Healthcare Organizations: What Must Be Done Before Jan. 1, 2015?

What must be done before you walk out of the office for the last time before the stroke of midnight Jan. 1, 2015? It’s a simple question with many possible responses. Each healthcare organization, based on its needs and priorities likely has a fix what it needs to do, though, perhaps those things are not necessarily what it wants to do. Like people, the final couple weeks of the year are different for everyone and practices are no different.

So, if you’re making a list and checking it twice, here are a few suggestions that you might want to add to it to be well prepared for the new year, based on your practice’s business needs, of course.

Review the ONC Federal Health IT Strategic Plan

Chris Boone
Chris Boone

At Health Data Consortium, we have three must-do items before we close the door to 2014. First, we urge the health IT community to review the recently released ONC Federal Health IT Strategic Plan 2015-2020. Public comments are open until February 6, but don’t let your response get lost in the start of the year flurry. Second, we are preparing for the arrival of the 114th Congress and the opportunity to share Health Data Consortium’s public policy platform for 2015. Our platform will have an emphasis on the key issues that affect data accessibility, data sharing and patient privacy – all critical to improving health outcomes and our healthcare system overall. Finally, on January 1 we’ll be only 150 days from Health Datapalooza 2015. We are kicking off the new year and the countdown to Health Datapalooza with keynote speakers and sessions confirmed on a daily basis. We’re already making the necessary preparations to gather the innovators who are igniting the open health data revolution. As 2014 comes to a close, we look forward to hit the ground running in 2015.

Chris Boone, Executive Director, Health Data Consortium

Turn off the technology, and hire

David Finn
David Finn

Ideally, turn off not only your lights, but everything — I mean every piece of digital technology and every way digital technology can connect to your organization. That is the only way to assure there are no accidents, glitches, failures or breaches. Here are some other things you can do:

• Fill every open position you can. Have positions and people identified and include backups. The only thing worse than not having a position to fill is having one to fill and leaving it open.

• Address mobility, medical devices and patient engagement, and not just from a security perspective — this is everyone who provides access, information or uses these devices or systems.

• Address the culture and have a plan to include every individual in the organization, if the technology touches them, from BYOD to analytics to privacy to cloud storage.

IT, regardless of the industry, is ultimately about people. In healthcare, it is also about the data itself, which represents your patients. It has to be there, it has to work, it has to be secure.

– David Finn, CISA, CISM, CRISC, is a member of ISACA’s Professional Influence and Advocacy Committee, and the Health Information Technology Officer for Symantec

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HIPAA Is Not Do It Once and You’re Done

Lea Chatham
Lea Chatham

Guest post by Lea Chatham, Editor-in-Chief, Getting Paid Blog

I remember when the Health Insurance Portability and Accountability Act (HIPAA) passed. I was working for a leading practice management software vendor. Everyone was overwhelmed by what was involved. We developed a huge amount of education and information for our customers. Some people wondered if the healthcare industry could make such a major change.

Today, HIPAA is ubiquitous. Many practices take it for granted. They are not concerned about a breach because they believe they have done everything they need to do. In a recent study by MedData Group of physicians top practice management priorities for 2015, HIPAA didn’t even make the list.

“We instigated HIPPA when it came out, and it is in place and second nature to us,” said Joann Lister, a provider at a family medicine practice in Texas. “We have all worked at the hospital so we had plenty of training on the rules. Our physical space and computers are confidential. Our practice management and EHR software, Kareo, always goes back to login when we are done in a room so the next patient does not see anything. We have limited personnel so it is easier to know that everyone honors the HIPAA rules.”

The question is: Have practices gotten too complacent with HIPAA? With the latest changes to HIPAA in 2014, have they followed through on making changes and updates? The data and experience of industry experts and consultants suggests that there may be a problem with HIPAA compliance.

“The last analysis we did for a practice had 41 pages of regulations that required implementation,” recalled practice management consultant Rochelle Glassman, CEO of United Physician Services. “Most practices do not know what the complete requirements are. They believe that if they have the patients sign the privacy form that is all they need to do. This year there were updates that included the new HITECH Act and the HIPAA Omnibus rule. I can guarantee that many practices have not updated their HIPAA program to include the changes because they do not even know they exist.”

