Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
When one thinks of the areas targeted for healthcare delivery reform by the Patient Protection and Affordable Care Act (PPACA), Medicare, the largest area for healthcare spending by the federal government, obviously comes to mind. Notably, there are more than 400 Medicare accountable care organizations, and that figure is projected to rise in the coming years.
However, Medicaid is another significant and growing area of healthcare spending that could benefit from reform.
According to the Centers for Medicare and Medicaid Services (CMS), as of February 2015, 70.5 million people—more than one in every five Americans and 25 percent more than the number of Medicare beneficiaries—were enrolled in Medicaid or the Children’s Health Insurance Program, which represents an increase of almost 40 percent from the number enrolled at the end of 2009.
In 2013, the federal government and states together spent $438 billion on Medicaid, with $250 billion (57 percent) covered by the federal government. With 28 states and the District of Columbia expanding Medicaid coverage, in 2015 the federal government will spend $343 billion on Medicaid, an amount equal to 9 percent of total federal outlays and two-thirds of Medicare expenditures. Taking into account funding by the states, well over half a trillion dollars will be spent in total on Medicaid in 2015.
Moreover, spending on Medicaid is projected to eclipse the growth of the U.S. economy over the course of the next decade. The Congressional Budget Office projects the federal government’s spending on Medicaid will reach $576 billion in 2025, a compound annual growth rate (CAGR) of 5.3 percent over 2015 to 2025. That compares with projected a 4.3 percent CAGR for U.S. gross domestic product for the same period.
Although the coverage or access-to-care issue has been partially addressed via Medicaid expansion—with much more work to be done—how to provide high-quality care in a cost-effective manner through Medicaid constitutes the next challenge.
Guest post by Dr. David Whitehouse, chief medical officer, UST Global.
“The Uberization of healthcare” has recently shown up as an expression in blogs and articles. However, each time it seems to possess a different meaning. For some, this phrase summarizes the transformation that happens when there is a deep understanding of the real hopes and needs of consumers, operationalizing them effectively. Facilitated by the latest technologies this concept is making life simpler and happier.
This concept of “uberization” keeps the comfort and concerns of consumers at heart. For others, it hints to a democratization minimizing competency, regulation, and oversight – essential ingredients to maintaining healthcare quality and standards. Some fear that this consumer empowerment will lead to people self-diagnosing, leading to the ultimate detriment of patient health with minimal support or evidence. This also raises major concerns regarding the maintenance of patient privacy. An example is when someone catches an Uber and something bad happening because the driver lacked experience.
What does all of this mean to me? Earlier this year at HIMSS in Chicago, I was looking out over the million dollar booths. I wondered how many of the vendors would remain as powerful or relevant 15 years from now. I also considered the transformation of health delivery where ACOs, PCMHs and new versions of retail health are growing. New approaches to healthcare payment and transparency are forging into the mainstream, enabling consumer empowerment, personalized medicine and cultural sensitivity. It’s all creating new levels of individuation; where we continue to struggle with effective models of behavioral change. Here is where the digitized self is beginning to show the first moves in the health field. From exercise enthusiasts to empowered consumers managing chronic illness, digestibles are being added to wearables to increase the panoply of both individualized and physiologically dynamic data, where social networking and gaming have coupled with crowd sourcing solutions and new insights to create new paths for data to create insights and action.
I was reminded that we occasionally overestimate the cognitive and logical aspects of our humanity with insufficient thought to emotional impact. Sometimes we set the bar too high for the impact disease management could have when patients are classified more specifically, bringing each individual evidence-based advice to alter their behaviors and change that path coupled with an enthusiastic coach. What we had missed was that people have messy, complicated lives with different resources practically and emotionally available both permanently and on a day-to-day basis. People who had emotional lives complicated with depression, anxiety and stress with goals for each day were not necessarily maximizing control of their chronic illness, but rather looking for moments of relief, happiness, and excitement.
I think the true power of Uber is genius. Its power partly goes beyond the world of satisfaction, which is now a major concern in medicine since it directly relates to revenue. Much of the Uber concept comes down to bliss, going beyond the typical expectations that we articulate. Satisfaction manifests when we match experiences to expectations. It goes beyond creating opportunities for moments of joy – it takes away pain points we do not even think about until they occur.
Guest post by Amit Cohen, co-founder and CEO, FortyCloud.
