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CONTENTS
January 2015 Vol. 36, No. 1
6
COLUMNS
2
Viewpoint
Some medical societies would make
lousy students
By Jason Free, Features Editor
24
Thought Leaders
Viewing patient data holistically
By Cristine Kao, Global Director,
Healthcare Information Solutions,
Carestream
4
Industry Watch
.
What CISOs are up against in 2015,
top health technology hazards,
HIT awards winner, tablet-based
ultrasound
18
Compliance
Simplifying RAC audit issues
By Bob Zimmerman,
Solutions Analyst, Hyland
20
THINK TANK
6
RSNA Show Recap
Dose monitoring, patient records,
next-gen PACS, 3D imaging
22
Solutions Guide: ICD-10
5 steps to improve documentation
accuracy, conversion costs, Best
in KLAS consultants, how your
readiness stacks up, products
and services
Clinical Data Analytics
Solving data analytics delivery
problems
By Rick Dana Barlow, Editor-at-large
10
Mobile Health
Healthcare IT’s future
Is it mobile and wearable?
By Rick Dana Barlow, Editor-at-large
EXPERT Q&A
20
12
EHRs
The questions you should ask about your
EHR/EMR
Expense, security, integration and EHR 2.0
CASE STUDY: Laboratory Information Systems
16
LIS trends for 2015 and beyond
How will the laboratory information system adapt
to the restructuring of healthcare?
By Kim Futrell, MT (ASCP), Products Marketing Manager, Orchard Software
www.healthmgttech.com
HMT201501-TOC_DUM_EB.indd 1
HEALTH MANAGEMENT TECHNOLOGY
January 2015
1
12/15/14 5:57 PM
1
Photo Credit: XXX
DEPARTMENTS
● Viewpoint
GROUP PUBLISHER
Some medical societies
would make lousy students
By Jason Free | Features Editor
A
2
.
s an educator, I encountered countless explanations by my students for
not handing in their assignments on time.
“I left it at home. I’ll bring it in tomorrow.”
“It was too confusing for me to do on my own. Will you explain it again?”
“My computer died. Can I get an extension?”
I never heard the infamous, “My dog ate my homework,” but many of the
excuses posed to me during my 15-year teaching career were just as weak and
unimaginative.
These memories of unmotivated, unfocused students came rushing back
when I learned the Texas Medical Association (TMA), our nation’s largest state
medical society for physicians, is asking its nearly 50,000 members to write
Congress requesting another two-year delay to the implementation of ICD-10.
TMA President, Dr. Austin King, says in an open letter on the TMA website,
“It’s imperative that you contact your representative today and explain how you
cannot afford the cost and disruption of ICD-10 implementation to your business, especially now, when you are buried in myriad other bureaucratic burdens.”
Really? So if there weren’t “other bureaucratic burdens” on physicians, then
ICD-10 would be implemented in a timely fashion and without objection? I
doubt it. Considering that ICD-9 utilizes 13,000 diagnosis codes and ICD-10
possesses 68,000 codes, I have to call “nonsense.” The TMA President comes
across as the stereotypical, slacker student in the back of the classroom trying to
stage a revolt against his teacher.
“How’s this going to help any of us in real life? Do you know how much work we
already have to do for [insert subject name]?”
These types of histrionics reveal a mindset that exists within too many
healthcare organizations, and classrooms, across America. When faced with the
opportunity to accept and transition new information into our lives, we instinctively spend our limited time and energies futilely resisting the inevitable: change.
Rather than rolling up your sleeves to incorporate the more specific, often
more relevant, codes of ICD-10 (nearly 30 years after their initial release), some
want you to write to Congress demanding yet another extension.
Considering ICD-10’s history, chances are good that another delay may occur, but what good for our industry will come of it? Such a delay would push
the implementation of ICD-10 back to 2017, the same year the World Health
Organization is set to unveil its final version of ICD-11 codes. Many seem fine
with the notion of staying behind a grade level while the rest of the class moves on.
Even worse, based upon its current stance, it’s safe to assume that some healthcare
organizations plan to work just as hard to push off ICD-11 as well. In the near
future, won’t physicians still be “buried” in bureaucracy? Won’t the financial
demands to implement ICD-11 be just as great as those associated with ICD-10?
Maybe a better question to ask is how will we be able to ensure the accuracy
of hospital outcomes, performance reports and insurance payments with codes
dating back to the 1970s?
Our new value-based care system cannot mature if we don’t value the basis
of our care, which is precise documentation and clear communication. Unfortunately, it seems some medical societies will never spend the time needed to
learn this important lesson.
2
January 2015
HMT201501-Viewpoint FINAL.indd 2
HEALTH MANAGEMENT TECHNOLOGY
Kristine Russell
[email protected]
EDITORIAL
Features Editor Jason Free
(941) 388-7050 ext. 124
[email protected]
Associate Editor Mike Foley
(941) 388-7050 ext. 114
[email protected]
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[email protected]
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CareGroup
Healthcare System,
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Elsevier
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Department of Health
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3
● Industry Watch
COMMENTARY: WHAT CISOS ARE UP AGAINST IN 2015
Happy Old Year?
By David S. Finn, CISA, CISM, CRISC, Health IT Officer, Symantec Corp.; and
George W. McCulloch Jr., MA, MBA, FCHIME, CHCIO, Executive VP, Membership
and Professional Development, CHIME
David S. Finn
4
.
’Tis the season for wishing others a Happy New Year. If you happened
to have celebrated the holidays with a healthcare Chief Information
Security Officer (CISO), they were probably relieved to see 2014
come to a close. The year 2013 was the “Year of the Mega Breach,”
and 2014 may as well have been the “Year of the Advanced Threat”
– from Heartbleed to Regin to the “Sony-pocalypse.”
So as 2015 kicks off, what visions are dancing through a CISO’s
head? Today, we have more of everything … good and bad. There are
more security frameworks, legal/regulatory requirements, checklists,
security management, executive reporting and best practices. But
information security events and data breaches continue at a staggering rate.
Here is what healthcare CISOs are up against in 2015:
• Poor visibility into the data and the risk posture of the overall
environment – changes happen too fast, and a risk-based approach
is best, not a checklist.
• Lack of understanding by individual organizations of what
security is and requires – CISOs are now being asked to provide
security reporting to senior leadership (even Boards), but making
it meaningful to business leadership is a real challenge.
• Security, despite a lot of talk and media coverage, is not the priority for providers dealing with a lagging budget and resources to
implement security initiatives.
• Risks in mobility, medical devices and patient engagement need
special assessments and resources.
• Addressing culture effectively and making security a business
problem. Ultimately, the problem isn’t just technology – it’s people
and process. It has to be a team sport.
George W. McCulloch
This is the year to move from compliance to assurance.
Here are the leadership challenges for CISOs in 2015:
• Understand the needs of the business.
• Have the security knowledge and skills to match the demands of
the business and the threats to it.
• Understand, define and communicate critical success factors for
information security from a business perspective.
• Learn to manage real risks, prioritize risks and document the plan
to address them.
• Drive process change, across the organization, in collaboration
with other business leaders.
• Think and communicate about both security and privacy.
• Have a plan, and communicate in terms that the customer understands.
Finally, CISOs need to demand uniform standards. “Reasonable
and appropriate” doesn’t work as a governance standard to guide
investments in security, privacy and risk management. Until we set
a minimum standard, allowing everyone to do their own thing puts
us all at risk, especially given how interconnected and interdependent
we’ve become.