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First Real-World Trial of Impact of Patient-Controlled Access to Electronic Health Records

In the first real-world trial of the impact of patient-controlled access to electronic health records, almost half of the patients who participated withheld clinically sensitive information in their medical record from some or all of their health care providers.

Should patients control who can see specific information in their electronic medical records? How much control should they have? Can doctors and other clinicians provide safe, high-quality care when a patient’s preference may deny members of the medical team from seeing portions of the electronic medical record? What is the appropriate balance between individual privacy concerns and health care providers’ need for relevant data?

The Regenstrief Institute, Indiana University School of Medicine and Eskenazi Health (formerly Wishard Health Services) partnered to design and conduct the first real-world trial intended to help answer these and related questions. During the six-month trial, 105 patients in an Eskenazi Health primary care clinic were able to indicate preferences for which clinicians could access sensitive information, in their electronic medical records, such as information on sexually transmitted diseases, substance abuse or mental health, and designating what the clinicians could see.

Regenstrief informatics developers then created a system where those preferences guided what information doctors, nurses and other clinic staff could see. Patients were able to hide some or all of their data from some or all providers. Importantly, the healthcare providers were able to override patients’ preferences and view any hidden data, if they felt the patient’s healthcare required it, by hitting a “break the glass” button on their computer screens. When providers hit this button, the program recorded the time, the patient whose electronic chart was being viewed and the data displayed.

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HHS Gives $665 Million for State-led State Innovation Models to “Improve” Healthcare Quality

Twenty eight states, three territories and the District of Columbia will receive more than $665 million in Affordable Care Act funding to design and test healthcare payment and service delivery models that will try to improve healthcare quality and lower costs, Health and Human Services Secretary Sylvia M. Burwell announced.

Together with awards released in early 2013, more than half of states (34 states and three territories and the District of Columbia), representing nearly two-thirds of the population are participating in efforts to support comprehensive state-based innovation in health system transformation aimed at finding new and innovative ways to improve quality and lower costs.

The State Innovation Models initiative supports states in planning or implementing a customized, fully developed proposal capable of creating statewide health transformation to improve health care. Example initiatives include:

  • Improving primary care through patient centered medical homes, building upon current Accountable Care Organization models or integrating primary care and behavioral health services.
  • Providing technical assistance and data to healthcare providers and payers that are working to advance models of integrated, team-based care, or transition to value-based payment models.
  • Creating unified quality measure score cards that health care payers and providers can use to align quality improvement and value-based payment methodologies.
  • Expanding the adoption of health information technology to improve patient care.
  • Fostering partnerships among public, behavioral and primary healthcare providers.
  • Strengthening the healthcare workforce through educational programs, inter-professional training, primary care residencies and community health worker training.

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8 Certifications You Need To Compete In Health IT

Tim Cannon
Tim Cannon

Tim Cannon is the vice president of product management and marketing at HealthITJobs.com.

The health IT industry is growing, but it’s also becoming competitive. While a career in health IT is fairly easy to break into, professionals will continually need to increase their value by gaining the knowledge needed to adapt to the evolving technology in the industry.

Fortunately, increasing your credentials and experience in health IT has been simplified by numerous certifications available. In fact, my company’s recent salary survey found that health IT professionals with certifications typically make $10,000 or more than those without.

If you’re looking to boost your career in health IT or increase your salary, here are a few certifications you should look into:

1. CISSP

The CISSP certification is ideal for professionals who work or want to work in information systems security. In any profession that requires the transfer and curation of patent data and confidential records, it’s helpful to have experience keeping information secure. This certification requires five years of paid full-time experience in the field, but one year may be waived with a four-year degree.

2. CCNA

The CCNA certification is for network engineers who are looking to advance their skills in networking. It provides training and education for installing, monitoring, and troubleshooting network issues. Training covers important topics such as IOS, IPv6, IPv4, OSPF, Cisco Licensing, Serial Line Interfaces, VLANs, Ethernet, VLSM, and basic traffic filtering.