Remote access is changing the practice of medicine – from data collected remotely from newly developed telemedicine devices, to surgery conducted by a surgeon in an offsite location. A smartphone application, currently in development, is set to monitor a user’s voice to detect mood changes for individuals with bipolar disorder. Devices and applications such as these not only improve the quality of care available to patients across the globe, their use also results in exponential growth in the sources and volumes of data. These cutting-edge technologies present new challenges for IT professionals who are responsible for ensuring high availability (always-accessible data), scalability and flexibility for their healthcare organizations.
To enable scalable, high performance from at lower costs, even from remote locations, healthcare and pharmaceutical IT have adopted the cloud. Since cloud data centers can be diversified across the globe, cloud computing provides quick access to globally diverse users.
The cloud also offers the scalability to handle the massive influx of new data generated by new health care applications expected from the implementation of the U.S. Patient Protection and Affordable Care Act (PPACA). The U.S. Department of Health and Human Services (HHS) Stage 3 Proposed Rule, is also likely to result in additional volumes of digital data. This Rule seeks to align the EHR Incentive Programs with other CMS quality reporting programs that use certified EHR technology to promote improved patient outcomes and health.
Therefore, it is not surprising that healthcare cloud computing is forecasted to grow to $9.48 billion by 2020, according a recent study; an impressive increase from the current, 2015 market value of $3.73 billion.
Healthcare is not without its issues. Seemingly, for each source asked what the biggest problem the sector faces, there is a differing opinion on what’s most important. I’m often perplexed by the lack of cohesiveness shown toward the industry’s leading issues, too, and sometimes wonder how many of us could name the most pressing threats to the industry, as agreed upon by the community. There are clear problems – interoperability, lack of transparency, disparate systems working against each other — to name a few. So, in the following series, I’ve asked some insiders for their opinions on health IT’s greatest problems, and as you’ll see, they responses received vary greatly.
Healthcare IT struggles mightily with patient information that is not in the medical record system, but has leaked into other locations in the healthcare organization (cell phone emails, USB drives, employee desks, etc.). Healthcare organizations have moved Protected Health Information (PHI) into HIPAA compliant electronic health records (EHRs) systems, patients maintain electronic copies of their health information, which they give to their different providers as they move between appointments. This “patient distributed information” becomes PHI, with all its associated compliance and legal burdens for the health care organization.
There is liability associated with this, and information governance strategies available that reduce the associated risks. Patient distributed information is present on smartphones, tablets, laptops, and the like are not sanctioned EHR (such as email, file directories, etc.). These devices are not part of the organization’s HIPAA compliant system, and never can be. Most healthcare providers ignore the problem, which eventually leads to catastrophic security failures resulting in patient privacy breaches, and career damaging incidents for the healthcare IT department.
To eliminate the problem, IT needs to look to integrate an information governance framework that can:
Interview employees to understand how they deal with and understand this issue.
Audit, usually done with software systems, to provide objective evidence and quantification of the presence of PHI on your digital systems.
Set specific policies and procedures employees can follow in each and every situation when they come into contact with “patient distributed information.”
Provide raining and review of policies and procedures work.
Automate the policies and procedures with software systems to ensure compliance.
Surveil your digital systems is the best way to monitor and review your program, as well as seek to improve it.
Acknowledge the increasing presence of patient distributed information on your digital systems, and have a plan for how to address it. Look to information governance to establish a strategy and program to address patient distributed information. With the proper policies, procedures, training, and systems in place your organization will be able to effectively handle and mitigate the risks.
Interoperability between healthcare’s disparate systems seems to be the stickiest of wickets, and a Holy Grail that every soul in the sphere is trying to find. Given the number of conversations about the topic, there’s often little discussed about its actual importance. Perhaps this is an assumed measure or an outcome that should be clearly understood as positive, but every relevant aspect of every story should be covered, not simply assumed. Because far better reporters and publications have done a far better job of describing the interoperability issue and its place in the current healthcare landscape, I decided to ask one question of the community, in an search of a foundational answer to: How is interoperability critical to healthcare innovation?
The prospective provided here, from some of healthcare’s most knowledgeable insiders, offers some interesting insight into a topic that seems more or less overlooked in the larger conversation of achieving interoperability or its capabilities.
Rick Valencia
Rick Valencia, senior vice president and general manager, Qualcomm Life Interoperability is the future of healthcare innovation, especially as we move toward an era of connected, team-based care. We need to create platforms and devices that enable the seamless, frictionless flow of data to allow doctors, patients, providers and care teams to collaborate efficiently to make critical care decisions. As care moves from the hospital to the home and more patients are remotely monitored, we need solutions that enable continuous care, informed interventions, and better management of at-risk populations. Without interoperability, we can’t innovate. Without innovation, we can’t improve the health of our nation.