For healthcare CISOs, is that cup of New Year’s punch filled with
honey or hemlock? Let’s make it the sweet stuff.
Finn and McCulloch are leaders of the newly formed Association for
Executives in Healthcare Information Security (AEHIS), the College of
Healthcare Information Management Executives (CHIME) organization that represents chief security officers (CSOs) in the healthcare setting.
Learn more at http://cio-chime.org/aehis/.
MOBILE IMAGING
Tablet-based ultrasound shines as emergency tool
In a first-of-its-kind field trial that began July 1, 2014, six emergency
services vehicles in the Dallas-Fort Worth metropolitan area have
been equipped with Samsung tablet-based ultrasound systems to
provide real-time imaging of on-scene trauma patients back to
clinicians in hospital facilities.
The wireless transmission of ultrasound
images has enabled
medics and/or doctors at Texas hospitals
to positively identify
internal bleeding/fluids, resulting in faster
treatment upon patient arrival at the ER.
Medics have also used
the Samsung PT60A
4
January 2015
HMT201501-IndustryWatch MECH JF.indd 4
ultrasound system
to detect heart
m ov e m e n t o n
cardiac patients
presenting no
pulse. While the
existing protocol
has been to contact their medical director to determine whether to
cease resuscitation efforts, in several instances medics have continued
treatment based on the ultrasound information, resulting in return
of spontaneous circulation and eventual patient discharge.
The tablet ultrasound rides along in emergency services vehicles
at the Bedford, Hurst and DFW Airport Fire Departments. Ultrasound images are transmitted wirelessly from the PT60A to doctors
at JPS Health Network through Trice Imaging’s mobile encryption
and image management system. Wireless image transmission to the
medical director takes as little as 30 seconds.
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 2:04 PM
EHRS
Truman Medical Centers wins two big HIT awards
If you are looking for advice on integrating electronic health record (EHR) technology to produce measurable patient-outcome
and safety improvements while bettering clinical workflows and
the bottom line, Truman Medical Centers (TMC) in Kansas
City, MO, is the place to find some real answers. TMC was recently named the recipient of two prestigious health information
technology (HIT) awards: the CHIME/AHA Transformational
Leadership Award and the 2014 HIMSS Enterprise Davies Award.
The TMC organization comprises a pair of not-for-profit
acute-care hospitals with 600 total beds, more than 50 outpatient
clinics, a behavioral health program, the Jackson County health
department and a long-term care facility. The organization provides 11 percent of all uncompensated care in the state of Missouri at a cost of $130 million, so cost avoidance through clinical
improvement is crucial.
The CHIME-AHA Transformational Leadership Award,
sponsored by the College of Healthcare Information Management Executives and the American Hospital Association, honors
an organization that has “excelled in developing and deploying
transformational information technology that improves the delivery of care and streamlines administrative services.” The award
was given to the organization’s CIO and CEO: CHIME member
and TMC’s Senior Vice President and CIO, Mitzi Cardenas, and
the recently retired TMC President and CEO, John W. Bluford.
TMC is a participant in the Partnership for Patients, established by the Centers for Medicare & Medicaid Services (CMS)
to make hospital care safer, more reliable and less costly. The
organization has also launched Q6, “Quality to the Sixth Power,”
which led to the formation of multidisciplinary committees to
drive quality improvement across clinical workflow, IT and business processes using data from the organization’s EHR.
Using data from and the capabilities of its Cerner Corp. Millennium EHR system, TMC has been able to improve a variety
of clinical processes:
• Using real-time EHR data and order sets, and integrating
pharmacists into the care team, has reduced adverse drug events
(ADEs), saving the system money and improving professional
satisfaction for pharmacists.
• Developing a data-driven approach to develop protocols for
moving patients has reduced the prevalence of healthcareacquired pressure ulcers (HAPUs) by 78 percent.
• Creating a clinical decision support (CDS) system for hospitalassociated venous thromboembolism (VTE) enabled clinicians to make informed decisions at the point of care. In the
27 months after the VTE CDS was implemented, some 48
incidents were headed off, 800 patient days were eliminated
and approximately $400,000 in costs were avoided.
The Davies Awards program, sponsored by the Healthcare
Information Management Systems Society (HIMSS), “promotes
EHR-enabled improvement in patient outcomes through sharing
case studies and lessons learned on implementation strategies,
workflow design, best practice adherence and patient engagement.”
Davies Enterprise Award recipients are HIMSS EMR Adoption
Model Stage 7 and 6 hospitals and healthcare delivery organizations that have demonstrated significant sustainable improvement
of patient outcomes by using EHRs and IT while achieving return
on investment (ROI).
The Davies Awards program noted that TMC’s EHR-enabled
automated interpreter requests and streamlined workflow enabled
www.healthmgttech.com
HMT201501-IndustryWatch MECH JF.indd 5
a more personalized
care experience for each
unique patient while
providing the correct
care in the fastest time
possible. The program
also cited the CDS system for VTE prevention
as providing TMC with From left to right: CHIME Board
Chair Randy McCleese, CHIME Board
significant savings.
The CHIME award member and Children's Medical
Center of Dallas VP/CIO Pamela
was presented at the Arora, Truman Medical Centers SVP/
CHIME14 Fall CIO CIO Mitzi Cardenas, and CHIME
Forum in San Antonio, President and CEO Russ Branzell.
Texas, on Oct. 31. TMC
will be recognized for the 2014 HIMSS Enterprise Davies Award
at the 2015 Annual HIMSS Conference & Exhibition, April 1216, 2015, in Chicago.
Sources: CHIME, HIMSS
PATIENT AND WORKER SAFETY
Top 10 health technology
hazards for 2015
.
Need a guide to help prioritize
technology-related safety initiatives
for your hospital in the new year?
ECRI Institute has you covered.
The independent nonprofit that
researches the best approaches to
improving patient care has released
its annual Top 10 Health Technology Hazards report to help
hospitals reduce technology-related risks. This year, the focus is on:
1. Alarm hazards: Inadequate alarm configuration policies
and practices;
2. Data integrity: Incorrect or missing data in electronic health
records and other health IT systems;
3. Mix-up of IV lines leading to misadministration of drugs
and solutions;
4. Inadequate reprocessing of endoscopes and surgical instruments;
5. Ventilator disconnections not caught because of mis-set
or missed alarms;
6. Patient-handling device use errors and device failures;
7. “Dose creep”: Unnoticed variations in diagnostic radiation
exposures;
8. Robotic surgery: Complications due to insufficient training;
9. Cybersecurity: Insufficient protections for medical devices
and systems; and
10. Overwhelmed recall and safety alert management programs.
ECRI’s report is available as a free download. Each hazard
includes an overview of the issue and recommended action steps
to aid healthcare facilities in their efforts to maintain a safe environment for patients and healthcare workers. Get the full report
at www.ecri.org/2015hazards.
HEALTH MANAGEMENT TECHNOLOGY
January 2015
5
12/15/14 2:04 PM
5
● Think Tank: Clinical Data Analytics
By Rick Dana Barlow, Editor-at-large
Following several years of intense debate and industry
saber rattling, healthcare reform became the law of the
land, hinging on personal and professional mandates as
well as copious use of electronic capabilities for improved
access, data collection and analytics.
