Hospitals

Planning and partnership now brings relief in 2013.

The May 2011 “HIMSS VANTAGE Point Survey” showed that 33 percent of respondents felt the greatest challenge their organizations face in converting to ICD-10 is the lack of staffing resources, especially clinical coders. Identified as one of the top five “gotchas” of ICD-10 implementation, coder concerns have grown beyond health information-management (HIM) directors and garnered significant attention within executive suites.

AHIMA conducted an informal survey of association members in 2011 regarding coding priorities. Only 49 percent of respondents told AHIMA that their departments were fully staffed. The biggest problem was a lack of qualified candidates. As the 2013 deadline approaches, we expect coder shortages to worsen. Finding qualified medical records professionals will surely be an executive issue – unless it’s addressed now.

Providers fall into three different groups with regard to ICD-10 preparation and their coder staffing approach. The first group is still doing nothing. They are waiting for someone else to give direction and initiate the ICD-10 process. This is called the ivory tower approach, although some call it the “head-in-the-sand” approach.

The second category, which encompasses the majority, is where executives, HIM directors and ICD-10 committees are beginning to conduct assessments, create timelines, survey vendor readiness and line up outside partners for backup coder staffing. They are giving coders anatomy and physiology and/or medical terminology coursework. Furthermore, they are sending coders to AHIMA’s ICD-10 train-the-trainer program.

The third school is the most advanced. They are already testing ICD-10 readiness. These early adopters plan to begin ICD-10 coding in January 2012. Dual coding, or the coding of cases in both ICD-9 and ICD-10 classification systems, will be performed. Coders are being trained now to support the effort.

All three approaches agree they will eventually need staffing help. First, there is the need for coverage while internal coding staff is being trained. And training may be extensive: between 50 and 480 hours depending on the coder’s existing knowledge set and experience. Secondly, there is an anticipated major drop in productivity at go-live on Oct. 1, 2013. Lastly, there will be an ongoing drop in productivity with ICD-10 that will require permanent staffing increases.

According to Kerry Johnson in 2004’s, “Implementation of ICD-10: Experiences and Lessons Learned from a Canadian Hospital,” initially, charts completed per hour dropped from 4.62 (ICD-9) to 2.15 for ICD-10. Productivity improved somewhat 10 months later to 3.75 charts per hour. That translates to a 54 percent drop in productivity on initial go-live and about a 20 percent ongoing decrease in productivity.

These numbers are consistent with our observations and those of many of our clients and prospects. Many feel that they will need to double the number of coders that they currently utilize to protect revenue streams and buffer the potential of some ICD-9 coders retiring.

Many providers are partnering with coding services companies now, while qualified resources are available. Remember that all coding companies must also take their existing ICD-9 coders offline and out of day-to-day production for training. Several approaches are being explored, and it is important to understand which one the coding company will take.

One approach is to start a whole new coding force dedicated solely to ICD-10. For example, our firm is training 40 brand new ICD-10 coders every four months to build a competent, well-trained ICD-10 staff. Of course, the potential downside of this approach is the coders are all new and inexperienced. The upside is that they have no bad habits or previous baggage to correct.

To mitigate the inexperience issue, this new team of “ICD-10 only” coders will work exclusively in the new classification system. Existing ICD-9 coders will be trained in small groups and then shadow the ICD-10 team to gain hands-on experience. Lastly, another group of coders will not be trained on ICD-10 until after ICD-10 go-live.

With this three-step approach, a coding team can gain the experience they need without missing their day-to-day production or revenue goals, and have a solid pool of experienced personnel ready for 2013.

Other providers are throwing up their hands and outsourcing the whole thing. “By transferring the entire coding department and need for coder training to an outside partner, we are relieving our organization of the entire coder staffing worry,” says Pedro Melendez, CEO, Hospital General Menonita, Cayey, Puerto Rico.

Five-year outsourcing agreements that get the provider well past the ICD-10 deadline and free them up to deal with other healthcare issues are common in this scenario. However, if providers wait until 2013 to contract for a complete outsourcing agreement, the partnership will be very expensive, if even still available.

Of course there are providers who believe they can do it all themselves. They view ICD-10 as a lesser problem, more of a minor shift. They will do some minimal training and then just flip the switch and be fine. The upside of this approach is lower cost and minimal disruption, if they are right. If they are wrong, the revenue impact could be substantial – if not fatal.   

