service to more of a bundled fee for delivering care. It’s mission critical for my customers to understand where they’re making money and where they’re not. Line-of-business reporting has become mission critical for them.
What are the staffing, recruiting, and productivity challenges that health systems are dealing with given that a high percentage of their cost involves labor?
Going back to what I said before around the lines of business, you want to make sure that you’re focusing the right talent and the right job to perform the right service. That, married along with where a hospital can continue to remain profitable, is very important. It takes certain skills. If you take it to a specialty hospital, like a children’s hospital as an example, nurses and doctors who deal with children have a certain skill set, a certain mental approach, and a certain soft skill. That goes across the board, depending on what type of care that you’re delivering.
Specializing and understanding what certain behaviors are relative to delivering care and making sure that since 60 to 70 percent of the hospital’s expenses are related to labor, you want to make sure that you’re hiring the right people, that you’re onboarding them, that you’re keeping them for a long period of time to reduce those expenses.
Is the idea of clinical staffing based on patient acuity still controversial?
The industry is still hanging on to the idea. I would say that nobody’s mastered that. Having the right person at the right bedside with the right supplies and with the right skill, but also then maximizing your workforce productivity — that’s still nirvana or utopia.
There are products in the market that help with that, but getting to the point where you enter things in like seasonality as well as population health and population management to predict hospital inpatient stays as well as outpatient care delivery needs — that’s where we still need some assistance in the healthcare industry.
Floating nurses to cover other areas based on workload needs appeared to worsen patient outcomes because they weren’t as familiar with the workflows and relationships in those areas. Have hospitals improved that situation to give them more workforce flexibility?
It’s the reason that you’re seeing the world of the minute clinics and delivering care in mall settings as well as in the retail space. There’s a need to push those types of resources out to the population. That trend is going to continue, where you have more skilled labor outside of the acute care setting and putting them in those remote settings.
There’s a balance to that as well. You need to have people that continue to deliver family practice medicine, but specialize in some of the things that you’re talking about. The US is going to continue to have the need to push services out into the population. Balancing that with the costs that we’ve been talking about is the real challenge.
Do hospitals have the necessary expertise to run freestanding EDs, urgent care clinics, and population health management programs?
That’s a very good question. What I see is that there are more executives who are coming outside of healthcare into the healthcare world, as well as more physicians who are getting into IT-related services. The reason for that is that if you come from a manufacturing or retail world and understand things like distribution, workforce management, and the distribution channel, that’s different from somebody who has been in healthcare their entire career.
If you layer on top of that the care delivery path aspects that a doctor or nurse understands, that adds that layer of knowledge as well as flow to what needs to be delivered to remote locations that are delivering care.
How do hospitals use technology to help them continue to offer money-losing services by funding them from profitable lines of business?
There’s certainly a technology aspect to what you’re talking about. What I see is that there are more referral networks that are being built through affiliations, through relationships, through of course ownership and consolidation. You make decisions as a hospital what you can and you can’t do. Then you build affiliations around things that you need to deliver.
Labor and delivery is a good example of that. Heart would be another good example of that. If you have somebody who needs critical care related to a heart condition, you want to have an affiliation, a brother or sister hospital that you can send that person to given the time available to do that. I see that as driving the need for technology.
Building the referral network drives the need to then share information between those facilities to get integration. Certainly resource sharing as well as supply sharing. Twenty or 25 percent of a hospital’s expenses are supply related, so you have to make sure you’re maximizing those as well. The technology is needed to accomplish the things I talked about.
Some hospitals choked in the late 1990s and early 2000s by trying to implement SAP, which was then mostly known as an enterprise resource planning system for manufacturing. What’s the status of ERP in healthcare and how has that evolved from yesterday’s materials management systems?
I laughed when you said SAP. I had a couple of personal friends who left Lawson when I was there to go run the SAP healthcare practice. I know exactly what those challenges were.
What ERP is turning into for healthcare specifically is sitting adjacent to the electronic health record and enabling a healthcare institution to be able to capture the cost components that we’ve been talking about. Analyzing that and looking at lines of business reporting.
ERP has become the need to start to drive the analytic, which we believe starts right with setting up the general ledger and setting up how you’re going to look at the lines of business and then reporting from those. Controlling labor, controlling cost, as well as measuring the cost. ERP in healthcare has become a central strategy to being able to do those things.
The pendulum swung hard to the left to implement EHR systems in the past. It’s now swinging back to the right. Once those EHR systems are implemented, now you need to implement and maximize the other side, which is where an ERP system comes into play.
Do hospitals expect their EHR and ERP vendors to share information bi-directionally?
Absolutely. They’re looking for plug-in integration points. From my side, they want my system to immediately talk to Cerner, Epic, or Allscripts. Give me something that’s going to plug right in where I don’t have to build point-to-point integrations, because we know what integrations need to happen. We know where the data needs to reside and where it needs to get to. That’s what we’re being asked to do and what we’re delivering.
There’s a push for hospitals to implement customer relationship management systems for both business and population health management purposes. How are hospitals addressing that need?
Most of the time when we get into that conversation with a customer, we drop the “C” part of CRM and talk about relationship management, which seems to resonate. Their relationships with their patients …you immediately go there with population management, measuring customer satisfaction or patient satisfaction, making sure that you’re engaging the patient on an ongoing basis. Once they’re discharged, make sure that they’re following their instructions for their medications, those types of things. That relationship that you have with the patient certainly is important.
The other relationships that are important … I talked before about the referral network. The physician referral process and physician referral relationship is extremely important. One physician referring to another physician that’s in the network of the hospital that has built, either through acquisition or through affiliation, this network that they want to continue to feed. The relationships between the physicians become strategic and important as well to making sure that you’re keeping the patients inside of your health network.
We see those two huge needs as relationship management going forward. Of course then you can take the relationship management to the population health to that next step, being able to look at recurring patterns in your population for certain patients and patient outcomes via that relationship management.