6
HMT: Clinical data analytics are used to
measure trends in disease prevalence,
the effectiveness of care management
programs and identifying population
risk profiles. How much progress have
healthcare organizations made in these
areas within the last year?
.
Foster: Progress in this area has been slow. Some
providers are dealing with EMR and HIS that
don’t share data well with systems from other
vendors, limiting their ability to have a truly full
view of the populations for which they are taking on risk. Additionally, data analyst and data
scientist shortages are impacting the ability of
healthcare organizations to leverage their valuable
Tina Foster,
data assets for transformation. A survey published
R.N., BSN, MBA,
Vice President,
[in early 2014] showed that the largest healthcare
Business Advisor
organizations are concerned about their ability to
Services, McKesson
conduct the deep analysis needed under valuebased reimbursement and population health management, both
from a technology and a talent standpoint. However, the mid- and
small-sized providers think they are well prepared. This suggests
that the mid- and small-sized providers may be underestimating
the complexity they are facing.
Keegan Bailey,
Vice President,
Collaborative Care
Strategy, NextGen
Healthcare
6
Bailey: Progress has been made, but there is a long
way to go. This would be an easier question to
answer if there was a common definition of what
constitutes “clinical data.” Unfortunately, the
market is overwhelmed with a perspective that
claims data is clinical data and can have the same
impact. Claims data alone cannot. Healthcare
must progress beyond this.
Still, the market relies too heavily on quality
measures (sometimes claims-driven, sometimes
January 2015
HMT201501_ThinkTank-ClinicalData.indd 6
Under the auspices of President Obama’s healthcare
initiatives and finally reaching predecessor President Bush’s
electronic health record deadline in 2015, is the healthcare
industry where it was envisioned? Where did it go right?
Where did it go wrong?
To examine the healthcare industry’s progress to date with
clinical data analytics, Health Management Technology reached
out to a variety of industry experts to share their insights.
EHR-driven) that are not true outcomes and really only indicators and
proxies for true outcomes. Healthcare still struggles to measure outcomes that really matter in business, which are a sense of wellness or
wellbeing, functionality and functional status, time to return to work,
and activities of daily living (ADLs) and quality of life, for example.
These true patient-reported outcome measures are critical inputs to
creating a local and trusted risk model at the health-system level.
Yet incremental progress has been made in the march toward ideal
value, as demonstrated by publicly reported Medicare Shared Savings
Program (MSSP) results and an increase in the number of public
and commercial value contracts. Unfortunately, even with these two
examples there is still more work to do on measuring what really matters to healthcare consumers and creating real value in the business.
Aminzadeh: There are several crucial data characteristics that ultimately determine how we can
develop effective clinical analytics capabilities.
These characteristics include, but are not limited to:
• Complete patient profile: Do we have access
to 100 percent of healthcare data for a given
Saeed Aminzadeh,
individual across various healthcare settings?
Chief Executive
• Comprehensive clinical and cost information:
Officer, Decision
Point Healthcare
Do we have access to useful clinical (EMR)
Solutions
and cost information?
• Timelines: How quickly can we have access to data?
• Population perspective: Do we have access to data for all individuals for a given population?
• Data standards.
• Methodology.
Heath plans were pioneers of clinical data analytics because
of their access to complete patient claims history for the entire
population. However, historical claims data lack clinical depth and
timeliness. On the other hand, earlier versions of clinical workflow
tools (such as EMRs) lacked effective analytical capabilities, and
as a result, the development of analytical capabilities in clinical
settings was significantly delayed.
Historically, clinical data analytics has evolved into two disparate analytical silos:
Continued on page 8
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 4:49 PM
.
INFORMATION SYSTEMS. MOBILE TECHNOLOGY. PATIENT DATA.
ALL CONNECTED TO HELP
TRANSFORM HEALTHCARE.
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HMT201501-AD Verizon.indd 7
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7
● Think Tank: Clinical Data Analytics
Continued from page 6
8
.
• Point-of-care perspective: This focuses on clinical settings and
supporting clinical decision making at the point of care.
• Administrative perspective: Population-based analytics focuses
on organizational settings and supporting administrative decision
support, population-based health and program management.
Over the past several years, we have managed to overcome
many of the structural and technology barriers (i.e., connectivity, lack of analytical capabilities and data access) to effective clinical analytics via changes in reimbursement policies,
financial incentives, regulations and advances in informatics.
These improvements have intensified over the past 12 months,
allowing organizations to integrate both point-of-care and
administrative perspectives in a comprehensive set of clinical
analytics. For example:
• Disease registries have become a common functionality for most
clinical and population health management tools, and the accuracy and speed of these registries has improved significantly.
• The development and availability of clinical outcomes is shifting
the focus of program evaluation efforts from using process-ofcare measures to true clinical outcomes.
• Analytical advances, such as the deployment of machine-based
learning algorithms and Big Data techniques, are making the
deployment of real-time predictive models for populations
and individuals feasible, shifting the focus from retrospective
to prospective and predictive.
• A new generation of clinical analytics capabilities designed
to understand patient behaviors is enabling organizations to
improve patient engagement and increase adherence. These
capabilities assess a member’s clinical, utilization, psych-social
and consumer profile in the context of their engagement with
the healthcare ecosystem and provide guidance on what the
healthcare organization can do to address the member’s specific
barriers to engagement.
HMT: What strategies and tactics will
it take for them to progress even more
in 2015?
Foster: There are three keys to making progress relative to healthcare analytics:
• Data discovery tools that help end users explore data for root
causes and unique correlations that might be missed in typical
reporting. These tools also help end users visualize the story that
the data is telling them for greater impact and understanding.
• Enterprise data governance. It is imperative that healthcare organizations move analyses out of individual departments and into
an enterprise governance structure so that full organizational
impact can be assessed through the same data set for every part
of the organization.
• Expert consultants with technology, analysis, change management and healthcare expertise. With talent shortages and complexity as key issues related to healthcare analytics, consultants
are critical to a healthcare organization’s success. Additionally,
all of the analysis in the world cannot create impact unless
changes are made based on the stories the data tell. Experts can
help guide change in resistant organizations.
8
January 2015
HMT201501_ThinkTank-ClinicalData.indd 8
Bailey: More important than measuring trends in disease prevalence,
care management effectiveness and identifying population risk profiles
is taking a broader approach and focusing on value as a network. This
is required in order for healthcare organizations to make more progress
in 2015. Real value is equal to meaningful outcomes over the true
cost of care, where meaningful outcomes are not proxies and costs
are not charge-based. Value is also about creating high-functioning
teams across the care continuum focused on: key disease and prevention programs, meaningful outcomes for every patient, true costs in
support of comprehensive episodes of care, integrating care across all
settings, clinical network growth and optimization, and implementing
enabling technology.
One of the biggest challenges in meeting value objectives is having all essential and longitudinal data. There are business, clinical and
technical aspects to this challenge. On the business side, data-sharing
agreements and resources are needed. On the clinical side, validation
and buy-in are both key. Finally, on the technical side, many organizations rely too heavily on subsystems for measurement and monitoring.
Enterprise data modeling is essential. Most organizations are just beginning to recognize this need and implement central data repositories for
their operational data needs and enterprise data warehouses for their
analytic needs supporting their health system.
Aminzadeh: Organizations need to continue to:
• Eliminate or address structural barriers such as linking additional,
disparate and member-centric data sources.
