LOOKING TOWARD THE FUTURE: 2012
Industry insiders weigh in on the year ahead in healthcare technology.
Editor’s note: Because we received so many responses, the forecasts will be split into two parts and concluded next month.
Medical research to move to cloud
By Oleg Bess, M.D., CEO, 4medica
As adoption accelerates of electronic health records software and standardized medical vocabularies and administrative codes such as HIPAA 5010, ICD-10 and SNOMED, digitization of this massive vat of personal health information (PHI) will become more prevalent. Many stakeholders are excitedly looking forward to using their data for clinical and business improvements. However, interest in making PHI easily and widely available for research purposes is surging, which ultimately will have an even greater impact on the overall health system and medicine than analytics.
That realization hit me when I made a recent presentation at a conference featuring the top 40 oncology researchers in the world. Those individuals shared their frustration with policies that allow them to forward their self-developed protocols with colleagues outside their organization – but not the PHI that drove development of the guidelines. The reason was institutional concern about patient privacy and consent. Researchers found this puzzling because the subjects supported authorizing their data being made available to others, believing it could help others in need and further medical science. Additionally, technology is so advanced today that it is easy to re-identify information if genetic data is attached to it.
To overcome resistance and maximize use of information to fuel scientific and medical advances, the researchers are developing a consent form for patients to sign during the initial care assessment. I expect practicing physicians, academic medical centers and other institutions will follow suit and use cloud technologies to collaborate and collect information in real time. They are starting to recognize that policies governing research were developed years ago, when trials generally occurred at one location. Today, these same policies occur at multiple sites, and engaged stakeholders realize the cloud makes the huge challenge of gathering data easier and more affordable than a traditional computing model.
RTLS will be must-have technology
By Merrie Wallace, executive vice president of product solutions, Awarepoint
Real-time location systems (RTLS) in 2012 will be a must-have solution for hospitals because it generates revenue and controls expenses.
Until now, RTLS primarily has been used for asset location or management, enabling users to lower costs by minimizing the amount of misplaced, lost or stolen equipment. But pioneering hospitals have used RTLS to increase top-line revenue growth by automating workflow and streamlining throughput. This same technology also ensures hand-hygiene compliance to prevent hospital-acquired conditions and “never events” that Medicare, Medicaid and many private payers no longer pay for.
A Pennsylvania hospital, for example, used RTLS to generate $14.8 million in revenue by improving patient flow and reducing the number of patients who leave the emergency department (ED) without being seen or are diverted to competing EDs. The solution also helped an Oregon institution increase surgery volume by 49 cases per month.
Other facilities also are using RTLS to improve care; reduce medical errors; monitor temperature of blood products, tissues and selected medications; facilitate regulatory compliance and eliminate unnecessary equipment rentals.
The shift toward accountable care, bundled payment and pay for performance means providers increasingly will be paid based on quality of care rather than fee for service. Their revenue will decrease as insurers steadily cut reimbursement rates while redirecting money from one payment model to another. Moreover, the pressure overcrowded EDs face will intensify as millions of uninsured Americans gain health coverage. To cope, hospitals will need to become more efficient. Facilities will embrace RTLS and automated workflow solutions because doing so makes the challenge of achieving those objectives low-hanging fruit that will fatten their bottom line within a year or less of deployment.
BI set to soar
By Vik Torpunuri, CEO, CentraMed
Implementing business intelligence (BI) will be a top priority for hospitals and health systems in 2012, driven in part by coordinated, patient-centered accountable care, making clinical and business analyses and reporting essential.
For decades, healthcare has underutilized BI, traditionally deemed a costly, time-consuming capital expense that often yielded disappointing results due to poor momentum. Thanks to accelerated BI product development and technological improvements, adoption will be driven by:
- New architecture platform: BI is now delivered as a software as a service, meaning vendors, not users, are responsible for updating and maintaining the solution and the e-infrastructure it runs on.
- Low price point: Organizations pay a monthly subscription fee – a fraction of first-generation BI costs ? that allows users to experience ROI within days and months of rollout.
- Increased automation and interoperability: As providers implement EHRs to comply with meaningful use, they will connect clinical data with financial information from all departments, including silo units such as materials management. Aggregating data from uncommon sources will enable enterprises to view and analyze data globally to improve quality, identify variances, develop best practices, change behaviors of employees and clinicians, and strengthen physician alignment in the pursuit of delivering higher quality, cost-effective care.
