Systems engineers help healthcare refine its processes and achieve a more compassionate bottom line.
The weary looks on the faces of the people in the crowded emergency room lobby make it plain that you are in for a long wait.
Your injury is painful but not lifethreatening – a fractured metacarpal, sustained in a game of pick-up basketball.
As you take a seat near the TV and begin marking time – 30 minutes, one hour, two hours – you also begin experiencing what Hisham Nabaa calls America’s contradictory healthcare picture.
The information you print onto your five-page patient history form is the same that you provided on your last three or four visits to the doctor – but you need to give it again because the ER doesn’t have access to your doctor’s records. And as you struggle to tune out the blaring sitcom, three or four ER waiting rooms might actually be sitting empty due to a staffing mix-up that assigned too many nurses to other hospital departments.
When finally you are treated, however, your doctor, and later your physical therapist, will have at his disposal an impressive array of world-class diagnostic equipment, surgical tools and medical devices.
The scenario, says Nabaa, director of Lehigh’s new Healthcare Systems Engineering (HSE) program, underscores the dilemma of 21st-century American healthcare: The U.S. offers perhaps the world’s best medical care but at an unsustainable cost and with an efficiency that is barely mediocre.
According to the U.S. Centers for Medicare and Medicaid Services, health expenditures in the U.S. totaled $2.5 trillion in 2009 – more, per capita, than in any other country – and consumed 17.6 percent of gross domestic product. According to the World Health Organization, the U.S. healthcare system ranked 37th globally in overall performance in 2000.
Since HSE was launched last summer, Nabaa has recited these and similar statistics to a variety of audiences. No one knows what direction the national debate over healthcare reform will take, he says. But systems engineers, by applying the same optimization tools that have already streamlined the airline, manufacturing, transport and other industries, are positioned to transform the provision of healthcare as well.
The HSE program is an outgrowth of the Lehigh University Strategic Plan, which identifies three areas – globalization; health; and energy, environment and infrastructure – where Lehigh is seeking to be a leader in learning, innovation and creativity. Together with programs in energy systems, structural engineering and technical entrepreneurship, the HSE program is among a new breed of innovative professional master’s-degree programs in the P.C. Rossin College of Engineering and Applied Science. Each of these programs was created to address a pressing societal need, each has received extensive industry and community input, and each is partnering with national leaders in the field.
HSE’s goal is twofold: to prepare graduate students in a new one-year master of engineering degree (see p. 22) for leadership positions in healthcare and related organizations, and to bring together representatives from all sectors of the economy related to healthcare. A close collaboration with the Mayo Clinic is helping to shape HSE’s systems engineering focus and give the program a unique identity. HSE’s industry leadership board (ILB) has attracted the leaders of health insurance companies, hospital networks, home-healthcare agencies, pharmaceutical companies and government agencies. (ILB chairman Gary Sieck, dean of research and academic affairs at the Mayo Clinic, is featured in the Q and A section on pp. 8-9.)
This mix of viewpoints and backgrounds, says Nabaa, will improve communication among healthcare’s varied players, help HSE students gain hands-on experience while completing their degrees, and enable Lehigh to develop an innovative database of best practices in healthcare and its related fields.
A case to be made
HSE is one of the few graduate-level healthcare programs in the U.S. with a systems engineering and analytical focus. Its diverse population of students includes physicians, nurses and engineers. Many programs in healthcare policy and healthcare management are offered by the nation’s universities, says Nabaa, but HSE meets an unfilled need. It offers tangible tools to model, optimize and improve the hundreds of processes that make up healthcare, and to intelligently analyze the enormous amounts of real-time data that are generated by these processes.
But can the tools of systems engineering – algorithms, statistical modeling, information management, data mining, simulation – optimize something as subject as healthcare is to the vagaries of human nature and the whims of Mother Nature?
Several decades ago, says Nabaa, leaders of the airline industry raised similar doubts.
“When systems engineering was introduced to the airlines, they said, ‘Our industry is very complex. You can’t implement your methods here.’”
Today, says Nabaa, from the moment you first search online flight options to the moment you collect your luggage in the baggage terminal, air travel is a model of optimized seamlessness. Advanced software lets you choose your flight time and seat assignment and issues you an electronic ticket that you pay for through a secure online, automated system. This involves streamlining millions of processes in minutes.
“By contrast,” he says, “you can have two healthcare facilities in the same town, both run by the same company, and they’ll have two completely different information systems.”
With the ability to refine large amounts of data into ever-smaller subsets and draw meaningful inferences from that data, says Nabaa, modeling and optimization tools are wellsuited to streamline the delivery of healthcare. Sophisticated modeling tools already in use, for example, generate nursing schedules that account not only for shift preference, but also for individual tendencies to arrive early or late, for experience levels and for areas of expertise.
