Industry insiders weigh in on the year ahead in healthcare technology.
Editor’s note: Because we received so many responses, the forecasts were split into two parts; part I was featured in the January 2012 edition of HMT.
Emergence of the individual network-exchange model
By Robert Connely, SVP, Medicity
In the past few years we have seen a tremendous shift in the way technology is used to connect people, and in 2012 we will see the emergence of a new model in healthcare, the individual network exchange. In healthcare, as in other industries, software technology is advancing to the point that it can adapt to how people work, rather than requiring people to adapt to the technology. Just as Facebook and smartphone apps have transformed the way people share information and use technology, a grassroots model that enables physician practices to own and control how they use technology to interact with each other and with health information exchanges (HIEs) will ease the adoption curve for practices and grease the skids for improving healthcare quality and costs.
The individual network-exchange model enables physician practices to establish and control their own secure health information-exchange network. Its success will lie in several factors. First, it plays on the dynamics that form the reality of healthcare. Security, trust and understanding of terms and meaning can be greatly simplified in a small exchange community, such as one created around a single patient. And by building the networks themselves, ownership and use of the system stands a high likelihood of success.
The individual network-exchange model will fit well in the current healthcare technology landscape. Practices fully engaged in electronic collaboration in their immediate community can connect their individual exchange to larger HIE initiatives, enriching collaboration throughout regions and states. And on the broader scale, the individual network-exchange model complements existing approaches and emerging standards, such as the Direct Project and the continued advance of Internet, platform and cloud technologies.
Physician practices establishing their own secure exchange networks with other practices will be key to driving forward effective care collaboration. This new model will make it easier for physicians to share information, collaborate with other care team members and deliver high-quality care.
Manage revenue cycle to support accountable care
By Ron Jones, SVP of hospital solutions, OptumInsight
The pressures of healthcare reform – not to mention the looming ICD-10 transition and industry shift toward accountable care – are requiring major changes in hospitals’ financial and clinical operations. Changes in payment structures and ICD-10 will topple revenue cycle management if organizations are not ready for them. Two key issues should be top priority: end-to-end management of revenue cycles and ensuring they can support accountable care.
Major challenges are mounting for hospitals’ revenue streams: increasing numbers of outpatient visits and self-pay patients, rising costs and regulatory challenges, such as Medicare cuts, ICD-10 and payment reform. For hospitals to successfully adapt to these pressures, they must examine their revenue cycle holistically – starting with scheduling on the front end and extending to billing and accounts receivable on the back end. This will be especially important for ICD-10 readiness, which will wreak havoc on revenue processes and productivity levels. Hospitals must arm themselves with the technology and training necessary to prepare staff for the transition, while mitigating the disruption to their revenue. Hospitals need to understand denials, prevent audits and fix revenue cycle issues, while aligning with government reimbursement changes for the future.
A sharper focus on the revenue cycle brings the added benefit of preparing for the move from fee for service to pay for performance, and all the changes that will bring. In 2012, we’ll see some hospitals completing the implementation of their EMRs and HIEs, while others will take advantage of population analytics and care-management technologies. Hospitals can take cues from the payer market with many of these, but will need to customize them to be provider friendly. Once up and running, these solutions will be the backbone of a sustainable health community – a clinically integrated, financially viable health system that increases the quality of care, improves the patient experience and lowers overall healthcare costs.
Year of the healthcare cuts?
By Fauzia Khan, M.D., FCAP, co-founder, CMO, DiagnosisOne
CMS has been threatening to cut its programs, but those changes continue to get pushed off. The proposed changes could have a very negative impact on the availability and quality of care for anyone on Medicare, and physicians will not be able to afford to treat Medicare patients. Knowing that private insurance typically follows Medicare reimbursement leads, the total compensation for physicians will be slashed drastically. If these cuts become reality, the industry could eventually see an even greater decrease in people becoming physicians. With the volume of medical school debt they typically accrue and the prospect of significantly lower income, it will not be a lucrative career path for many.