• Invest in emerging analytical and Big Data techniques such as the
ability to use both structured and unstructured data sources.
• Develop and deploy analytical methods that can address emerging
analytical fields such as patient engagement and behavioral analytics.
• Learn how to take advantage of non-traditional data sources such
as social networks, wearables, consumer data and mobile apps.
While claims and/or clinical data provide a rich view of a member’s
utilization patterns and clinical history, other data sources provide a
different and very telling view of a member’s behavior. For example,
call-center data may provide a view into a member’s engagement with
the health plan; consumer data may provide a view into a member’s
interests, buying patterns and household structure; and physician data
may provide insights on a member’s relationship and proximity to their
doctor. All these data sources can work together to provide insights into
the patient that go well beyond traditional clinical assessments, and
they can provide important clues into a member’s barriers to health.
HMT: Collecting claims-based data,
which highlight actual utilization, as well
as clinical data, which focus on individual
and collective physiology, may not be
enough without integrating the two. How
successful have healthcare organizations
been with this integration, and what will it
take to drive them in 2015?
Foster: Some organizations are being extremely successful in integrating claims and clinical data to impact patient and financial
outcomes. These organizations have implemented technology
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 5:58 PM
tools that can consume multiple data sets from virtually any
source, and have implemented enterprise-level data governance.
Organizations that keep data analysis at the departmental level
will progress more slowly (or not at all) as department heads
choose data that meet their objectives rather than setting objectives based on the story that an enterprise-level, single-sourceof-truth data set tells.
Bailey: Healthcare is just scratching the surface of the possibilities
here. Some larger challenges include:
• What does “integration” mean? The audience for the analysis
is important to consider. Staff that interacts with patients on
varying levels require actionable outputs from analyses to close
the loop, whereas executives and business intelligence teams
require an ability to look for patterns and trends in data.
• Claims and clinical data are insufficient to model value. Cost
and outcomes data must also be included. Cost data require
a data-driven approach to measure and monitor true cost.
Outcomes data requires instruments such as those from the
International Consortium of Health Outcomes Measurement
(ICHOM) and Patient Reported Outcomes Measurement
Information System (PROMIS) and must be automated to
be used for a true outcomes analysis.
The real focus for data integration should be on using all data
possible to tackle the huge waste in healthcare while improving
Audit Chaos
outcomes. This must be a core business focus of health systems
as it is a primary concern for all payers and the impetus driving
value-based contracts. Over $700 billion spent on healthcare annually is considered waste (overuse, misuse, variation, inefficiency,
harm, etc.). Waste is spending that could be eliminated without
harm or reducing quality.
Aminzadeh: The integration of clinical (i.e., EMR, biometric
devices) and non-clinical (claims, consumer, service) data is
critical to developing and deploying effective clinical analytics
capabilities. The degrees of success vary significantly across various healthcare organizations and, unfortunately, the majority
of healthcare organizations have been marginally successful in
integrating claims and clinical data to date. That being said,
I’m optimistic about incremental improvements in this area
in 2015 and 2016. There have been an increasing number of
significant and in-depth collaborations between health plans and
health systems, which has necessitated collaborations for data
sharing and data integration. Until recently, there has not been
a strong and compelling business case for this type of integration. However, because of changing reimbursement policies,
emerging delivery models, revenue sharing and at-risk business
relationships, there’s a greater need to operate as transparently
as possible, while also using the richest data sources to positively
HMT
manage patient health.
vs.
Audit Relief
All audit requests are
centralized through HealthPort.
High volumes of audit
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other is doing.
DEPT.
DEPT.
B
A
HealthPort best practices are used to
process requests quickly and efficiently by
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DEPT.
D
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You will have peace of mind with:
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Secure, fast, electronic record receipt and delivery.
Elimination of third-party vendors.
800.737.2585 | healthport.com/auditrelief
www.healthmgttech.com
HMT201501_ThinkTank-ClinicalData.indd 9
HEALTH MANAGEMENT TECHNOLOGY
January 2015
9
12/15/14 4:50 PM
.
9
● Think Tank: Mobile Health
Healthcare IT’s future
Is it mobile and wearable?
By Rick Dana Barlow, Editor-at-large
10
.
When people share relevant health data and information – including the patients from whom the data originates – they may be
better prepared to make improved care and treatment decisions.
However, when you grant more people access to the data pool
you either beef up security measures or suffer the consequences.
These points are especially vital relative to mobile and wearable
medical devices.
While 2014 could bear the label “year of the data breach,”
it also could carry the moniker “year of mobile access and
HMT: In what specific ways
can mobile devices improve
clinical operations and
financial operations for a
healthcare organization?
Justin Lelacheur: The
enhanced mobility afforded with mobile
devices has the potential to improve clinical
operations as providers
adopt clinical referJustin Lelacheur,
ence and decision supProduct Manager,
port applications deEmerging Markets,
McKesson
signed for these new
Managed Services
medical devices. As
these applications are adopted, improvements in rounding and charting
can be found where the application
improves but does not disrupt existing
workflows. From the financial operations perspective, where charting and
document deficiencies can now be
completed while mobile, improvements
in revenue cycle can be achieved and
shorten billing cycles.
10
January 2015
HMT2014_ThinkTank-Mobile FINAL.indd 10
convenience.” Balancing this qualified need for access
against shielding access from unqualified intruders continues to be a struggle for healthcare information technology
executives. Accomplishing either is hard enough; achieving
both through a strategy of integration not only is a science
but an art form. Where are efforts going right? Where are
efforts going wrong?
Through a pair of industry experts, Health Management
Technology examined the progress of mobile health.
Tom Giannulli: Mobile
devices can help improve clinical operations
and create cost efficiencies in many ways in
healthcare businesses of
all sizes. Using mobile
Tom Giannulli, M.D.,
devices allows providers
MS, Chief Medical
to have access to clinical
Information Officer,
Kareo
decision support tools
to check drug interactions and review disease-specific information while at the point of care or from
remote locations. Whether they are individual apps for things like e-prescribing
or a full electronic health record, mobile
devices provide more flexibility while
helping to reduce errors and the need to
submit repeat tests or prescriptions.
When using a fully mobile electronic
health record (EHR), providers can go
one step further and truly practice headsup medicine. They can look the patient
in the eye and have a conversation while
using intuitive tap and swipe to document important information. They can
also show the patient illustrations, graphs
and education in the moment by simply
flipping the device around. Doctors who
use technology like this properly can
HEALTH MANAGEMENT TECHNOLOGY
fully engage patients and find higher
levels of patient satisfaction. By reducing
errors, repeat testing, phone calls around
prescriptions and follow-up questions,
practices save time and money. There is
also some indication that these physicians
are less likely to be sued and may eventually see lower malpractice premiums. New
research also suggests patients are more
loyal and more likely to switch to physicians who use modern technology like an
EHR, patient portals, text reminders and
other tools. As a result, these providers
may see increased panel size and more
overall visits.
HMT: What are some key
mobile device access and
integration mistakes that
hospitals make?
Lelacheur: Two key mistakes that are
common are improper security practices and the introduction of new mobile
applications that do not complement
current clinical workflows. As far as
www.healthmgttech.com
12/15/14 3:23 PM
security is concerned, it is often found
that many hospitals lack proper security
assessments of their mobile policies to
restrict [personal health information]
data storage and transmission on these
new mobile devices. It is often found
in initial release versions that mobile
applications have limited feature capabilities and a user interface design and
experience that result in an inability to
free the clinician from the traditional
desktop application and disruption to
current workflow efficiencies.