3. PMP

The most important one for project managers, this certification is highly renowned in the industry. Professionals with this certification demonstrate the experience and competency needed to lead and direct projects. Project manager was found to be the most lucrative job function in the health IT industry, pulling in an average of more than $111 million annually, according to our survey. The Project Management Institute also found obtaining a PMP certification further increased salaries.

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Physicians Foundation Watch List Finds ICD-10 and Need for Cost Transparency the Leading Issues of 2015

As significant changes continue to reshape the U.S. healthcare system, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients – has identified five critical areas that will have major impact on practicing physicians and their patients over the next 12 months. The Physicians Watch List for 2015 is based on the Foundation’s insights into the medical practice landscape, supported by data from its 2014 Biennial Physician Survey of 20,000 physicians and other Foundation research and white papers.

Consolidation Hits the Gas Pedal

An increased rate of consolidation among hospitals and health systems continues to drive smaller, independent medical practices into larger systems. This trend is adversely impacting competition in regions where consolidation is most pronounced, while increasing costs and reducing patient choice. Rapid medical consolidation is also presenting a challenge to clinical autonomy. According to the Foundation’s 2014 Biennial Physician Survey, more than two-thirds of all physicians (69 percent) expressed concerns relative to clinical autonomy and their ability to make the best decisions for their patients. Since the rate of medical consolidation shows no signs of abating, it is imperative that hospitals and physicians work together to ensure that clinical decisions are being made independent of any bureaucratic or organizational pressures that could potentially affect the integrity of medical decision-making.

External Pressures Strain the Physician/Patient Relationship

An inadvertent effect of medical consolidation and the rising emphasis on valued-based payment models is increasing strain on the physician / patient relationship. According to the Foundation’s most recent Biennial Survey, 80 percent of physicians describe patient relationships as the most satisfying factor of practicing medicine. Yet, factors such as growing levels of non-clinical paperwork and rising administrative and regulatory pressures are leading to an erosion of quality face-time physicians are able to spend with their patients.

In addition, these pressures can also limit physicians’ choices in terms of practice type while increasing the amount of time and resources they must spend on negotiating with payers and vendors. As these regulatory and marketplace forces persist, it will be more critical than ever for physicians to identify ways to work with support staff in order to maximize the amount of quality time they are able to spend with their patients.

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All I Want for Christmas: Health IT Stocking Stuffers

As we head into Christmas, and 2015, millions of Americans have hopes for a bright holiday willed with hope, health and happiness. And while America’s consumer engine is in full force, presents are getting bought, wrapped and covered with ribbons and bows, it’s hard to image that there’s little that can’t be bought and given in the spirit of good cheer for the betterment of man and for the greater good. But, as in all areas of life there are a few things that won’t fit nicely in the stocking or under the tree.

If only everything we wanted and needed could be placed in our stocking to be unwrapped on Christmas morn, but there’s just too much on the list. The list would be long for those in healthcare – interoperability, improvement of policies, better communication with care providers, and even more, qualified employees to join healthcare-related ventures.

If only some of these Christmas wishes could be packaged and stuffed in the stocking. Here are a few ideas from several healthcare folks who wish they could make the world’s dreams come true.

Allen Kamrava, MD, MBA, attending staff, Cedars Sinai Medical Center, Department of Surgery, Division of Colorectal Surgery

Common language between all healthcare electronic health records (EHR) systems, such that they can communicate with each other and patient notes may be accessed between all providers. We have gone digital, but none of the systems communicate with one another. This does not make any sense. Patients should be able to elect to have their records “shared” between systems when they visit other physicians, and more so to have their accounts sync’d between systems so that all physicians are up to date with
all tests, procedures and visits. For now, the only thing EMRs have provided for is more legible notes that are inundated with information required by national standards regulations. Healthcare is far beyond the rest of the IT world. Indeed, it functions in the pre-internet era – we have electronic systems, but they do not communicate in any meaningful way. Healthcare IT is still functioning as if we are in the 1990s.