The reimbursement for care must be focused on the patient and outcomes rather than on services rendered. The ACO concept is a start, but it needs to be adapted. Bundled payments are on the right track, and they can be implemented without the massive overhead and legal structure required for an ACO. Improving quality and efficiency, rather than just reporting on it, places a heavy reliance on the ACO-wide sharing of clinical and cost data. Modernizing processes will enable healthcare organizations to provide efficient workflows throughout the system, while also providing a higher quality of care for the patient. However, most physicians will not enter into an ACO agreement due to the lack of return on investment. Regardless, the mechanism to analyze clinical outcomes based on actual data and improve measures accordingly will likely be worth the upfront investment.
Structured vocabularies for the healthcare industry will empower continuity of care and communication across multiple clinical-care settings. With the migration to a universal code, translating into ICD-10 from ICD-9 will pose a challenge and require resources, both human and IT, but the result will be better quality of care. This transition will become the next hot topic, as it is already looming on the horizon. Additionally, the shift to ICD-10 could create thousands of jobs as hospitals and other healthcare facilities adjust to an initial delay in claims submissions.
There is an increased focus on the patient at the core of the plan of treatment. To truly impact care, the patient must be engaged, educated on all options and able to help choose the best course of action along with the allied care professionals responsible for treating the patient. Engaging the patient is also at the crux of the patient-centered medical home, which is becoming increasingly significant as an emerging model of healthcare delivery. Coordination of care can reduce duplicate tests and prevent errors in conflicting treatment when patients have several doctors.
Practices will begin implementing the features of 5010
By Ken Bradley, VP of strategic planning, Navicure
In my opinion, 2012 promises to be a year marked by growing awareness of how the effective use of data can be used to transform the medical revenue cycle that is only possible with full implementation of the HIPAA Version 5010 electronic transaction standards. One of my greatest worries, in fact, is that most healthcare organizations – providers and payers alike – will have rushed to meet the bare minimum 5010 requirements by Jan. 1, 2012. Then, on Jan. 2, they’ll move straight into planning for ICD-10 without first ensuring maximum 5010 functionality. That could prove costly.
The effective use of data is becoming the undisputed driver for improving administrative healthcare processes, and 5010 will definitely start streamlining and replacing many manual processes this year. But without fully and correctly implemented 5010 standards, we won’t be able to take advantage of tons of good data.
Eligibility is the perfect example. Under 5010, the eligibility response has been greatly enhanced to include patient demographic information and financial responsibility amounts. But if that valuable data never makes it back to the practice – because either an IT or clearinghouse vendor hasn’t appropriately updated its software, for instance – everyone loses the ability to report, benchmark and make business decisions based on it.
This year, I think we’ll begin to see forward-thinking practices examining how to implement the features of 5010 in order to update business processes to reduce operational costs. As they’re doing so, they will begin to analyze ICD-9 code data in much the same way. (We can’t forget, of course, that 5010 sets the framework to ensure even better data mining capabilities once ICD-10 is implemented.)
Make no mistake: 5010 is worth the effort. You just need to make sure all the benefits of 5010’s standardized and more robust data are put to work to help you reap the highest reward.
ED prepares for the risks and rewards of ICD-10
By Sunny Sanyal, CEO, T-System
As the 30-plus-year reign of ICD-9 ends and ICD-10 becomes healthcare’s official coding system, hospitals must pay close attention to the impact on the emergency department (ED). ICD-10’s requirement for more detailed information may have profound effects on ED workflow and productivity, and thus the entire hospital’s patient flow and profitability. Hospitals are faced with numerous challenges in switching to ICD-10, the most onerous of which will be physician training for increased documentation needs and IT system readiness. Already overburdened by rising patient volumes, the severity of the productivity slump will depend on the approach the ED and hospital information-systems vendors take to comply with ICD-10.