Giannulli: The biggest mistake is choosing solutions that aren’t designed for
mobile, such as when a vendor places its
existing technology on a mobile device.
That doesn’t make it truly mobile. It is
important to choose mobile applications
that are designed for mobile use.
5 best practices for deploying/expanding
BYOD programs
Dell recommends that companies carefully align their bring-your-own-device
(BYOD) program with data security and privacy regulations to avoid any
pitfalls concerning compliance. While BYOD initiatives can be great for
employees, they often pose a potential nightmare for employers as failure to
comply with regulations can result in companies suffering financial penalties,
litigation and damage to their reputation. Dell advocates the following five
best practices for protecting regulated data and employee privacy.
Best Practice No. 1: Identify, confirm and protect
regulated data
Start by identifying all regulated data and then determining which data will
be generated on, accessed from, stored on or transmitted by BYOD devices.
Once regulated data has been identified, organizations can decide on the
best strategies for protecting it and ensuring compliance. Heavily regulated
data may require a multifaceted approach, including a combination of:
• Encryption to keep data safe in the event of a breach;
• Secure workspaces to keep regulated data from commingling with
personal information;
• Virtualization for heightened IT control of applications and the data
they access;
• Data leakage protection (DLP) to control which data mobile employees
can transmit through BYOD devices and to prevent the transfer of
regulated data from a secure app to an insecure app; and
• The ability to remotely wipe data from a device, if necessary.
Best Practice No. 2: Control access to data and
networks
HMT: How do “wearables”
(e.g., body-worn sensors,
scanning/tracking devices)
fit into this mix?
Lelacheur: It is still the early days for
mobile body-area sensors within the
clinical setting. Thanks to mass market adoption of consumer wearables,
we do see a future where the fusion of
both clinical and consumer body sensors can yield a more complete picture
of a patient’s diet and wellness, but
more advanced clinical, as well as consumer health sensor capabilities, will be
needed to make a significant impact to
modern diagnostic practices.
Giannulli: There is real potential for
wearables to help improve engagement
and wellness for patients. What this really requires, though, is for physicians and
patients to work together. Physicians
should prescribe devices based on what
can help the patient and the provider to
better manage a given disease. This will
require vendors and physicians to work
together to integrate devices with other
technology like EHRs. Without good
coordination, the patient-submitted
data may not get reviewed or be a factor
in medical decision making for a busy
provider.
HMT
www.healthmgttech.com
HMT2014_ThinkTank-Mobile FINAL.indd 11
.
Deploy solutions for monitoring, tracking and controlling access rights
according to a user’s identity, device type, location, time of access and
resources accessed. In addition, prevent employees from accessing data
on unsecured (or jailbroken) devices or transmitting unsecured data using
their own device.
A complete solution for identity and access management (IAM), firewalls
and virtual private networks (VPNs) can protect data and networks. It
also can help control administrative complexity and support numerous
device types, operating systems, user roles, data types and regulatory
requirements. The solution should make it simple for authorized users
to access information and resources from personally owned devices to
maximize mobile flexibility and productivity.
Best Practice No. 3: Secure devices
Demand extra security for employee-owned devices. As a first step,
require a password to access devices or the secure workspaces on
them. In addition, a smartcard reader or fingerprint reader can
prevent unauthorized access to tablets and laptops if they are lost,
stolen or inadvertently used by family or friends.
Best Practice No. 4: Develop compliant apps with
proof of compliance
Be sure the applications developed for mobiles devices maintain
compliance. To assess application compliance, ask the following questions:
• Can the multifactor authentication required for enterprise applications
be employed on smartphones?
• Are the mobile devices storing sensitive information as an employee
interacts with an enterprise application?
• Does a secure Web session expire in the same amount of time on a
tablet as it would on a corporate desktop?
To assist with the application compliance process, many companies
enlist the help of an application development consultant with experience
and expertise in ensuring the compliance of mobile apps. To show proof
of compliance, be sure the solution supports appropriate reports and audit
trails while controlling complexity.
Best Practice No. 5: Train employees on the
importance of maintaining compliance
Employees must understand the critical importance of adhering to
regulations and potential consequences of compliance failures. Mobile
employees must be especially sensitive to potential breaches while outside
corporate walls. A signature on a document promising adherence to rules
is not enough. Ongoing education is essential.
Source: Dell
HEALTH MANAGEMENT TECHNOLOGY
January 2015
11
12/15/14 3:24 PM
11
● Expert Q&A: EHRs
The questions
you should ask
about your
EHR/EMR
EXPENSE
Is the reality of the true cost of an EMR sinking in now
that systems are live?
12
.
Becky Quammen, CEO, Quammen Health Care
Consultants
For years, healthcare organizations have been in
search of the pot of gold on the other side of the
technology-implementation rainbow. The good
news is that many healthcare organizations are realizing improved quality of care, greater operational
efficiencies and better financial performance.
But they are not on easy street ... yet. In fact, many healthcare
leaders continue to struggle with a sense of buyers’ remorse, fearing
that their EMRs will result in a financial drain and they will not be
able to allocate resources to other initiatives. They are also confronted
with unending “sticker shock”as they watch EMR implementation
and maintenance costs rise.
As a result, healthcare leaders must keep a watchful eye on the
ongoing and rising costs associated with EMRs. But that doesn’t mean
leaders should shift into complete penny-pincher mode. Instead, they
need to strategically allocate resources, both financial and human, to
get the most out of their EMRs. That means spending money when
needed and pulling back on the purse strings when warranted. It is
time to re-engage tactical and strategic IT planning with emphasis on
projects that bring the greatest value to the organization.
To start, leaders should make sure they are actually allocating
the dollars required to optimize the clinical, workflow and financial
benefits associated with their EMRs. For example, it’s important to
go beyond “cursory” clinical adoption and really get physicians, nurses
and others to use all the functions of a system. As such, investing in
the internal or external resources required to put robust computerized
physician order entry initiatives in place is likely to be a good use of
money. When physicians become fully engaged, EMRs are much
more likely to produce those all-important clinical benefits that lead
to improved patient outcomes.
At the same time, leaders need to know when to pull back on the
spending as well. For example, software vendors continually introduce
upgrade after upgrade. For each of these instances, leaders need to
discern if the new functionality – and all of the coordination and testing required to implement it – will actually be worth the investment.
The ability to assess the technology and truly determine if it will result
in additional worthwhile benefits is key and leaders need to hone this
ability now more than ever before.
12
January 2015
HMT201501-ExpertQ&A MECH GH.indd 12
SECURITY
How are security credentials received?
Paul Calatayud, Chief Information Security Officer,
Surescripts
Credentials are like the keys to the treasure chest. In
the wrong hands, unauthorized persons could have
full access to a wealth of private, valuable information.
This is why it is best to have a thorough understanding
of who has access and how it is granted.
After an EHR system is installed, how are doctors, nurses, administrators and other EHR users receiving the information to log
in? Credential assignment is one of the first opportunities for security
compromise. In some cases, the EHR vendor will manage this process
on behalf of the hospital. If that holds true, they are on the hook for
verifying identities remotely. Because they are not at the company and
familiar with who should and should not have access, hospital decision makers should not be shy about asking how the company verifies
requests. ID provision is critical to establishing accountability for the
doctors and medical staff using the EHR. Proper ID provision creates
the trail mapping to how the EHR system is being used.