Bill Marvin, president, chief executive officer and co-founder, InstaMed

Bill Marvin

Health IT Christmas wish: Interoperability. By integrating technology and processes across heterogeneous environments, providers automate administrative processes and simplify compliance requirements, resulting in lower operational costs.

Bill Fera, M.D., principal, EY Americas Health Care Advisory practice

I would love to see a fully functional telemedicine capability in every hospital and office across the country. What I mean by fully functional is that reimbursement hurdles have been cleared, apps are standard, we have a maturity and adoption model in place all so that patients are receiving the best care from the right clinician in the most optimal manner possible.

Charles Settles

Charles A. Settles, product analyst, TechnologyAdvice
There are a myriad of things I’d like to find in my figurative “stocking” come Christmas morning, but perhaps the one I’d like to see the most is more widespread patient, provider and payer use of health wearable devices or fitness trackers, i.e. Fitbit, FuelBand, Jawbone, etc. The spread of these devices is something we are keeping a close eye on here at TechnologyAdvice; we recently surveyed nearly 1,000 adults about their use of fitness trackers and uncovered several key insights. Perhaps the most actionable of those insights was that nearly 60 percent of adults would use a fitness tracking device if it would help reduce their monthly health insurance premiums. Of course, there are potential benefits to payers and providers as well — in the push to switch the healthcare reimbursements from a fee-for-service to a outcomes-based model, these devices could provide invaluable information to physicians that would aid in health maintenance, preventative care, and overall population health modeling. As these devices evolve and are able to track more and more biometrics, they could enable less expensive and higher quality telemedicine.

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PwC’s Health Research Institute Announces Top Health Industry Issues of 2015

In its annual top health industry issues of 2015 report, PwC’s Health Research Institute (HRI) anticipates that the $2.8 trillion U.S. healthcare sector will start feeling like a true market. HRI’s report explores the top 10 trends that are expected to shape the sector in 2015, including the expansion of do-it-yourself healthcare, how industry will adapt to the newly insured, and consumers’ competing desires for convenience and privacy. Top health industry issues of 2015 include insights from a survey of 1,000 U.S. consumers and interviews with health industry leaders.

“With consumers leading the way, bearing more costs and making more decisions, change is erupting throughout the health industry,” said Kelly Barnes, PwC’s U.S. health industries leader.  “Established healthcare companies and new entrants are rapidly developing cost-efficient products and services tailored directly to consumers.”

HRI’s top 10 issues for the health industry in the year ahead:

1. Do-it-yourself healthcare

U.S. physicians and consumers are ready to embrace a dramatic expansion of the high-tech, personal medical kit. Wearable tech, smartphone-linked devices and mobile apps will become increasingly valuable in care delivery.

2. Making the leap from mobile app to medical device

A proliferation of approved and portable medical devices in patients’ homes, and on their phones, makes diagnosis and treatment more convenient, redoubling the need for strong information security systems.

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CHIME: Low Stage 2 Attestation Numbers Validate Need for Shortened Reporting Period in 2015

The College of Healthcare Information Management Executives (CHIME) is reiterating its call to immediately shorten the reporting period for 2015, as substandard meaningful use low Stage 2 attestation numbers lag for the 2014 program year, the organization said in a statement.

According to the data recently released by the Centers for Medicaid and Medicare Services (CMS) during the Health IT Policy Committee meeting, less than 35 percent of the nation’s hospitals have met Stage 2 meaningful use requirements. While eligible professionals (EPs) have until the end of February to report their progress, just 4 percent have met Stage 2 requirements thus far, CHIME cited.

“Despite policy efforts to mitigate a disastrous program year, today’s release of participation data confirms widespread challenges with Stage 2 meaningful use,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO.

Roughly one in three hospitals scheduled to meet Stage 2 in 2014 had to use alternative pathways to meet MU, administrative data current through December 1 indicates.

“This trend demonstrates how vital new flexibilities were in 2014 and again, underscores the need for the same flexibility in 2015,” said Branzell. “It is imperative officials take immediate action to put this critical transformation program back on track. Shortening the time frame for MU reporting in 2015 will help to ensure the program delivers on its promise to advance the transformation of healthcare in this country.”