Dave Wessinger, chief technology officer, PointClickCare
Dave Wessinger
Interoperability is critical to innovation in healthcare IT, particularly when it comes to connecting the care delivery ecosystem to provide safer transitions of care between acute and senior care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individuals will be available when they arrive at their new destination. However, this is not always the case. Healthcare providers must invest in an infrastructure and emerging technologies, such as electronic health records and mobile communications, which support seamless transitions; interoperability plays a vital role. Compared to single-purpose or “best-of-breed” software solutions, comprehensive platforms can optimize many parts of the business, from enabling better-connected resident care and documentation, to delivering high quality data insights for financial management and risk mitigation. In the end, this will allow for better health outcomes, help reduce unnecessary hospital readmissions, ensure organizations are financially sound and keep healthcare costs down.
Guest post by Jay Schulman, managing principal, Cigital.
Throughout the past two years, if you’re like me, you’ve had your credit card number stolen a number of times. I’m up to six. In one case, someone purchased a $500 TV with my stolen card information. Yet, I sit here today having lost nothing. Every bank and institution has made me whole. The money that was taken was quickly replaced. While I can complain about the inconvenience, I haven’t lost anything.
The financial industry has the luxury of replacing what was taken. The healthcare industry does not.
Once your medical record is stolen, there is no way for the institution to take that information back. If an electronic medical record (EMR) or MRI system is breached, the information and images are out in the open. While the credit card companies can trace fraud back to a common source, it’s very hard for healthcare companies to figure out who has been breached. That’s why the security of healthcare information is so important.
While many healthcare organizations are HIPAA compliant, that only reflects on their ability to properly control personal health information. It doesn’t necessarily assert that you are secure.
As a healthcare organization, you need to take a holistic approach to secure your environment. This includes:
Understanding your portfolio – what applications and systems are in your environment? Understanding the applications, their development languages, what data they store and access, and other pertinent data points are key to understanding your portfolio. Understanding what needs to be secured is a critical and often missed first step.
Assessing the risk of the portfolio and making priorities. It’s easy to say “anything with personal health information (PHI) needs to be secured.” But, do you understand where PHI is stored or what areas of the network or systems can access systems with PHI? The retail breaches of the past two years have taught us that attackers aren’t always going directly to the critical systems but instead to weak links in the environment. Those weak links can give an attacker access to your data.
Performing a threat model to properly understand those weaknesses. A threat model looks at an environment, who the actors are that can breach your system, and what actions they could perform (steal data or cause a denial of service for example). Given the results of the threat model, you can develop a new ranking of the portfolio.
Determining the best ways to improve the security of the environment. If the organization writing the software is highly outsourced or primarily buys commercial software, assessing their risk is important. Otherwise, how can you be sure that they know how to write secure software? With medical devices, being able to assess the risk and impact of the device to your environment before you put it on your network is essential. Two years ago, many hospitals would assume the device was secure. Today many are starting assume they are not.
Interoperability in healthcare is critical for doctors to coordinate care for their patients and improve their health. However, if physicians are using proprietary software in their offices, interoperability becomes a very difficult and very expensive challenge. Without interoperability in healthcare, doctors cannot guarantee the data they sent to a specialist will be received or interpreted properly. Today, doctors have to rely on fax machines to exchange patient information. This is an outdated and un-secure form of communication to exchange patient information.
At the center of all this is the patient, whose medical records containing their most sensitive information is traversing across fax lines. ELXR Health will change healthcare by giving physicians a new way to coordinate care and exchange information. With the platform, patients can create and manage their medical consents anywhere on a smartphone or tablet. ELXR Health can transform and translate health data into multiple formats; doctors can seamlessly exchange patient information regardless of the EHR software they sent to, or receiving from.
Elevator pitch
The ELXR Health platform is cloud-based engine that translates and restructures electronic health records into a format easily readable by any doctor’s office. We center our solution around the patient by providing them a responsive web application to create and manage their consents. This doctor-patient collaborative system will improve coordination of care systems and dramatically increase patient outcomes.
Founder’s story
Paul Emanuel, HCISPP, is the co-founder and CEO of ELXR Health. Emanuel has worked in healthcare technology for many years as a technician, a systems and security administrator, an EMR consultant and an HIE Engineer. His years of service in health IT enabled him to receive 14 IT certifications, and is a certified healthcare information security and privacy practitioner. He started his first company in 2008 helping rural health clinics adopt electronic health records and connect with state health information exchanges. He came up with his idea for ELXR Health from his years of experience in Health IT. ELXR Health was created to be the solution for doctors and patients to better coordinate care.