The technology also exists for patients to electronically authorize a healthcare provider to access their entire medical histories with the swipe of a card, much as a supermarket verifies your credit history in a split second.
Systems engineers can also identify and eliminate redundancies, says Nabaa, by enabling healthcare facilities to examine their entire operations in a “holistic” way.
“Studies have shown that through the use of systems engineering principles, modeling techniques and analytical thinking, healthcare industries can improve efficiency, cut costs and treat more patients with a smaller staff.”
Improving the flow – and utilization – of data
The HSE program’s industry leadership board reads like a roster of Who’s Who in Medical Care. Members represent the region’s largest hospital networks – Lehigh Valley Health Network, St. Luke’s Hospital and Health Network and Easton Hospital – as well as the Mayo Clinic, Geisinger and Susquehanna Health; BAYADA Home Health Care, one of the largest providers of its kind; the Hospital and Healthsystem Association of Pennsylvania; the pharmaceutical risk management company ParagonRx; insurers such as Capital Blue Cross and Highmark; and the global consulting firm Towers Watson.
“We are an accurate reflection of the healthcare industry,” ILB member Anne Baum said at an HSE panel discussion last fall. Baum is vice president of the Lehigh Valley region of Capital Blue Cross. “We are an unusual group of individuals with a set of common goals – to improve healthcare while cutting costs and making delivery more efficient.
“But the organizations we represent often operate in silos. A lot of the data we generate is not transported between healthcare providers and patients, between different providers, or between insurance companies and providers.
“The HSE program gives us a rare opportunity to sit down together, share data across the entire gamut of healthcare, and integrate our individual goals into a common initiative.”
The need for smoother flow of data is perhaps the most frequent topic of conversation at ILB meetings. Better communication, members say, would improve healthcare quality and accountability and enable the industry to shift from a volume- to value-based reimbursement structure – a change being pushed by the 2010 Patient Protection and Affordable Care Act.
“Insurance companies, as the ultimate payer of healthcare services, generate a huge amount of data,” says Tom Huntzinger, account manager for Emerson, Reid & Co., the largest group health insurance general agency in the northeastern U.S. Huntzinger also chairs the Healthcare Legislative Committee of the Greater Lehigh Valley Chamber of Commerce.
“The ability to share data with providers is crucial to making improvements over time. Students in the HSE program can analyze data from multiple perspectives and help us evaluate insurance plans in terms of their outcomes. For example, if an insurance carrier introduces a wellness incentive into a plan, students can help us quantify corresponding changes in policy holders’ behavior and improvements to their health. This will help carriers provide information to providers about the costeffectiveness of plans.
“Students could also do comparative studies of different health insurance companies to find out which are doing well in a particular area, and which are not. This could help us write policies that help improve individual behaviors.”
Another area of healthcare where systems engineers can contribute, says ILB member Tom Cassidy, is in enabling patients to avoid hospitalization and recuperate at home.
“Healthcare is a very fragmented world,” says Cassidy, who earned a B.S. in industrial engineering from Lehigh in 1987 and is an area director responsible for operational quality assurance for BAYADA Home Health Care. “It’s an oddly shaped sandbox we have to play in – and, therefore, a good environment for systems engineering skills.
“In particular, systems engineers can figure out the optimum discharge time and follow-up plans for hospital patients. This will help us minimize the possibility of rehospitalization.”
A systems engineer’s potential impact
Deborah Halkins uses a variety of methods to analyze healthcare processes at Lehigh Valley Health Network (LVHN), where she has served 11 years as director of management engineering.
Halkins and her staff combine systems engineering tools such as productivity analysis, statistical modeling, simulation and data mining with the traditional skills of observation, interviewing and time studies. They pay special attention to dynamic events where errors, delays and bottlenecks are most likely to happen. These include the “hand-offs” that occur when patients pass from one provider to the next in their journey through the continuum of care.
“As systems engineers, we work with everyone involved in a process, from the people who make meals and prepare operating rooms to nurses and doctors, in order to improve that process,” says Halkins, who earned an M.S. in industrial engineering from Lehigh in 1983 and a Lehigh MBA in 1997.
“Our main focus is to heal, comfort and care for people by providing compassionate, quality healthcare.”
In the last few years, says Halkins, LVHN has incorporated Toyota’s Lean Thinking and A3 problem-solving techniques into its continuous improvement efforts.
“One role of systems engineers is to be good stewards of resources, including people, materials, equipment and time. Everything falls into place when creating systems that provide the best patient care possible.
“We are looking forward to working with the HSE program and engaging its students in solving systems problems in healthcare.”