CHIME and several other national provider associations have repeatedly told CMS that without more program flexibility and a shortened reporting period in 2015, the future of Meaningful Use is in jeopardy.

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Top Health IT Issues Faced By Hospitals

It’s obvious from the varying responses below that there are a plethora of health IT issues affecting a number of areas in and throughout hospitals. In reviewing a number of healthcare issues, the following thought leaders offer what they feel are the top IT issues in healthcare.

As is often the case in profiles such as this, the responses are diverse and varied. Do you agree with their assessments?

Badri Narasimhan

Badri Narasimhan, founder and CEO, AlertMD LLC

I work with hospitals nationwide and I find that the top issues facing the hospital are:

1. How to align the interests of the physician with the hospital in a world where the hospital takes risk? Physicians used to get paid by “time and material” in the old world and the hospital got paid by “contracted costs.” The new reality has both the physician and the hospital getting paid a fixed amount to then manage the cost of healthcare on a “fixed price” for lack of a better word. IT challenges: The tools in the “time and material” world are unsuitable to manage the new reality in a “fixed price” world. This is a top challenge.

2. Real-time P & L — If you ask a hospital CFO what the profitability of the current patients in Unit 10, they would give you a blank stare. This is because the do not know what they are going to get paid (the DRG or diagnosis-related group reimbursement) much less what their current costs are. Thus, the lack of visibility into managing costs creates havoc. IT challenges: Systems that can develop a view into costs and projected revenue require a lot of specialized people to provide the information even in hospitals that have a partial solution. Most hospitals do not know where to turn for new ways of thinking. This is a big IT challenge.

Doug Nebeker, owner and technical expert, Power Admin LLC
Staying on top of compliance and auditing tasks is a top issue facing hospital IT departments today. As more and more data moves into the digital space, IT departments can easily become overwhelmed as staff gets bogged down with the tedious task of trying to keep track of what’s happening where in the system. Network monitoring software is seeing a boom as a result, quickly becoming an IT necessity for managing increasingly complex network auditing and compliance processes. Technology is meant to help, not hinder, and so as we continue to utilize it in new ways we must ensure our process management keeps pace.

Paul Banco, CEO, etherFAX

Hospitals and other healthcare organizations will always have the need to exchange “unstructured” data. While there is a large focus on meaningful use, ICD and other mandates, many hospitals and organizations are not taking into account the need to quickly, affordably and securely transmit unstructured data while also staying HIPAA compliant. One of the main issues is that public cloud services are not HIPAA compliant. Healthcare organizations can work around this by extending their existing fax server solutions to the hybrid cloud, allowing both custom and popular EHR applications to communicate with each other via a private secure network, guaranteeing delivery with military grade end-to-end encryption. By eliminating the need for costly and cumbersome network fax systems, such as fax boards and recurring telephony fees, hospitals can leverage the hybrid cloud to swiftly manage all business-critical fax communications while staying HIPAA compliant.

David Finn
David Finn

David S. Finn, CISA, CISM, CRISC, ISACA professional influence and advocacy committee member, health IT officer, Symantec
Healthcare is undergoing fundamental changes in reimbursement, care delivery models and the technology required to make these changes. Technology and information is no longer an adjunct to the business of healthcare — it is a strategic imperative. This information, however, is among the most regulated and protected information under the law. The data must be shared more widely with more people and organizations, all the while with stricter security and privacy controls. At a high level, the most critical issues facing health IT are:

1. Security and Privacy
Healthcare, historically, has not invested in nor staffed appropriately in terms in of Privacy and Security. Providers and business associates need to catch up with other regulated industries and those targeted for the value of their data.

2. Data Management
The digitization of healthcare has led to the massive collection of data. As healthcare becomes more dependent on this data, the storage, protection, back-up and recovery of the data is critical. It must include disaster recovery/business Continuity.

3. Interoperability and Information Exchange
Affordable Care Organizations (ACO), health information exchanges (HIE) and new care delivery models (home care, remote monitoring and other requirements) will drive information exchange.