Once users complete the ID provision process and are confirmed, it
is important to know how they receive their credentials. Is the information given over the phone, through email or otherwise? By identifying
how the credentials are received, an organization can identify any
opportunities for credential theft. And if a username and password is
compromised, is there a mechanism for protecting the credentials if
they are lost or stolen? Be sure to look into the registration process for
new users as well as password resets or renewals.
Who is accessing the system?
Some doctors have not worked EHRs into their workflow and prefer
to focus on the patient while an assistant, nurse, administrator or
scribe handles the task of data entry during interactions with patients.
Scribes can input information to the EHR in real time, cutting down
on paperwork the doctor has to complete afterward and ensuring
nothing is forgotten after the patient has left the hospital. With the use
of scribes becoming increasingly common in care settings, concerns
arise around credential sharing.
To better understand who is accessing the system, each person
should be using unique credentials. While a scribe or nurse might be
entering patient data on behalf of a doctor, that person should use his
or her own login to enter the EHR system. This is necessary for proper
tracking and access to history logs, which is often how misconduct and
breaches are identified. Determining who has access to the information is critical, and background checks should be conducted for all
individuals in contact with patient data.
How do I protect patient data in a mobile world?
Brian Voves (left), Principal Solution Architect, Security, CDW; and
Jeremy Weiss, Senior Solution
Architect, Security, CDW
As EHR applications become more
prevalent, healthcare organizations
must accept that mobility and bringyour-own-device (BYOD) instances will happen with or without
support from IT. A recent Gartner survey found that 45 percent of
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 1:51 PM
workers not required to use a personal device for work were doing so
without their employer’s knowledge. Rather than locking down and
restricting mobile devices on the network, which can cause hospitals
to lose competitive ground, health IT professionals need to understand that security and mobility must exist in tandem.
Even though organizations already protect the infrastructure
that mobile devices access, securing the individual device remains a
necessity to avoid putting critical data at risk. Mobile device management (MDM) solutions enable IT professionals to set various device
permissions for accessing data, while also restricting which apps employees can download on their devices. When dealing with the highly
fragmented mobile app market where not all developers implement
the same security standards, MDM solutions ensure that employees
only use EHR apps that have been vetted through the organization.
In a worst-case scenario where a device containing patient data is
lost or stolen, IT professionals can also use the MDM solution to
remotely wipe the device, thus reducing the impact of the breach.
What organizational policies should I establish to
ensure patient data is secure?
The best security technology in the world is only as effective
as the personnel and policies that support it. A 70-page security
policy – while entertaining for lawyers – has very little practical
effect. Simplicity is vital to ensure that employees “buy in” to your
security policies. A one-pager identifying EHR security strategies
and tips will go much further in protecting personal health information. Reinforcing those security policies, healthcare organizations
should also commit to continuing education and enforcement of
employee standards.
HMT201501-ExpertQ&A FINAL.indd 13
Although many organizations prefer to think in the positive, it’s
also wise – and realistic – to have a contingency plan in case a security
breach does occur. After all, while complete data security is unrealistic,
the ability to mitigate the risk, recognize the breach and react effectively
can reduce damage by a meaningful margin. Risk mitigation starts
with developing a comprehensive security response plan and clearly
defining each IT employee’s role.
Healthcare organizations certainly hope that such a plan is never
needed, but like many things, it’s always better to be prepared. Healthcare is experiencing a patient data explosion, and the industry is
increasingly relying on EHR systems to catalog the mountains of
data. Beyond EHRs, health information exchanges (HIEs) and affordable care organizations (ACOs) are influencing the healthcare data
proliferation, in that data sharing is a critical component of provider
eligibility for federal funding to meet Meaningful Use benchmarks.
The ability to access and share patient data anytime, anywhere is
paramount to the evolution of efficient and enhanced patient care.
Backed by Meaningful Use criteria, this data portability can enable
healthcare organizations to improve health outcomes and deliver a
more personalized healthcare experience, but organizations must be
sure to take the necessary precautions when managing patient data.
Securing patient data – and the overall infrastructure – is not a
one-time effort, but rather an ongoing process. Securing an EHR
system starts with proper planning, is enhanced through effective
technology and policies, and is maintained through constant vigilance
and upgrades. As healthcare embraces EHRs and the next generation of health IT, staying one step ahead of security threats will help
organizations realize the full operational and economic benefits of
the latest technology.
12/15/14 1:57 PM
.
13
● Expert Q&A: EHRs
INTEGRATION
How do we map different terminologies within
devices, hospitals and across the industry so EHR
integration can be completed more efficiently and
effectively?
14
.
Terminology isn’t comprehensively mapped within most hospitals, let alone across the industry, therefore EHR integration
projects continue to be overly complex with an increasing number
of moving parts. The lack of comprehensively mapped terminology
Jeff McGeath, Senior Vice President of Software means integration experts have to formulate additional plans, further
straining project bandwidth.
Solutions, Iatric Systems
The ability to deliver interfaces that are semantically How do we address and resolve the limited availability
interoperable has become much more complex in of integration experts that has resulted from the
the last five to seven years. Therein lies a significant increasing integration complexities?
EHR integration challenge – the extensive termi- Integration resource and expert pools have grown especially thin due
nology mapping process that has to take place at to recent hyperactivity around healthcare reform and government
interface build time. We can no longer just build regulations, such as the HITECH Act. Further, new technologies
interface translations and simple maps to manipulate data in an brought to the market are great, but they continue to rapidly dilute
HL7 message. That is not good enough. As the market matures and the integration skill set, creating challenges for hospitals’ EHR
regulatory pressures increase, emerging goals and standards require integration projects.
hospitals to communicate data among EHRs and other systems in
Finding in-house integration experts with the knowledge, skills
this new way. Due to this, integration tool sets and interface develop- and bandwidth needed to complete all of a facility’s integration projment are tremendously more complex.
ects is nearly impossible. However, as is often the case, this demand
The industry’s response to semantic interoperability has been the has created supply in another area: outsourced integration services.
introduction of multiple coding systems, not only at the data level,
Healthcare organizations wanting to engage an outsourced intebut also the identifier level. Experts now need to know which codes gration company should focus on finding one that has delivered a
to use and even the code value of the coding system being used – it multitude of various interface projects and possesses a solid coding
quickly snowballs. Further complications arise because many EHR system library. In addition, it’s important for an integration company
systems support localized coding, meaning one hospital can refer to have dedicated staff working closely with regulatory and industry
to a procedure or item as one name and another facility can use an bodies to understand new regulations as they emerge.
entirely different name. If these organizations try to share EHR data
within a connected community, the clashing codes would require
significant resources to resolve.
EHR 2.0
Physicians sometimes focus more time on the
electronic health record than on the patient. What will
be done to make EHRs less time consuming?
Mark Janiszewski, Senior Vice President, Product
Management, Greenway Health
In the 2014 Medscape EHR Report, the biggest concern expressed about EHRs was that they can decrease
face-to-face time with patients. That concern is driving a great deal of innovation, and physicians should
find EHRs much more second-nature in the future.