Joe Gurrieri, RHIA, CHP, is VP and COO of H.I.M. on CALL Inc. For more on H.I.M. on CALL Inc. click here.

Managers at a 25-bed critical-access hospital hoped the software could make regulatory surveys smoother by addressing their three biggest challenges.

Accreditation bodies, such as the Joint Commission and Centers for Medicare and Medicaid Services (CMS), stress the importance of following policies and procedures for providing safe, quality patient care. These bodies conduct frequent regulatory surveys to ensure hospitals fall in line with their own standards as well as those required to achieve national patient-safety goals.

To keep up with pertinent standards and regulations – but most importantly, to provide the best possible care for the patient – St. Vincent Randolph, A 25-bed acute-care facility serving the residents of Randolph County, Ind., chose to implement PolicyStat’s web-based policy and procedure-management software in early 2011. Managers at the 25-bed critical-access hospital hoped the software could make regulatory surveys smoother by addressing their three biggest challenges:

1.    Making policies more easily accessible to staff by putting a centralized, easily searchable repository in place to organize and store policies;
2.    Increasing accountability by ensuring associates refer to policies and by holding policy authors accountable for editing and updating policies within the appropriate timeframe; and
3.    Standardizing policies throughout not only the hospital, but also with other hospitals across the St. Vincent Health system.

Director of Human Resources Zach Matthews and Chief Nursing Officer Carla Fouse were charged with getting policies and procedures up and running in the PolicyStat system. “When PolicyStat came to present their product, I knew their system was going to be an immense improvement over our current paper system,” Matthews says.

Surveys

Shortly after a recent Joint Commission survey at St. Vincent Randolph, CMS conducted an extensive validation survey. Normally, CMS comes in with an itinerary and conducts a “tracer,” where they take a certain population, age group or diagnosis and pull a chart on the nursing unit, for example. They check that standards are being followed – especially in regard to national patient safety goals – then ask associates questions about specific policies related to those standards or goals. Each survey ends with an exit interview conducted by the auditors, with results ranging from simple fixes to significant issues for which an action plan must be implemented.

Surveyors look for different things, but mainly they want to make sure staff knows where each policy is. “It would be very unsafe to the patient if we had associates providing treatment without the ability to consult policies,” Fouse says. “Our goal is to provide safe patient care and to create a culture that promotes safety in all situations.”

Challenge #1: Make policies easily accessible

Joint Commission and CMS surveyors ask how associates know about a policy and where they can access it. “We lacked a system that would effectively inform all staff at once about new or revised policies,” Matthews says. Before PolicyStat, managers just made sure to inform associates of new or revised policies at the departmental meetings. Managers would still need to print policies off and hand them to associates.

The PolicyStat system made it easy for associates to find and access any policy in any area with a simple, Google-like search function. “With PolicyStat, nursing staff can easily find and access all applicable policies – not just those specific to his or her area, but also those in any of the other nursing units,” Fouse says.

Before PolicyStat, St. Vincent Randolph also lacked an organized way of housing policies, making it difficult to find policies on the spot during a survey. “The surveyors usually gave me a list of policies ahead of time which I could then pass off to the appropriate managers to retrieve,” Fouse says. During the most recent survey, however, auditors asked for policies to be produced right there on the spot. “PolicyStat allowed us to access the requested policies on demand,” Fouse says. After the most recent survey, managers who had not yet started using PolicyStat saw how it could help them access policies faster and make surveys go smoother. They immediately started jumping on board and importing their policies.

Challenge #2: Increase accountability

Surveyors want to see an organized and formal policy process for managing policies and communicating them to associates, and they also expect associates to know where to go to find the information they need. To address both concerns, St. Vincent Randolph put a system in place for increasing accountability.

While some hospitals used an intranet database to store and manage their policies and procedures, St. Vincent Randolph was using a completely paper-based system. The paper-based system often led to confusion regarding who was responsible for what policies and when they needed to be updated.

With the PolicyStat system, authors are held more accountable for editing and updating policies within the appropriate timeframe, so that all policies are kept active and applicable at all times. “We’ve seen a night-and-day difference with PolicyStat versus our outdated paper-based policy system,” Matthews says. “PolicyStat gives us a more organized system with better accountability.”

PolicyStat has greatly improved accountability among all associates, not just management staff. Each associate is now able to find policies and print them off within minutes, versus spending more time hunting to find which policies are applicable and active. “There is more transparency for the associates,” Matthews says. “PolicyStat has helped us get all policies in one place, and staff can access policies whenever they want. This is a much-improved process for us.”