Marketing/promotion strategy Behavioral health organizations, managed care organizations, hospitals and private practices are looking for a cost-effective way to exchange patient data electronically while improving patient outcomes while adhering to their state laws. Our engine allows doctors to translate, restructure and validate health data so the data being sent is the data being received.
ELXR Health gives the patient the ability to manage their consents at their convenience from their smartphone or tablet. We also give developers the ability to integrate with our API to improve their software and provide better care systems for doctors and patients.
We are nearly three months removed from the oft discussed ICD-10 deadline, currently scheduled to take effect Oct. 1, 2015. Barring any last-minute shenanigans by those in Washington, there is little do but wait, and prepare as best as possible for the transition to the new code set in the time remaining.
While there remains plenty of activity on Capitol Hill to, in the very least, delay parts of the roll out of ICD-10, there are countless organizations and individuals who are actively lobbying against a change to the 10th version of the International Classification of Diseases. For example, the American Medical Association has been a staunch antagonist rallying its members against the change. And, as recently as May 2015, the Heritage Foundation, with its report titled, “The New Disease Classification (ICD-10): Doctors and Patients will Pay,” made some strong recommendations against it: “While an updated diagnostic system for disease classification might be in order, there are significant costs and trade-offs,” write Heritage authors John O’Shea, MD, and John Grimsley, reported by Healthcare IT News. “To protect practicing physicians and other healthcare workers from such an unfunded mandate, Congress should delink the disparate goals of research and reimbursement, and develop a more appropriate coding system that makes the billing process less, not more, burdensome.
“In the interim, Congress should allow providers to have the choice of continuing to use the current ICD-9 system or adopt the new ICD-10 system until the alternative reimbursement arrangement is complete.”
However, given this level of dissent toward ICD-10, or the level of dissent that’s reported by the major healthcare news organizations, there’s actually a good deal of support for the change in code sets. When asked about moving ICD-10 forward or further delaying it, the responses received by Electronic Health Reporter were overwhelmingly in favor proceeding with the current timeline, and by no small margin. The following comments from some of healthcare’s insiders provide proof of that, and show that there are those among us that want to move on as soon as possible, and put the past to rest.
Dr. Jon Elion
Dr. Jon Elion, MD, FACC, founder and CEO of ChartWise Medical Systems I’m in favor of the transition to ICD-10 this October. The ICD-9 code set no longer provides the level of specificity necessary to adequately account for many of the patient ailments physicians are seeing today. After 30 years, the code set is outdated and cannot describe all of the diagnoses and procedures that have been discovered or created during that time. Many codes have been “lumped” together so that meaningful statistics and data analysis are not possible. For example, suturing the aorta (largest artery in the body) has the same ICD-9 code (39.31) as suturing an artery in the hand, despite the fact that they are vastly different in the resources the hospital expends in supporting the different procedures. Furthermore, delaying the transition again will only serve to prolong the limbo hospitals, medical centers and physicians have been in for the past few years. Waiting until ICD-11 also isn’t an option as the first versions won’t be ready until 2017 at the earliest and it will be years after that before a version is prepared that will work for the complexities of coding inpatient morbidity and mortality. ICD-10 is the best option we have right now to provide the level of detail physicians and coders need to properly convey patient symptoms and diagnoses.”
Keith Eggert, FHFMA, executive vice president and general manager, healthcare, VisiQuate
“In the short term, converting to ICD-10 has been a significant undertaking for the industry. But in the long run, it’s a valuable investment because more specific Dx and inpatient procedure codes can lead to more precise diagnostic, utilization and billing data, which positively affects revenue capture. They can also have a positive impact on clinical outcomes. Fortunately, there are third-party vendors who have solutions that eliminate much of the staff time and expense needed to convert to ICD-10 manually.”
I can honestly say with a resounding yes, I am in support of the ICD-10 transition. At this point, I feel any provider that is not ready for the transition, will never be ready and any further delay will add more burden than relief. I have been teaching ICD-10 since 2011 and I know the providers that I spoke to before the last delay were frustrated with the amount of time and most of all money that was spent only to have it delayed one more year.
Interoperability in healthcare is critical for doctors to coordinate care for their patients and improve their health. However, if physicians are using proprietary software in their offices, interoperability becomes a very difficult and very expensive challenge. Without interoperability in healthcare, doctors cannot guarantee the data they sent to a specialist will be received or interpreted properly. Today, doctors have to rely on fax machines to exchange patient information. This is an outdated and un-secure form of communication to exchange patient information.