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The year of irreversible convergence

By Jeff Margolis, founder and chairman, The TriZetto Group

No one can dispute that the healthcare landscape is complex and uncertain. The Great Recession has created high unemployment coupled with a slow economic recovery environment in proximity to the passage of costly healthcare reform legislation that creates myriad changes to government-sponsored and private-sector health insurance programs. No problem! Each year, I go out on a limb to identify important healthcare strategy and information technology-related predictions for organizations to consider over a several-year planning horizon. I believe that health plans, working collaboratively with providers, are up to the challenge of improving the coordination of benefi ts and care in this country to yield more value for every healthcare dollar spent. In 2011, I predict that social media will begin a noticeable and irreversible convergence with organized systems of

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healthcare. As the popularity of specialized social networks rises, payers, providers and employers alike will need to develop new strategies and utilize analytical tools to engage consumers in these venues while maintaining quality communications and following privacy rules.

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Second, I predict that efforts to increase the use of electronic health records will continue to garner broad support both legislatively and within the industry. However, their general

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inability to support evidence-based care and service multiple constituents (i.e., physicians, consumers, non-physician caregivers), as well as their inability to support population health management, will reignite the category of care- management solution applications. Third (and most promising), alignment of consumer

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and provider incentives, likely to take the form of value- based benefit design and value-based reimbursement methodologies, will become the constructive middle ground to reach compromise on healthcare reform that is more acceptable to a majority of legislators and industry leaders.

Smaller hospitals get on board the HIS train

By Robert F. Tilley Sr., vice president and chief technology officer, T- System

In the coming year, hospitals all across America will begin implementing electronic medical records in an effort to meet meaningful- use (MU) requirements and prepare for healthcare reform.

This change will be a herculean task for the nation’s small and mid-size hospitals, many of which lack a hospital- wide health information system (HIS) or use different IT systems across different clinical areas in the facility. In addition, few have the cash or credit rating needed to pay for such a signifi cant initial IT investment. Still reeling from the economic downturn, smaller hospitals can afford neither the millions of dollars required to implement a feature-rich enterprise HIS nor the hefty fi nes levied against institutions failing to meet MU criteria. Hospitals may save up-front costs by selecting systems that use a subscription model instead of a capital-intense license approach. For many, the best option is a smaller HIS system that’s less expensive and easier to install, yet provides an overall

22 February 2011

framework across the facility. Unfortunately, these systems lack the sophisticated clinical modules hospitals need, so hospitals should consider best-of-breed clinical modules. To overcome these interoperability challenges, administrators may also want to hire a consultant to develop the interfaces to integrate these modules with the HIS. These modules can cost as much as $25,000 each, but they allow hospitals to increase productivity and streamline their enterprise over time. Smaller hospitals may be tempted to implement an HIS and stop there. The danger is that smaller HIS systems often don’t offer the sophisticated coding capabilities to facilitate charge capture and may not meet the MU criteria in areas like the ED. According to the CDC, only 12.5 percent of emergency department patients are admitted to the hospital. If a hospital ED sees 10,000 patients per year, more than 8,700 of them will never be admitted. For the facility to capture MU reimbursement, they may need to include these ER-admitted patients. Without an effective emergency department information system, all the effort to install an HIS may not be enough.

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Despite the challenges, smaller hospitals need to migrate to HIS systems and electronic medical records – and soon. The risks of fi nes, lost revenue and diminished care quality are just too grave to ignore.


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