To deal with the complex documentation to support ICD-10 code generation, some vendors may comply with ICD-10 by incorporating lengthy pick lists (perhaps with filters) from which providers can select the appropriate ICD-10 code into their EDIS and EHR systems. This approach will be the most interruptive to clinician workflow and will cause severe productivity declines as clinicians navigate a thicket of drop-down menus.
Other vendors will make more extensive modifications to their systems to accommodate ICD-10, and their efforts will lead to far less significant impacts to the ED. Streamlined user interfaces with minimal mouse clicks and screen transitions will enhance efficiency rather than detract from it. Providing robust content from which to document can ease ICD-10 preparedness. Systems that algorithmically generate ICD-10 codes based on the providers’ documentation will improve productivity at the point of care and downstream in the back office.
Hospitals that prepare by reviewing their current practices to identify and address the most problematic areas of their ICD-10 implementation and by training staff (both coders and providers) will see minimal impacts to productivity and revenues. These organizations will also realize its greatest benefits: improved clinical data collection, advances in evidence-based medicine and enhanced quality of care.
Key 2012 trends: medical homes, digitization and automation
By Steve Schelhammer, CEO, Phytel
Automation tools for population health management will become more important than ever in 2012 as a growing number of healthcare providers begins to take responsibility for the cost and quality of care. Some organizations will further integrate their information systems and automate their care-coordination processes to prepare for the assumption of financial risk. And more and more providers will focus on the patient-centered medical home (PCMH), which can produce short-term financial and clinical benefits while paving the way for the formation of accountable care organizations (ACOs).
The PCMH is already generating tremendous enthusiasm among providers and payers. In 2012, it will join the mainstream of healthcare delivery as organizations recognize that it is the best vehicle for attaining the objectives of accountable care.
Without the ability to leverage digitized clinical data, it is impossible to achieve the medical home’s primary goal of improving care coordination in a scalable way. Fortunately, the federal government’s HITECH incentive program is driving the rapidly increasing adoption and meaningful use of EHRs. As structured electronic data becomes the norm, many more providers will be able to tap clinical databases for real-time identification of care gaps, automated outreach to patients who need preventive and chronic care, care coordination, predictive modeling and risk stratification of the population. These tools will help providers build successful medical homes and ACOs.
Meanwhile, efforts to promote patients’ engagement in their own care will benefit from the accelerating use of automation technology to replace outmoded, inefficient manual processes. In addition to automated patient outreach methods, online educational tools and health-risk assessments will become commonplace. Mobile health applications will proliferate. Most important, physicians and care teams will have the tools they need to maintain continuous contact with patients between office visits or episodes of care.
Finally, care management will benefit from the new automation approaches. Healthcare systems are placing care coordinators within physician practices, and those professionals are beginning to leverage digitized health data to help them manage patient populations. We will see much more of this kind of activity in 2012.
Drive throughput, remove waste and lock in best practices
By Debi Lelinski, director of product management, healthcare office of strategy management, Ontario Systems
The U.S. healthcare delivery system is in a period of unprecedented change. Surviving healthcare delivery systems and extended business office service providers will be those who adapt to manage through turbulent financial times.
Under any projected reimbursement scenario, providers will be expected to do more, for more patients, with lower reimbursement. Providers will see increased risk shifting to patients as high-deductible health plan (HDHP) enrollment grows. These plans leave many previously insured patients unprepared to pay their healthcare costs. Meanwhile, Gallup reported a record high 17.3 percent of the adult population is without health insurance as of the third quarter of 2011.
Electronic medical records (EMRs) will increasingly focus on care standardization and quality, with wave upon wave of stringent meaningful-use requirements. The focus on clinical-system enhancements may render legacy revenue cycle systems unable to respond rapidly enough.
Among the surviving organizations will be those who exploit technology to drive throughput, remove waste and lock in best practices across administrative, clinical and financial functions. Specifically, we see an increased need for technology that supplements the collection functionality of an organization’s patient accounting system, increases account representative productivity and reduces administrative costs while enhancing patient satisfaction. Technology that drives accuracy, speed and service into every administrative point of patient contact will help healthcare organizations maintain their market positions and meet their financial commitments.
