Last updated on October 8th, 2023 at 08:47 am

One of the implementation and planning problems that the tool had was that the payer did not take into consideration the different types of clinical information systems (CIS) used by lab centers in Puerto Rico. Lab centers were using more than 5 different types of data exchange and billing systems. In the beginning of the implementation, the payer focused mainly in the largest two CISs which caused some training and adoption issues when the tool was expanded later to other lab centers using different CISs.

A second issue was that the payer’s Provider Network Department was not included in the implementation of the tool since the beginning. Therefore, contractual agreements were not carried out requiring lab centers to share data electronically. This was crucial for the adoption of the tool by lab centers and also the primary care network. If lab data are not being shared on the tool, primary care providers cannot incorporate it in their workflows. These agreements were needed and key in the success of the tool. Lab centers are now contractually obliged to share lab information electronically using the tool. This resulted in a higher adoption of the tool by the lab centers and primary care providers.

Additional Key facts, as relevant to issues

• The company did not establish a steering committee where stakeholders can participate during the whole process

• Healthcare providers, lab centers and primary care providers, did not participate in the planning process so existence workflows were abruptly disrupted. This resulted in the implementation of parallel processes and other makeshift measures by healthcare providers.

Discussion Questions

1. What would you establish before the creation of the tool?

o Stakeholder committee

o Project committee

2. Which stakeholders should’ve been included in the process?

o IT

o Provider Relations Department

o Lab centers

o Physicians

3. Do you think lab centers would use the tool if there is no contractual agreement in place?

o No, the only way to make providers participate is through a monetary or contractual agreement

o Yes, as long as the payer build a strong provider relationship with its provider network.

4. How do you see the future of this tool?

o The tool would be obsolete eventually, more and more providers are sharing lab data directly through the electronic medical record.

5. Currently primary care providers and lab centers are using the tool, what other provider or stakeholder could benefit from the tool?

o Specialists

o Hospitals

o Patient

o The payer itself

Objectives

• Identify the major challenges related to an in-house lab data exchange system (tool) implementation and Integration into existing workflows at a healthcare provider network.

• Identify the major challenges, facilitators, and best practices related to the adoption of this tool by the healthcare provider network.

• Describe the terminology, classifications, methods, trends associated with the tool as deployed for contracted primary care providers and lab centers by a healthcare insurance company in Puerto Rico.

Role of interviewee:

• e-Connectivity Product Manager

• Implementer – She is in charge of implementing the tool and evaluating the adoption among healthcare providers.

Type of organization:

• Healthcare insurance company (payer)

• Size: Large. 300,000 Medicaid beneficiaries and 200,000 Medicare beneficiaries

• Location: Puerto Rico

• Private

CIS:

• Type – In-house lab data exchange system where healthcare providers can see lab data coming from lab centers.

• Stage of Implementation – it has been in use for a while, it has been expanded to provide other data like pharmacy.

Key actors

• CIO, oversees the implementation and on-going operation of the tool.

• e-Connectivity Product Manager, in charge of the implementation and on-going operation of the tool.

• e-Connectivity Product Specialist, educates lab centers and primary care providers on the tool.

• VP of Provider Network, in charge of contractual agreements between the payer and the provider network.

• Primary care providers, healthcare professional or organization that is responsible to provide healthcare services to the health insurance’s membership.

• Lab centers, a healthcare provider that carry out lab tests on clinical specimens to obtain information about the health of a patient. This information is shared with primary care providers to aid in diagnosis, treatment, and/or prevention of a disease.

Core factor(s) of success explored

• Strong implementation & Operations- Activities used to implement the tool are explored as well as the on-going operation of it.

• Attentive monitoring- Activities used to assess the use of the tool by lab centers and primary care providers are explored. Also, the implementation of new initiatives after assessing adoption of the tool within the provider network is evaluated.

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