- Cost of care exceeds payment: Hospitals will lose money if they are paid less than the cost of providing care. They will soon feel the impact of 30-day readmissions, continued decline in Medicare reimbursement and low payments when the uninsured gain coverage. Providers will turn to BI to better manage the revenue cycle and make more informed spend-management decisions to control costs of labor, supplies and services.
- Increased recognition of professional services: Unlike early BI adopters, providers are more aware of collaborating with service experts to maximize the use and value of BI solutions more effectively. BI will be inclusive, supporting the hospital’s business model.
Patient engagement is a business imperative
By Michael O’Neil, founder and CEO, GetWellNetwork
With value-based purchasing, bundled payments and accountable care quickly approaching, patient engagement has become a business imperative for providers. Technology that fosters the advance of patient-centered care, aids in the patient experience and improves outcomes will be a top priority throughout 2012 and beyond, and will be a key differentiator for hospitals and health networks. With the growing pressure for hospitals to both better inform patients and deliver outcomes, interactive patient care (IPC) technology will be a tool of choice. It has emerged as, and will continue to be, one of the most effective ways to proactively inform and engage patients and families throughout the patient journey, and has also proven to improve efficiency, operations and even increase revenue.
Healthcare institutions are, more than ever, looking for ways to create new and innovative patient experiences and educational environments from pre-admission to post-discharge. IPC is based on the premise that a more engaged patient is a more confident patient with better health outcomes. IPC technology provides a host of resources that engage, inform and empower patients to participate in their care while at the same time supporting staff with tools that facilitate more efficient and effective care.
Using the patient’s bedside TV, patients are offered an extensive amount of services, from access to award-winning educational content on their condition, the ability to submit feedback and make requests, to choosing the newest Hollywood movies to watch and connecting with friends and family outside the hospital walls. These capabilities support the patient throughout the healing process in the hospital and at home post-discharge, allowing them to remain engaged and active in their own care process.
By engaging patients in areas such as education, patient safety, service management and discharge preparation, hospitals can improve care measures performance, lower cost per case, provide workflow efficiencies for patient care providers and provide an overall more satisfactory patient experience.
ICD-10: No IT let-up for providers and payers
By George Schwend, president and chief executive officer, Health Language
Fresh off meeting compliance with the HIPAA 5010 transaction set that is the precursor to the ICD-10 diagnosis and procedural codes, providers and payers can’t spend much time doing a victory lap because the transition to ICD-10 will have them jumping out of the frying pan into the fire.
The conversion from ICD-9-CM to ICD-10-CM/PCS, which will increase diagnosis and procedure codes almost tenfold from 15,000 to 140,000, will significantly impact providers’ and payers’ bottom lines. Organizations that believe ICD-10 is just a technology issue will face a rude awakening once they realize that ICD-10 will require dramatic changes in physician behavior and impact how nearly every department within a group practice, hospital or payer organization works. In addition to identifying and upgrading all information systems that use ICD-9, entities must simulate the impact of ICD-10 codes to preemptively identify areas where they will potentially gain or lose reimbursement dollars, work with doctors to improve clinical documentation practices to successfully mitigate risk and migrate to ICD-10, overhaul revenue cycle processes, train coders and educate their workforce by Oct. 1, 2013.
While some organizations will overcome the challenge, others may not in time. Those that fall short, as well as those lacking the capital to make the transition, may actually struggle to survive. As a result, we may see increased provider and payer consolidation this year. The bottom line is that 2012 will be all about ICD-10, including how organizations deploy medical terminology-management tools to manage the new codes and other data standards. Entities that complete this necessary work will be in an excellent position to capture, leverage and analyze an enormous amount of information to enhance care, measure outcomes and reduce costs in a rapidly changing environment.
High-performing organizations emerge from the pack
By John Haughton, M.D., M.S., chief medical information officer, Covisint
As the nation’s healthcare delivery system begins to shift from a volume-based to a value-based approach, 2012 will emerge as a pivotal year for many healthcare organizations, including hospitals, independent delivery networks (IDNs), physician practices and public/private health information exchanges (HIEs).