Challenge #3: Standardize across the hospital and across the system

Before PolicyStat, inconsistencies existed among policies with similar procedures. It was crucial that these inconsistencies were resolved – especially before a survey – but it was a tedious process. “We didn’t have an effective way of keeping policies updated,” Fouse says. “All policies had to be updated at the same time, and that was a huge undertaking for surgery and med surg units that had hundreds of policies.”

It was also vital for St. Vincent Randolph to standardize using the most current, evidence-based policies and procedures. Time Out, for example, is a requirement on the forefront of many procedures, but it was not outlined the same in all policies. “We had Time Out in the procedures for surgery but not in the med-surg unit,” Fouse says. “When we perform a procedure in med surg, we should be doing it the same way as in the ER and OR.” PolicyStat’s software and the organized implementation process made standardizing policies achievable and less overwhelming, helping St. Vincent Randolph to reduce these types of inconsistencies.

Using PolicyStat’s applicability feature, authors at St. Vincent Randolph are now able to share and standardize policies across the St. Vincent Health system, borrow policies from other ministries and make them their own. This allows the entire health system to standardize across ministries and use only those procedures which are based on the most current, evidence-based practices.

“Policy writing can be a difficult process,” Fouse says. “One of the best things I have found about PolicyStat is the ability to share policies across the system. I can go to their site and ‘borrow’ some of their best practices. I have to customize some of the policy to make it specific to our hospital, but the scientific process or general principle is there for me to use. It saves us time and effort to have something that already exists out there – we don’t have to re-type or start from scratch.”

“We’ve seen policies from other ministries that we hadn’t yet thought of creating, but now we have been able to add them to our system too,” adds Matthews. Sharing across ministries has allowed authors to standardize and share their evidence-based practices with authors in other ministries, ultimately leading to better quality of care for the patient.

Beyond surveys: Reducing risk and achieving organizational goals

Outside of normal standards and regulations, St. Vincent Randolph also takes a proactive approach on their own to reduce risk and improve care for the patient. “We conduct a risk assessment every year by a body called the Nursing Senate,” Fouse says. The Nursing Senate is part of St. Vincent Randolph and includes elected members from each unit. It gives front-line staff shared governance and a say in how nursing provides patient care.

One of the goals for this year’s Nursing Senate is to ensure associates know where to go for policies and to encourage the consistent use of PolicyStat. To help reach this goal, members from the Nursing Senate help staff access PolicyStat and show them how to use it. They encourage associates to go to PolicyStat and look something up if they are unsure.

“It makes me feel good that they saw this as an issue and decided to work on it,” Fouse says. “Following policies and procedures is vital to providing safe, quality patient care. And that’s what’s most important.”            

For more information on PolicyStat solutions click here.

Clinical decision-support technology deployed in critical-care environments is a crucial element to enhanced care delivery.

The use of clinical decision support (CDS) to elevate patient care is a solid strategy in any healthcare environment. And while the benefits of decision-support tools are expected to be far reaching across the patient-care continuum, there are likely no areas more primed for realizing their potential than critical care.

Critical care poses a unique challenge and opportunity for evidence-based medicine (EBM) because the stakes are so high when less-than-optimum choices are made. Forgetting to write down just one order can have life-threatening consequences – a reality for even the most detail-oriented physician. Thus, when clinicians can rely on CDS to help ensure that nothing is overlooked, a hospital is poised for greater control over its efforts to achieve the highest level of patient care and safety.

Also a reality for critical care is the fact that industry best practices tend to be moving targets, with new research and outcomes constantly coming online. Physicians in this environment are used to this continuous change and are much more open to the use of CDS if it will alleviate the pressure that comes with staying abreast of the latest evidence.

To this end, many hospitals are realizing the integral role that evidence-based order sets can play in meeting national quality expectations and metrics going forward – especially since faulty decisions can have dire consequences.

Evidence-based order sets provide a foundation for elevating patient care. The challenge for many hospitals is finding the resources needed to deploy these tools efficiently and effectively into physician workflows. That’s where advanced technology and automation play key roles.

Sibley Memorial’s EBM challenge

Consistency of care and adoption of EBM into clinical practice have been central tenets of Sibley Memorial Hospital’s efforts to raise the bar on quality to exceed regulatory standards. A 328-bed acute-care hospital in Washington D.C., the facility set out to overcome the challenges of a decentralized order-set strategy and limited adoption of practices that support the latest evidence.