The cloud will keep providers afloat
By Rick Jennings, chief technology officer, vRad
For years innovative cloud-based technologies were viewed with skepticism as unproven or on the bleeding edge, because they were based on a computing model that challenged the status quo. These technologies were spurned in favor of traditional software that is more complex, costlier and time consuming to install. However, this will change in 2012, as technology executives adopt a Web-based platform to address increasingly tight capital budgets (and face the fact that a disruptive shift, similar to the one that occurred when client-server computers leapfrogged mini-computers and mainframes, is now underway).
CIOs tasked with modernizing PACS and other information systems will lack the capital to replace the traditional solutions that have reached their end of life. Critical business, financial and competitive pressures confronting their organization will force them to rethink their IT approach. Technology that made sense in years past simply will not be economically feasible in 2012 and beyond.
As CIOs and risk-averse physician practices look for solutions that fit the new economic reality, improve care, enhance customer experience, reduce cost of I.T. operations, increase efficiencies and create competitive advantages, they will come to find that the cloud is their only option. Cloud technology is not the risky, unproven proposition they thought it was. It has proven itself and been used very effectively in financial, manufacturing and other industries over the past decade. The cloud will not only keep their organizations afloat, it will also help them navigate the changes ahead.
The cloud will be an imperative for technology executives in 2012.
Less time documenting, more time delivering
By Janet Dillione, EVP and general manager, Nuance Healthcare
With ACOs looming and a major transition to ICD-10 less than two years away, healthcare organizations must prioritize and enable the capture of high-quality clinical data.
As we all know, physicians have different documentation styles. While one might type at 100 words per minute, another might still rely on medical transcriptionists. When adequately supported by innovative technologies, however, clinicians can spend less time documenting patient care and more time delivering it.
The prioritization of high-quality data is occurring today and will continue alongside the U.S. healthcare system’s conversion to ICD-10. As we begin shifting from 18,000 codes to 140,000 codes, innovations such as natural language-understanding technologies and mobile speech-enabled capture must be added to the documentation workflow in order to capture the full patient story at the specificity level required, to streamline the coding process and to reduce physician interruptions. To understand this, let’s take a present day example: A physician documents that a patient has a “fracture of the forearm.” Did he mean lower forearm, right forearm or left forearm? And what was the severity? These specific details often instigate a query and require follow up, thereby disrupting clinician workflow. But by turning to technology, we can prompt the physician for more specificity through computer-assisted physician documentation (CAPD) technologies while the details are fresh in his mind. In the end, documentation will be more complete, resulting in more accurate billing and improved care.
Clinical documentation is currently one of the most undervalued resources in healthcare. By improving upon and expanding the scope of the documentation process we can drive clinician efficiency, eliminate unnecessary costs and refocus the care team back on the patient, not the process.
Year of collaboration
By John Klimek, R.Ph., SVP of industry information technology, NCPDP (National Council for Prescription Drug Programs)
As the first year of Medicare’s accountable care demonstration project and second year of meaningful use of electronic health records kick off, hospitals, physicians and others will increasingly collaborate to promote health information technology interoperability, build health information exchanges and develop business processes and data standards in order to communicate and share information more efficiently outside their walls. There’s been a lot of talk about it, but 2012 will mark the year of collaboration.
Countless projects are underway, bringing organizations, associations and providers together to define what a collaborative model looks like, how it should function, the technology infrastructure needed, and how to efficiently and effectively sustain such a model. It is a massive undertaking to facilitate large-scale coordination across diverse groups and interests in an increasingly complex health system.