Driving this transition, the Centers for Medicare and Medicaid Services (CMS) and Congress have enacted an alphabet soup of regulations and legislation – ACOs (accountable care organizations), PCMHs (patient-centered medical homes), MU (meaningful use), P4P (pay for performance) to name just a few. However, not all healthcare organizations will adapt easily to the new healthcare ecosystem.
As the healthcare landscape transforms, healthcare providers must also evolve into high-performing, innovative organizations. They must continuously enhance clinical, operational and financial outcomes by communicating, aggregating and analyzing data to generate useful, timely and intelligent care. They will require an HIT infrastructure that provides seamless interoperability and clinical communication while offering a wide array of benefits, ranging from facilitating evidence-based care to enabling coordination throughout the care continuum.
For long-term sustainability, all types of HIEs must demonstrate ongoing, measurable value. It sounds simple, but in many cases it requires the right technology and mindset to support a new way of thinking about the HIE’s purpose, which has often focused on the narrow task of capturing and securely moving data.
In 2012, there will be mounting pressure for HIEs to quickly and accurately aggregate the data to create 360-degree, real-time patient clinical views, as well as to analyze the data to produce useful intelligence about specific patient populations to improve the quality of care. This population reporting will also facilitate the development of evidence-based care guidelines that can be shared throughout the community to help hospitals and physicians implement best practices and identify outliers.
Government and private payers are increasingly aligning payments with quality and outcomes, which will be a boon for those organizations that successfully pursue and enable high-performance care. Those organizations that win will build sustainable bridges across their community data islands.Covisint
A look into the healthcare IT market
By Charlotte Martin, president and chief operating officer, Gateway EDI
The evolution of healthcare IT means going beyond managing costs to improve quality of care across the system. Progress in connecting providers, payers and patients will set the stage, with leadership coming from those with products that help providers figure out not only how to get paid, but how to care for patients.
There is a clear need for payers and providers to work more closely to cut administrative costs. Directly connecting providers with health plans will reduce bad debt, eliminate the need to rework denials and lessen time spent collecting patient payments.
As payment models shift and the world moves toward better outcomes and cost management, payer-provider connectivity will become the new way of paying, as well as the new way of measuring if care is appropriate.
The game will keep changing for reimbursement (with 5010 as one example of trying to make improvements), which comes with some chaos. Healthcare IT organizations will introduce tools that help patients and providers make better decisions and avoid getting crunched by industry changes.
Consumer engagement will grow as costs keep shifting to patients. Patients want to know how their costs compare to what others spend.
To meet the demand, social media will gain influence among patients making decisions. Like checking online consumer reviews to decide where to have dinner, patients will use similar tools to see how providers stack up against quality measures and their peers, share recommendations and decide who to trust for their care.
EMR adoptions drive new trends
By Brandon Savage, M.D., chief medical officer, GE Healthcare
As meaningful use continues to play a central role, we will see a significant uptick in the adoption of EMRs among smaller physician practices in 2012. With this large influx, we will see three new trends emerging.
First, there will be an increased demand for interoperability and communication, as seen in many other industries that have crossed a critical digitization threshold. Due to this demand, a growing number of EMR vendors will begin to embrace standards for communication. Vendors that embrace interoperability and openness will succeed.
Second, physician practices will also demand the best ROI in EMR systems, leading to a need for more benchmarking and reporting capabilities. Since smaller practices typically do not have the IT support staff for performing this analysis, a new business intelligence and consulting market will emerge. Many vendors will take advantage of this.
Third, we will also see the emergence of population health-management systems. Unlike EMRs, which tend to focus on the management of individual patients, these systems will enable healthcare delivery systems to manage their entire patient population, even outside of the office walls. The technology will help care managers better identify patients in need of specific services and provide personalized services to improve their health, prevent conditions and potentially avoid unnecessary ED visits or hospitalizations. Population health management will be crucial to preventing and managing chronic diseases, and for bringing down healthcare costs for the country as a whole.
Gazing into the future of analytics
By Daniel J. O’Donnell, M.D., senior advisor for medical informatics, InterSystems
Billions of dollars will be spent on HIT applications, and most of these applications will not be able to communicate in an effective, efficient way. Pressures from all payers, including giants Medicare and Medicaid, will relentlessly ratchet up the demand for ever-more-granular data regarding cost, quality and outcome. This will increase need for real-time understanding of what is happening for innumerable business reasons, including complex new payment metrics, such as those of ACOs. As a result, two fundamental HIT challenges will grow over the next few years: first, difficulty getting accurate clinical data into so many systems; second, difficulty making sense of all that data. Each problem will grow in scope as complex medical knowledge grows; each must be taken into consideration, both for entering data and for understanding what it means: the critical analytics component.
