Guest post by Shameem C. Hameed, founder of ZH Healthcare.
The past five years have seen monumental changes in the world of healthcare information technology. As 2013 comes to a close, it seems appropriate to look forward to the developing trends for 2014 and beyond and how they will impact vendors, providers and patients.
Open Source Technology Use and Development Will Accelerate
The continuing acceptance and use of open source software is the most important healthcare trend, since it ties directly into every point on this list. Open source software has become part of the healthcare mainstream and is used in many areas of the healthcare industry. Open source software is behind everything from the EHR system doctors use to enter patient data to the web browser or smartphones and tablets patients use to check their records through patient portals. Even the much talked about Healthcare.gov website utilizes open source software.
The benefits of open source development over proprietary software will continue to fuel its expansion over the next few years. Open source software has many advantages for providers and patients, including interoperability, speed of problem resolution, flexibility and more frequent updates.
An example of how open source software provides these benefits can be found in the area of EHR systems. One of the most common complaints by physicians and staff about EHR software is that the software is difficult to use. Now that EHR adoption has become widespread, there is much more thought and resources going into refining the user interface. With proprietary software, the amount of developer resources that can put into refinements may be limited to that one vendor’s resources. With open source software, countless companies and individuals are constantly collaborating to make the software easier to operate and more user-friendly for everyone.
Guest by Michael Charest, vice president healthcare, insurance and financial Services, GMC Software Technology.
Healthcare organizations today are pursuing a wide range of health IT initiatives in the hopes of reducing costs, improving efficiencies and, most importantly, enhancing patient care. While a great deal of attention is being paid to high-profile health IT topics, such as electronic health records (EHRs) and health information exchange (HIE), there are basic aspects of the workflow at healthcare organizations that can also play a key role in driving healthcare efficiencies. One of these is the patient discharge experience.
How well patients are communicated with upon discharge is a leading threat to a healthcare organization’s top-line revenue, as well as an endangerment to the patient experience. With Medicare/Medicaid regulations now making it difficult to collect revenue for a patient’s second visit for the same problem within 30 days, special attention needs to be paid to how well healthcare organizations are preparing the patient when they walk out the hospital door—and at home following their release. Patients need to be able to understand their at-home instructions for post-visit care so they don’t have to return to the healthcare facility for more treatment or instructions, which will negatively impact the hospital’s revenue and the patient experience.
Creating a more effective discharge experience for patients requires providing clear, easy to read discharge instructions. Accomplishing this is not always a simple task given that the instructions typically are compiled from a large set of data feeds, gathered from multiple treating physicians and need to be provided in a language that the patient can understand. Health IT can play a critical role in overcoming these hurdles.
Similarly, healthcare organizations will benefit from considering the archival system in place. It is important to have an archival process that will enable the organization to prove that discharge instructions were complete and comprehensive. This will avoid the potential for losing Medicare/Medicaid reimbursements in the event of an audit. Not having the ability to easily retrieve all relevant records exposes the healthcare organization to avoidable revenue loss.
In the new healthcare ecosystem that is increasingly migrating to cyberspace, who can healthcare consumers rely on? Who in the healthcare service supply chain will prevail? Who will be the next Amazon or Yelp? Chances are it will be the organization that can deliver and mediate a centralized consumer experience – connecting healthcare consumers not only with care and treatment options, but also with pharmacists, labs, therapists, clinics, wellness coaches and other resources along the care chain.
More today than ever before as the care conundrum continues, fewer and fewer crave office visits, hospital stays or trying to reach physicians by phone. When we’re well, we see no reason to visit a physician. When we’re sick we increasingly wait until we’re sicker. And when we’re somewhere in between, we avoid calling because we know we’ll be put on hold. If there were a better way to consume healthcare, most of us would likely take it.
Interestingly, within this conundrum lies an opportunity for the myriad of healthcare players – from payers and providers at one end of the supply chain to wellness tacticians, retailers and mobile tool providers at the other end – to create a sustainable dialogue with healthcare consumers.
According to a recent survey conducted by Purdue Healthcare Advisors, a nonprofit healthcare consulting organization, hospital executives are reluctant to implement ACOs — 46 percent — and they have no plans to implement an Accountable Care Organization (ACO)-like model in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
“This survey has identified a significant need for advocacy and education to support hospitals and help them survive the wave of changes brought on by the Affordable Care Act,” said Mary Anne Sloan, director of Purdue Healthcare Advisors. “Hospital executives are charged with enhancing patient care and managing margins with a shrinking workforce and diminishing patient volumes.”