As the voice and forum of the pharmacy industry, NCPDP has successfully facilitated such collaboration, bringing its consensus-building, collaborative model to pharmacy and healthcare stakeholders to affect the kind of change many will vigorously pursue in 2012. The NCPDP model calls for involvement from all parties, such as physicians, pharmacies, third-party administrators, insurers, pharmacy benefit managers, vendors and others affected by a particular issue. The stakeholder-inclusive approach equips NCPDP with the information it needs to understand the full scope of an issue and develop an effective standard that can adapted or enhanced to evolve with industry needs. Moreover, the model makes it easier to secure widespread industry buy-in and adoption.
The proven model has supported the advancement of the pharmacy industry and delivered patient health and safety solutions – such as e-prescribing, which incorporates real-time clinical alerts on potential allergies and drug interactions. Before trying to re-create the wheel, we encourage healthcare industry stakeholders to tear a page from NCPDP’s playbook to ensure a seamless, effective and sustainable process is developed, implemented and used to optimize the benefits of collaboration for all participants, including patients.
Voice-enabled technologies will be a focus
By Vern Davenport, holdings chairman and CEO, MedQuist
During 2012, we’ll see significant investment into the migration of ICD-10, with an initial shift from fee-based to value-based care and a continued focus on EHR adoption.
It’s anticipated that voice-enabled technologies will be even more of a focus. The first generation of speech recognition, or capturing the physician narrative from the spoken word, has matured. Speech recognition, or the “what you say,” is a simple concept with input available from almost any device.
The second generation, natural language understanding, or the “what you mean,” is what will convert the flat narrative into a structured clinical document that enables collaboration and eliminates inefficiency in clinical and administrative workflow, while driving greater quality for care and reporting. It will also be a focal point for ICD-10, fueling technologies like computer-assisted coding (CAC) – a prime industry focus in 2012.
We’ll also have an eye on what we’ve termed collaborative intelligence. This is the “what you get,” which combines the narrative with data from other sources (i.e. EHRs) to provide workflows that support differentiated clinical and business decision making.
Robust information in the physician narrative will have greater impact on clinical decision support. What was just simple dictation and putting words into a document will now be the foundation used to move the industry to collaborative uses of data.
There is excitement in where we are moving. The industry leaders are those that will capture accurate context in the clinical setting and effectively follow through and discover significant ways to get the most from the information. The New Year will bring a renewed interest in the data-rich content captured at the point of care. How we analyze and make that data more than just blobs of text will be a differentiator.
Healthcare data is currency of the future
By Andrew Fitzpatrick, CEO, Washington Publishing Company (WPC)
With 5010, ICD-10, meaningful use and other regulations coming down the pike, many healthcare stakeholders are taking heed and implementing stronger foundations to enable the capture and utilization of a vast amount of data that will dramatically change their approach to IT integration. This is a positive turning point in the quest to transform our healthcare ecosystem model for the better.
Historically, providers have used enterprise application integration (EAI) solutions to integrate internal systems. However, for better or worse, payment models, consumerism, the economy and other factors affect each facility’s bottom line. Those reforms, coupled with constant economic fluctuations, will require providers not only to coordinate care but also aggregate and exchange data with internal and external stakeholders. Entities will stop building expensive point-to-point interfaces and use newer EAI technologies that enable easier and more affordable connections with disparate applications from multiple parties in both structured and unstructured formats. With the need to process more data, let alone innovations in imaging, providers will invest heavily in storage and security solutions.
Looking forward, health systems and insurers may collect several times more data than previously collected at a growth rate projected to expand exponentially. While EAI solutions have traditionally been built around structured data models, newer technologies and ideas linking metadata and data together (such as XML) are redefining how structured and unstructured information can be exchanged and mined seamlessly, quickly and widely. What’s more, we’ll have a clearer picture of the data to better identify patterns, develop best practices, measure outcomes and calculate true costs.
Indisputably, the industry has always been awash in information. Stakeholders have been bound by a lack of incentives to do much more with it. But with revenue cycle and fiscal survival at stake, data will be the currency of the future. Organizations that invest and leverage their treasure trove of information will recognize a faster ROI and long-term competitive advantage.