The result will be an increasing need for technology that will help clinical and business decision-makers make better evaluations and judgments in real time. Even in theory, this is complicated. And, in reality, it is extremely, and often surprisingly, difficult, expensive and prone to failure, as many organizations are painfully discovering. Proven technology already exists that will efficiently aggregate, clinically organize and reliably move data from system to system, in real time for multiple purposes. This is a major advance over copying limited selected data to a static data repository and reporting from that repository. However, the use of this new technology, for real-time, active analytics, is still barely explored territory that will require many different, and possibly new, skill sets and organizational processes. My final conjecture is that, within a few years, we will have a fundamentally different approach to using the content of free text, which will make clinical data entry and understanding easier.
Overcoming IT security breaches
By David Kennedy, vice president and chief security officer, Diebold
The healthcare industry experienced more information technology (IT) security breaches in 2011 than any other industry. From January through October 2011, the healthcare industry was responsible for 170 of 480 total breaches (double that of any other industry), according to privacyrights.org. But the future presents opportunities to avoid violations and protect patients’ and organizations’ sensitive information.
Most of the 2011 healthcare security breaches occurred when portable data devices, such as laptops and flash drives containing sensitive and private information, went missing, according to securitymanagement.com. Although healthcare institutions can’t always avoid theft, they can take precautions by using encryption, which keeps data secure even if the portable device is stolen. Unfortunately, only one-third of healthcare organizations are currently using these types of security practices, according to a Ponemon Institute study. IT security goes much further than HIPAA (the Health Insurance Portability and Accountability Act), and protecting privacy and ensuring confidentiality, integrity and availability of systems need to be priorities.
Based on the Ponemon Institute’s “2010 Annual Study: U.S. Cost of a Data Breach Study,” the average cost per lost or stolen record is $214. This quickly adds up when one considers the average number of records lost for an organization is approximately 16,000, translating to a cost of about $3.4 million for each incident.
In the digital age of storing personal health information on portable devices, cloud computing and an expansive use of technology, it has never been more important to focus efforts around proactive security and ensuring an organization is protected from an attack or breach.
Tablets are the future of healthcare
By Tom Giannulli, M.D., chief medical information officer, Epocrates
The adoption of tablets among healthcare providers accelerated in 2011. More than 20 percent of U.S. physicians are currently using one in practice, with an additional 46 percent planning to purchase within the next year (Epocrates, 2011). Future physicians are getting on board too, with an 800 percent usage increase in just one year. Popular devices, such as the Apple iPad, Samsung Galaxy and Motorola Xoom, coupled with custom-built native medical apps, are changing the way healthcare providers practice medicine.
An increasing number of hospitals and larger practices are supporting tablets in clinical settings for accessing reference applications, documentation, practice management and medication-management tools, such as e-prescribing. As this trend continues, more clinicians will realize the true potential of this mobile technology for workflow improvements, productivity advancements and, most importantly, enhancements in patient care. These benefits, coupled with the usability and accessibility of tablets, mean they are poised to become ubiquitous within the practice of medicine.
Tablets will also play an important role in the future of EHR systems. SaaS-based EHR models have emerged as cost-effective solutions for smaller physician practices looking to become meaningful-use compliant without the significant upfront costs of traditional systems. A tablet can be used as a tool in conjunction with a SaaS-based EHR as a superior outlet for point-of-care activities due to its size and portability. It easily fits into a physician’s workflow, promotes a higher level of approachability among patients and is easily maintained. The tablet is a powerful tool for the medical community; 2012 will be an exciting year to watch where it will take us.
The year of the quick IT win
By Dave Dyell, president, iSirona
There are some trends that I hope go away in 2012. But there are others that I truly hope continue strong into 2012. One such trend is the simultaneous implementation of EMRs and medical device integration (MDI).
Why are hospitals conducting these two initiatives at the same time? Why, in the midst of a daunting CIS change, would a CIO take on an MDI initiative as well?