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mHealth: Is the Healthcare Market Ready?

DataArt management team, Daniel Piekarz
Daniel Piekarz

Guest post by Daniel Piekarz, Vice President of Business Development, Life Sciences, DataArt.

mHealth is a broad category of healthcare technology including medical, health and wellness applications and devices. The mHealth market is exploding because of the vast interest in the space and a relatively low cost of entry. We are seeing the marketplace grow at a very rapid pace with likely more than 100,000 apps available on the market today.

Why is there so much excitement around the mHealth market? The platform that mHealth runs on has expanded around the entire globe with nearly 7 billion mobile phone subscriptions worldwide. This is equal to more than 95 percent of the world’s population as estimated by The International Telecommunication Union. This 7 billion includes 1.75 billion smartphone users globally, according to eMarketer. The world is more connected today than ever before and this has laid the foundation for the mHealth market to begin its climb into the mainstream.

But is the market ready?

In many ways the excitement in the market reminds me of the excitement that swarmed during the early 90s regarding the Internet. Every company was entering the space, trying all sorts of new business models and many companies were simply copying others trying to get in on the action. Unfortunately, as we saw with the Internet bubble, high levels of excitement around technology without a clear focus on the problem we are trying to solve can cause very expensive mistakes.

While government and patients are pushing for change in healthcare, a survey by PriceWaterhouseCoopers reveals doctors are less optimistic and more resistant to the disruption mHealth holds for their traditional roles. Only 27 percent encourage patients to use mHealth applications to become more active in managing their health; 13 percent actively discourage mHealth and 42 percent of doctors worry that mHealth will make patients too independent, and it seems to be the younger doctors who are the most worried, with 24 percent of them discouraging mHealth use.

The results of the PwC survey reflect what I have seen when discussing mHealth with doctors. The fear that patients will try to diagnose themselves, the fear of a relatively unregulated market and the lack of evidence-based information, a general fear of change.  Yet the same survey states that 60 percent of doctors and payers feel that the wide adoption of mHealth is inevitable in the next few years.

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Cloud-based Services the Limit for Care Coordination

Rodney Hawkins
Rodney Hawkins

Guest post by Rodney Hawkins, general manager, Diagnostic Solutions, Nuance Communications.

Over the past few years, we have seen the healthcare industry shift toward cloud-based services to improve workflow, patient care and access to information. In fact, a 2014 HIMSS Analytics Survey estimates 80 percent of healthcare providers use the cloud to share and store information today. A cloud network allows physicians, referring providers and specialists at many different sites to simultaneously and securely access patient information in real-time on any Internet-connected device to provide urgent care to patients. This technology is changing how information is exchanged to meet the needs of both physicians and patients. Specifically, using cloud-based services for medical image and report sharing can be a game changer when it comes to advancements in quality of care.

Patient care before the cloud

The best way to explain the benefits of cloud-based image and report sharing is to look at life without the cloud. For providers not using this technology, medical images are stored on a physical CD, and the patient is responsible for carrying it from facility to facility – or, even worse, providers rely on couriers and the postal service to ship discs (which takes days and delays patient care). Most physicians will attest that 20 percent of these CDs are lost, forgotten or corrupt. When this is the case, not only is all the information stored on the CD lost, but time and money is wasted having to repeat the imaging procedure.

Josh Pavlovec, PACS administrator at Children’s of Alabama describes the challenges physicians faced to read CDs before the facility moved to a cloud-based image exchange. “In the middle of the night, if a trauma surgeon needed someone to look at a CD that couldn’t be opened properly, that surgeon or a resident, would physically run the patient’s CD down the street, knock on doors and find a radiology resident to view that study; and then run back to their OR and start treating the patient.”

Another challenge arises when a complete profile is not made available to the entire patient care team. For example, if a patient is sent by a primary care physician to a larger hospital for an exam, and the hospital sends the patient to an outside specialist – that specialist will likely not get the patient’s full medical history, and will certainly not receive that information prior to the patient’s arrival. Children’s emergency physician, Dr. Melissa Peters explains, “Having the reading that’s associated with the transferred images is something that’s very helpful to us. When we have a child that’s transferred, our pediatric radiologists interpret the films, and they need the reading from the other facility in order to create a comprehensive report.”