The challenge is that EHRs essentially ask the provider to capture
patient information and diagnoses in a way that will be meaningful to
other information systems. For quality reporting, that means capturing
a greater level of documentation than in the past, and the trick is to do
it with as little effort and friction as possible. Look for breakthroughs
in the near future in four important areas:
1. Intuitive recording according to the physician’s documentation habits.
In much the same way Google learns people’s Web-searching habits
and tailors itself accordingly, EHRs will adjust automatically to the
habits of each physician. Almost no two physicians do the same thing
the same way, but for a routine problem, an individual physician com-
14
January 2015
HMT201501-ExpertQ&A MECH GH.indd 14
monly uses the same orders for a given diagnosis. EHRs will capitalize
on that individual consistency.
2. Speech recognition and natural language processes. EHRs will
become less dependent on screen inputs and more capable of capturing verbal information. Speech will allow more individualized
documentation of the patient’s problems. The recognized speech will
also be turned into codified data for ordering tests, medications and
capturing billing information as well as quality reporting and population analytics upstream.
3. Having a common codified vocabulary. There are several major
medical vocabularies covering different domains of medicine, such as
RX Norm for medication, ICD for diagnoses, CPT for procedures,
SNOMED, etc., but they have caused a challenge in capturing the
essence of the patient’s true set of disease problems and state. Achieving true interoperability regarding the patient’s medical state and needs
between care providers will require a common codified electronic
language. The EHR industry has been working hard on this, and the
future looks bright in this area.
4. Cross-format documentation. Health records will work seamlessly
across multiple formats and form factors – desktops, laptops, tablets
and smartphones – in the not-so-distant future. Providers will be able
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 1:53 PM
to capture as much documentation as is appropriate in the exam room, ingful information at the point of clinical decision-making regarding
then finish up after exam completion on the form factor of choice. health considerations that go beyond the condition at hand.
Newer aspects of Windows 8.1 and other technologies will contribute.
How will EHRs support physicians in the trend toward
holding providers responsible for improvements in
population health?
There is a tremendous amount of development going on in this area
among innovative, third-party companies specializing in risk-management and care-coordination tools. The aim of these tools is to promote
patient management within program parameters to minimize healthcare
costs, improve the patient’s health and maximize the provider’s ability
to earn value-based reimbursement revenue. This innovation is coming
directly from the EHR vendors, as well as from emerging solutions that
integrate meaningfully with EHRs to advance care coordination and
improve population health.
In their most basic function, these tools track adherence for patients
with such chronic conditions as diabetes and COPD. They typically
include interfaces with leading EHRs that feature application programming interfaces (APIs) so they can exchange information that updates
tracking information and informs physicians of additional interventions
to manage these chronic disease states – including across the continuum
of care within a managed care model. For example, if a patient makes
an appointment to be treated for an unscheduled visit, the system can
flag to the physician that the patient is diabetic and has an overdue
HbA1c test or foot exam that can be administered during the same visit.
While that’s just one piece of the solution to improving population
health, it’s an important one in which the EHR serves to provide mean-
HMT201501-ExpertQ&A FINAL.indd 15
What else lies ahead in EHR information sharing?
Our ability to leverage the EHR to promote better care will ultimately
be limited only by the information that’s available and our imaginations.
The entire world is going digital, and digital means liquid data in healthcare as in everything else. Patient data in the future will be recorded by
an incredible number of devices that can all feed across the continuum
of care for a more complete picture of patient conditions and needs.
Home mobile medical devices are now becoming more common,
and with patients who have chronic diseases, such as diabetes, asthma
or hypertension, having the ability to monitor themselves at home and
transmit their health information to their care providers provides a real
opportunity to limit the significant complications of these diseases. This
puts the focus on keeping the patients as healthy as they can be and in
their own environments – not in the hospital.
Bluetooth-enabled scales, blood pressure monitors, at-home glucose
testers and similar health-enabled personal devices hold tremendous
promise. In truth, we have more technology than solutions at this
time, but the potential is there and will be realized in ways we can’t
fully imagine today.
Two decades ago, few were predicting physicians coast to coast
would be charting electronically. Reaching that stage was an amazing
first step. Get ready for advances that will greatly eclipse phase 1 in the
HMT
next decade.
12/15/14 3:38 PM
.
15
● Case Study: Laboratory Information Systems
LIS trends for 2015
and beyond
How will the laboratory information system
adapt to the restructuring of healthcare?
Kim Futrell, MT (ASCP),
Products Marketing
Manager, Orchard
Software
By Kim Futrell
L
16
.
IS development has historically been influenced by
the need for laboratories to comply with a plethora
of regulatory requirements. Laboratories have always faced changing regulatory requirements, but
never more so than now – as our overall healthcare system
struggles to reinvent itself into a system where patient outcomes and value drive reimbursement rather than the volume
of procedures performed. The Patient Protection and Aff ordable Care Act (PPACA) is the largest change to our healthcare
system since the introduction of Medicare in 1965. It is the
beginning of a complete restructuring of how healthcare in
the United States is delivered, and one of the reasons these
improvements in healthcare are possible is because of advances
being made in information technology.
In addition to the PPACA, the Medicare and Medicaid
Electronic Health Record (EHR) Incentive Program is driving the use of EHR technology, and consequentially having
a profound impact on the functional needs of the LIS. Prior
to the EHR, orders were placed in the LIS, making medical
necessity fl agging and Advance Benefi ciary Notice (ABN)
printing important functions for the LIS. With Meaningful
Use (MU) now in full swing, the majority of lab orders are
placed directly in the EHR using Computerized Physician
Order Entry (CPOE), making this pre-analytical functionality
less important in the LIS.
As change continues, the future of healthcare will require a
shift in focus and will bring new responsibilities to the laboratory that include a broadening of the laboratory’s focus beyond
workflow efficiency to include positive measurable impact on
patient outcomes. This initiative will make new demands on
the LIS. Not only are test menus changing and expanding,
but test methodologies and workflow processes are advancing.
Laboratories are under pressure to reduce cost, maintain efficiency and quality testing, and demonstrate value that reaches
beyond the walls of the lab. Being one of the most vital tools
a lab uses, the LIS must evolve alongside the laboratory to aid
in this progression.
Provide analytics to support best test utilization
One of the areas in which laboratories can be of crucial benefit
is in driving proper and best test utilization, and the LIS can
be a valuable tool to collect and sort this data. Crystal Run
Healthcare, a multi-specialty group practice in Middletown,
NY, part of a Medicare Shared Savings Program ACO, closely
examined its provider ordering patterns to achieve the cost
16
January 2015
HMT201501-CaseStudy FINAL.indd 16
savings and efficiency needed to thrive in an accountable care
environment. In collaboration with ordering providers, their
laboratory analyzed provider ordering patterns for specific
diagnoses. Using LIS data generated by the lab order variation
analysis, combined with associated costs and actual patient
outcomes, they were able to standardize care and reduce costs
while still maintaining high levels of quality. After six months
of following the best-practice guidelines that they developed
for ordering lab tests on diabetic patients, Crystal Run saw a 9
percent reduction in the overall cost of care and a 15 percent
reduction in lab costs.
Support automated testing algorithms
Another area directly related to best test utilization that your
LIS should be capable of supporting is the implementation of
automated testing algorithms or cascades. At East Tennessee
State University Clinical Laboratory, to promote appropriate
testing and reduce waste, they are using their LIS to automate
reflex testing and to develop and automate more complex
testing cascades. Proper implementation of testing algorithms
that cascade through a logical testing sequence based on initial
results, developed in tandem with ordering physicians, can
eliminate providers having to choose from an overwhelming
menu of hundreds of available tests. These algorithms can be
instrumental in making sure that only the appropriate tests are
ordered. Laboratory-driven algorithms, i.e., where clinicians
order a testing cascade and initial laboratory results drive subsequent test selection, allow the laboratory to handle the entire
cascade process with no further input from the provider (see
example Algorithm for Thyroid Testing in Figure 1).