Hospital executives find ACOs to be unstable and financially risky
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future (46 percent) cited the following reasons:
Why is the challenge of meeting meaningful use Stage 2 much more difficult, and why are many finding it to be a more rigorous certification process? To start, the requirements are more complex, and vendors are facing challenges in building solutions that are truly interoperable – which is the goal that all EMR/EHR vendors are pursuing as they upgrade their software to meet MU2 requirements.
While MU1 required that patient data be shared with patients or other healthcare professionals, MU2 has more in-depth requirements for sharing that data using advanced document architecture. EHR software needs to electronically connect and securely share data with patients, other practices, laboratories, hospitals, etc. Challenges arise for vendors when trying to build software that will easily integrate with other proprietary clinical systems. This means working with those other entities on their time frame. Because of the large number of EMR systems that need access to these entities, prioritization of these interface requests have led to long wait times and in turn, further delay certification progress.
The casualty claim arena involves evaluating and payment of claims for claimants who have suffered from an auto accident or workers’ compensation injury. This side of the health payment continuum has been omitted from the Health Insurance Portability and Accountability Act (HIPAA) as a covered entity.
This means that casualty claim insurers are not required to abide by the standards set forth in HIPAA and that these standards only apply to the health payer. Omitting the ICD-10 in casualty claims from standards does have merit, but when it comes to standardization, all health claims should be adjudicated and paid in the same manner. Why should a provider charge differently and be paid differently when the payer of the claim is not on the health side? This is a question many casualty payers ask and not being part of the standardization only raises the question more.
There is no option for submission of claims by the covered entity to not be compliant by October 1, 2014 with the International Classification of Diseases, 10 Revision (ICD-10). Why is it a good idea to omit the casualty payer from these standards if the majority of health payments are made using this new standard? In addition, if providers are covered entities, then why would the casualty payer not speak the same code language? It’s almost like trying to communicate in a foreign country without the benefit of knowing the language.
Guest post by Ellen Derrico, director of global market development, life sciences and healthcare at QlikTech.
Electronic health records (EHRs) are getting a lot of attention these days, but amid the hype there are skeptics out there arguing that the EHR is old news. However, I’d like to argue that the EHR is not dead; in fact, it’s growing up.
Today’s EHRs are so much more than a digital version of a paper chart. They are evolving and getting more sophisticated. One of the most promising and exciting developments of this is the integration of data discovery and analytics to analyze and compare EHR data. Where business intelligence (BI) was once used primarily to analyze data from a business perspective – revenue cycle management, finance, supply chain management – it’s increasingly being used to analyze patient data, physician performance, facility and utilization – all to improve clinical outcomes.
In healthcare, data discovery and analytics offer the possibility of improving patient care by synchronizing the resource planning with patient logistics and allowing physicians and nurses to focus on improving performance. With BI technology medical practitioners can look across data from different people and locations to support decision making not only for their individual patients, but also for larger patient populations. As a result, practitioners can improve patient outcomes and population health.
Guest post by Bettina Experton, MD, MPH, president and CEO, Humetrix.
Mobile technology core to HIT implementation, a silent revolution which took place on September 23 this year when the HIPAA omnibus rule took effect, giving Americans the right to obtain electronic copies of their health records. But how can this new right be exercised at scale to transform healthcare nationwide? How do we help patients better coordinate their care and ensure their safety by getting their health records in their own hands?
The scalable computing device of choice in the hands of many is a smartphone, now owned by more than 50 percent of the population, and for many the only computing device they use daily to access information on the Internet. Clearly, electronic access to health records would be best provided on the very mobile device most of us carry at all times, especially when navigating a complex health care system with multiple and dispersed providers.
Electronic copies of health records on CDs or flash drives are not only tools of the past, but also perpetuate the barriers and complexity most of us have to face when requesting copies of our records. Desktop and portal-only solutions are also not the optimum approach to consumer-directed health information exchange, since these cannot be available at the point of care where patients need to share their medical history in the most convenient and expedient way. Mobile is, therefore, central to health information exchange policies and new care delivery models built on patient-centered care, and should not be an afterthought or secondary implementation to dated patient portal systems.