The absence of readily available images and reports creates silos of patient information within healthcare leading to costly delays and repeat testing and, limiting the quality and efficiency of care provided by teams.

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The Power of Predictive Analytics in Healthcare, Told through a Netflix Lens

Dan Ward is VP of revenue integrity at MethodCare, now part of ZirMed.

To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.

Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.

As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.

Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?

As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.

In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.

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The Domino Effect of Bad Physician Data

Miranda Rochol
Miranda Rochol

Guest post by Miranda Rochol, vice president of product and strategy at Healthcare Data Solutions.

The recent DEA schedule change of hydrocodone prescription drugs has critical implications for prescribers, pharmacies and patients – not only for patients who are taking hydrocodone medications for chronic pain, but also for patients who experience new injuries that require short-term pain treatment.

The following scenario depicts how the hydrocodone schedule change can impact all of these stakeholders:

A patient goes to see her primary care physician because she twisted her knee in an exercise class and can barely walk. During the examination, the physician determines that the patient has torn her ACL and will need a referral to an orthopedic surgeon for further examination and treatment. In the meantime, however, the physician is going to prescribe the patient Vicodin, a common pain medication, which has recently been reclassified as a Class II drug under the DEA’s schedule change.

Sounds like a pretty common story, right? But as simple as this scenario sounds, there are multiple challenges that can arise when physicians don’t have the right tools to do their jobs efficiently.

The first potential problem has to do with the referral. The method a physician uses to refer patients to specialists matters – a lot. Paper-based referrals can cause a number of problems, from insufficient information provided to specialists, to lack of timely feedback to referring physicians, to inefficient referral tracking.

Electronic referral management through the use of electronic health records (EHR) solves potential issues with timeliness and tracking. But whom a physician selects to refer a patient to is also critical. In today’s value-based model of healthcare, careful selection and management of physician referrals is integral to improving patient outcomes and reducing healthcare costs. And one of the best ways to maximize physician referrals is to use an accurate physician directory, or database, that contains vital information like location, ZIP code detail, affiliations, areas of specialty, and organizational capabilities.

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Stop Arguing About ICD-10

Jennifer Della'Zanna, MFA
Jennifer Della’Zanna

Guest post by Jennifer Della’Zanna.

The debate rages on, despite the Department of Health and Human Services (HHS) issuing a rule finalizing Oct. 1, 2015, as the final date for ICD-10 implementation. Why? Because they said there would be absolutely no more delays last year. And the year before that. It’s kind of like a parent who doesn’t follow through with consequences in childrearing. If the child gets away with it once, they’re going to try again. I predict rages against the machine until midnight on Sept. 30, 2015.

The Delay

I was in the field, one day into a two-day boot camp, in Connecticut. UConn had just made it into the Final Four, and the hotel bar was filled with revelers watching ESPN. I was in my hotel room, on the phone with my husband because the hotel didn’t have C-Span. He gave me a blow-by-blow count of the votes required until the SGR “doc fix” bill would pass because, at the last minute, the bill had been revised to include language affecting ICD-10 implementation.

If it passed, doctors’ reimbursements would not be cut by 24 percent, but ICD-10 would be delayed by at least a year. My husband is a surgeon, so we had a stake on both sides of the fence … or aisle, I suppose. Of course, it passed — it always passes. But what did that mean for all the people I’d taught in the past months, and what would that mean for the class I had to face the next morning, smack dab in the middle of their training? I expected to see my class members just as disheartened as I was and worried about the energy level of the second training day.

It turns out I didn’t even need to bring cookies. Nobody was disappointed. In fact, there seemed to be a collective sigh of relief. And these were the people I thought were ahead of the curve on implementation.

So, I took a poll:

Did they think people not ready for ICD-10 in 2014 would be ready in 2015?

No.

Did they think people who were almost ready would spend the year getting extra-ready?

No.

So, what did the year gain us? Breathing room?

I say it gained us one thing: Fatigue.

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