One reason is data integrity; many EMRs today are error filled. One study found vital-signs errors in 14.9 percent of records. The point is that if the data in the EMR is wrong – or even if it’s right, but hours old – then the EMR is nothing more than a gateway to bad information.
Hospitals improve EMR data integrity through MDI. Because MDI channels data from medical devices directly into the EMR, it does away with unfortunate transcription errors. Perhaps more importantly, MDI happens in real time, turning the EMR into an accurate and timely (not to mention “meaningful”) tool for clinical decision making.
Another reason for concurrent EMR and MDI implementations is workflow. Without MDI, hospitals investing in EMRs must rely on their nurses to populate them. As far as data chains go, MDI is far more cost effective. In fact, one study estimates that MDI can save a 150-bed hospital 2,408 hours in nursing time annually.
In the last 12 months, I’ve seen smart CIOs synchronizing their EMR and MDI initiatives. There is great synergy in this IT combination, and I predict we’ll see a lot more of it in 2012. After all, if biomed and IT teams are already under the hood of a CIS or new EMR, it makes sense for them to implement a quick IT win: software-based MDI.
Insurers must address new business models
By Ray Desrochers, executive vice president, sales and marketing, HealthEdge
The healthcare industry is currently experiencing a period of unprecedented change. We are rapidly moving from the one-size-fits-all world of healthcare that has existed for the past 30 years to a world that now includes a number of new healthcare business models designed to drive better behavior from members, increase the role of providers and help reduce the overall cost of care. In order to successfully participate in this new healthcare economy, payers must quickly become familiar with these new models, and they must make sure that they have the systems in place that will allow them to be ready to address next-generation initiatives, including those driven by healthcare reform, ACOs, payment reform and value-based healthcare.
Payers can ensure that they are ready to compete in this new healthcare marketplace by following these three simple steps:
- Evaluate new healthcare business models: Payers should become familiar with the new business models that have been adopted or proposed, and should begin to make decisions related to which models they will want to support.
- Understand existing capabilities and identify gaps: Payers should carefully evaluate all of their existing systems and then determine which of the new healthcare business models cannot be supported by their current technology infrastructure.
- Implement required improvements: Once there is a clear understanding of both the new models that the payer wants to support and the limitations of their current systems, a plan should be created that details how the organization will transform its healthcare technology infrastructure in order to achieve its business goals. Given the rate of change in the market and the number of new options that will likely emerge over the next several years, payers should also make sure that they are choosing systems and technologies that will position them to be able to quickly and easily support additional models as they are announced.
Payers will continue to face significant changes over the coming years. Those that prepare now will find themselves ready to address many of the new opportunities that the market will offer. These industry leaders will have the opportunity to help shape the new world of 21st-century healthcare.
The patient will see you now
By Gary Kolbeck, president, LodgeNet Healthcare
The year of 2012 will mark the healthcare system’s shift to a true patient-centered focus that will have a profound and lasting impact on both patients and the healthcare delivery system. The push for greater patient-centeredness was one of the six goals identified in the Institute of Medicine’s landmark 2001 report, “Crossing the Quality Chasm.” So why – a full decade later – is patient engagement finally emerging as a priority?
Not surprisingly, the threat of financial penalties and the upside of improved outcomes are major drivers. Patient engagement requirements for hospitals (as contained in federal health-reform initiatives for value-based purchasing, meaningful use, avoidable hospital readmissions and the creation of ACOs) are jump-starting patient engagement efforts because non-compliance will substantially reduce Medicare reimbursement rates.
The soaring increase in often-preventable, lifestyle-related chronic conditions – which account for about three-quarters of all U.S. healthcare spending – has also created a sense of urgency. Research has shown that when patients become more knowledgeable about their conditions and understand the consequences of ignoring needed treatment and making poor behavior choices, they often stop being bystanders and start actively participating in their care.
As patient engagement becomes a priority, many hospitals will leverage their existing in-room TVs to empower patients via the use of an interactive system that includes shared decision-making tools, personalized information and education videos prescribed by care team members. Following discharge, patients will continue to receive education content and helpful information (such as medication and testing reminders) via cell phones, computers and other web-enabled devices. In addition, patient-initiated data captured during hospitalization will be shared with other care providers via EMRs, thus improving communications across the care continuum.
Patient engagement will continue to gain ground in 2012, resulting in improved care transitions, better clinical outcomes and reduced preventable readmissions.