Specifically, Sibley had in place a hybrid medical record system that included both electronic and paper-based processes. Without a centralized, electronic system for organizing order sets and forms, the hospital faced an uphill battle over version control and standardization of processes.

Further, the system for developing new order sets was fragmented at best, beginning with development in a departmental committee and proceeding through the daunting process of gaining approvals from numerous other committees. Without any real coordination between committees, the process could take months, making the effort to actually get an order set incorporated into workflow monumental. In the case of critical care – where the latest evidence changes rapidly – order sets could become outdated before they even made it into the clinical workflow.

Community-based hospitals like Sibley also face unique challenges to the adoption of EBM because the sharing of knowledge and new ideas doesn’t occur at the same pace as it does in a university hospital or academic setting. The ability to demonstrate the rationale behind certain practice changes is essential in these environments, as changes in clinical practice or workflow tend to receive pushback and can be painstakingly slow.

To address Sibley’s needs going forward, a project team was assembled to identify an appropriate solution to speed up and centralize the order-set development process, ensure that the latest evidence was attached to CDS and advance the practice of EBM. The obvious starting point was the ICU.

Advanced technology overcomes challenges

Sibley initiated a six-month pilot in early 2011 wherein paper-based order sets used in the ICU and joint-replacement program were converted to ProVation Order Sets, powered by UpToDate Decision Support. In addition to a robust project-management function that accelerates the development cycle, the electronic order-set solution features direct links to supporting medical evidence and an automated maintenance tool to ensure that the order sets stay current.

Most importantly, the software’s interfaces allow for fast deployment into the hospital’s CPOE system. Though a fully automated interface with any system is impossible, order-set tools with customizable interfaces make it easier to upload approved order sets into the CPOE system with limited manual intervention.

A key element to the successful rollout and implementation of the order-set technology was the identification of physician champions to oversee the process. Due to physician time constraints, as well as the need for consensus going forward, Sibley determined it would be impossible to have mass involvement. Thus, a limited committee structure was established to ensure that the program could move forward as smoothly as possible. Physician champions and subject-matter experts were identified in the targeted clinical areas to facilitate this process.

Once rolled out, order sets successfully served as a crucial checklist in the ICU to make sure nothing was missed or overlooked. The department staff was also able to draw on the integrated evidence to implement more efficient programs.

For example, in Sibley’s prior ICU admission orders, a pre-printed order set existed that listed an option for “stress ulcer prophylaxis.” This created a situation where the majority of patients admitted to the ICU were placed on prophylaxis, often including patients at low risk for developing stress ulcers. This created higher costs for the hospital as patients were often continued on prophylaxis until discharge from the hospital. That order set was revised based on the template available within ProVation Order Sets and linked to evidence provided by UpToDate to support the change in prophylaxis orders. This changeover has created a more effective and cost-efficient process.

As part of the ICU pilot, Sibley was also able to implement a nutrition order set that did not previously exist. Prior to the availability of order sets, a nutrition consult had to be obtained before enteral nutrition could be initiated. Now, clinicians feel much more comfortable implementing nutrition support in a more timely fashion.

UpToDate has been widely embraced, and the physician community has gained a great deal of confidence in the evidence provided. Direct links to UpToDate are provided for much of the order-set content, allowing physicians to quickly and easily click through to the supporting evidence to see the rationale behind the order set. This is especially valuable when the order set represents a change in typical practice patterns.

End result

The extent to which Sibley’s medical staff has embraced order sets and CPOE has far exceeded the initial expectations. When a new process is carefully thought out and well executed, the physician community is much more likely to embrace its benefits going forward. For example, the hospital’s ICU admission order set ultimately went from one page to five, but the end result has been the execution of more efficient and effective patient care alongside improved workflows.

By leveraging advanced order-set technology coupled with evidence-based decision support in the ICU, Sibley has been able to standardize care on a high level. This successful effort positions the organization to raise the bar on patient quality and places it at the forefront of the national healthcare movement.

About the author:

Hasan Zia, M.D., is CMIO and director of critical care and emergency surgery for Sibley Memorial Hospital, a 328-bed acute care hospital in Washington, D.C. For more information on Wolters Kluwer Health solutions, click here.

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.

4medica

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.

Awarepoint

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.

CentraMed

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.

GetWellNetwork

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.

Health Language

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.

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.

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.

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.

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.

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.

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.

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:

1. 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.
2. 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.
3. 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.

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.