In order to efficiently track test utilization by provider or
by diagnosis, and to configure automatic reflex testing and
algorithms, a robust LIS is a crucial tool that laboratorians
need to support their test utilization program. Essential provider utilization data can be presented in an easy-to-interpret
format. Although some data can and will be generated from the
EHR, the rules-based decision-support technology that enables
reflex cascades has to take place at the laboratory workflow
level within the LIS. By combining the rules technology and
data analytic capabilities of a strong LIS, laboratories have a
tremendous support tool and can develop a dynamic, ongoing
test utilization program.
Deliver valuable laboratory analytics
Changes to our healthcare system demand that we find a way
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 3:43 PM
to provide better patient care and simultaneously spend less
money. This challenge shines a light on the need for laboratories to focus on greater productivity, maximum efficiency and
useful data analytics that can guide future business decisions.
The shift to a value-based system brings to light the need for
integration and business analytics. Analytics will be the key
to survival in the new payment models. Laboratory analytics
can provide management data that can boost lab productivity,
and the LIS of 2015 going forward must be able to provide
detailed laboratory analytics to assess and improve laboratory
efficiency. This includes analytics for turnaround time, physician utilization, staffing workload, auto-validation percentages
and quality measures, such as tracking rates of blood culture
contamination, hemolysis, QNS and cancellations. These solutions must be rapid in order to proactively address problems
head on and develop time-efficient solutions.
ROI that reaches beyond the lab
At the University of Mississippi Medical Center, in order to
reduce unnecessary testing and provide greater diagnostic value,
Brad Brimhall, M.D., Ph.D., and team introduced MALDI
TOF testing for blood cultures. In a traditional financing scenario, it would have taken 20 years to pay for their MALDI
TOF analyzer. However, by looking at the value of implementing a test methodology with much greater diagnostic efficiency,
and thereby significantly reducing hospital length of stay, Dr.
Brimhall was able to demonstrate the ability to pay for the
analyzer in only 12.6 weeks. This example clearly points out
that lab analytic data is essential for labs to determine if they are
running in a cost-effective, optimized
way and to demonstrate value
and ROI beyond the lab.
Advances in technology –
preparing for the future
Another LIS trend to
look for, probably not in
2015 but not too far in
the future, is the ability
to handle the advances
being made in testing
methodologies in the molecular and genetic testing
arena. These changes,
encouraged by legislation,
are occurring quickly. As
new, more complex testing becomes available and
the need to make results
available to clinicians
faster continues to ramp
up, this trend is heavily shaping laboratory
dynamics and future LIS
development.
Laborator y professionals are finding new
opportunities to update
www.healthmgttech.com
HMT201501-CaseStudy MECH GH.indd 17
testing menus to reflect organization-wide savings and improved patient care, to be involved in best test selection and
to include value-added test interpretations on reports. In order
to continue to be a vital tool, the LIS must evolve to support
initiatives that allow laboratorians to expand their role and
increase their lab’s efficiency.
Powerful and flexible LIS imperative
Our healthcare system is revamping to become more patientcentric and more efficient, using IT tools to help achieve this.
Going forward, laboratory professionals must find ways to use
diagnostic testing to impact the total patient episode of care.
Focus will not only be on performing accurate tests, but on
finding better test methodologies and opportunities to improve
the overall health of patients and the population in general.
The lab will be required to expand its reach beyond the lab and
will need the necessary IT tools to support this shift in culture.
As diagnostics moves toward the use of genomics and personalized medicine, laboratories will need a strong informatics
partner who is extremely agile and able to adapt as testing patterns shift and workflow enhancements take place. Software
tools must be able to continually advance and become more
sophisticated to support more standardized, data-driven, bestpractice models. In order to face healthcare’s future, laboratory
software must have the functionality to allow the laboratory to
be a part of the clinical decision support system for providers
HMT
– enabling laboratorians to meet their full potential.
Figure 1
HEALTH MANAGEMENT TECHNOLOGY
January 2015
17
12/15/14 9:55 AM
.
17
● Compliance
Simplifying RAC audit issues
By Bob Zimmerman
Advancing RAC audits
The Centers for Medicare & Medicaid Services (CMS) revised
Statement of Work for Recovery Audit Contractor (RAC) audit(s)
came at the end of 2014 with contract renewal of the regional
intermediaries. CMS states they are “confident that the changes
will result in a more effective and efficient program, with improved
accuracy, less provider burden and more program transparency.”
But are these changes really addressing the concerns of providers? According to the American Hospital Association’s (AHA)
January 2014 RACTrac Survey results, almost 50 percent of the
respondents indicate on-going communication problems with
CMS RAC auditors:
Reported RAC process issues
18
.
Respondents
reporting issues
Not receiving a demand letter informing the
hospital of a RAC denial
49%
Long lag (greater than 30 days) between date on
review results letter and receipt of demand letter
48%
RAC is rescinding medical record requests after you
have already submitted the records
42%
Problems reconciling pending and actual
recoupment due to insufficient or confusing
information on the remittance advice
41%
Demand letters lack a detailed explanation of the
RAC's rationale for denying the claim
40%
RAC not meeting 60-day deadline to make a
determination on a claim
39%
Receiving a demand letter announcing a RAC denial
and pending recoupment AFTER the denial has
been reported on the remittance
35%
Long lag (greater than 15 days) between date on
demand letter and receipt of demand letter
33%
RAC is mailing medical record requests to wrong
hospital or wrong contact at your hospital
16%
Problems with remittance advice RAC code N432
15%
RAC is issuing more than one medical record
request within a 45-day period
9%
RAC is auditing claims that are older than the 3-year
look-back period
9%
RAC is auditing a particular MS-DRG or type of
claim that is not approved by CMS
4%
3%
Other issues/problems
12%
* Includes participating hospitals with and without RAC activity
While the changes CMS has planned will offer some level of
relief for providers, additional benefits could be obtained through
the automation and standardization of not only RAC audits, but all
audit requests, in the true spirit of advancement and automation.
The first step in simplifying RAC audits is to eliminate the manual
correspondence notifications. This item ranks at the top of the list
HMT201501-Compliance MECH JF.indd 18
50%
Other medically unnecessary
22%
Incorrect MS-DRG or other coding error
12%
All other
8%
No or insufficient documentation in the medical
record
3%
Medically unnecessary inpatient stay longer than
three days
2%
Incorrect discharge status
2%
Incorrect APC or other outpatient coding/billing error
1%
Lastly, organizations could also exchange information with the
audit contractor by allowing online viewing access to the chart.
Since over 80 percent of RAC audits are due to one of three primary
reasons in the table above, system automation can be simplified to
help identify and eliminate these issues on the front end of the billing
process to eliminate these problems from occurring.
It is mission critical to effectively and efficiently manage content
critical to supporting claims. Leverage a content management system
to streamline the denial process by providing quick and easy access
HMT
to supporting documents while also automating appeals.
References
1.
Simplifying RAC audits
January 2015
Percentage of
denials
Reason for complex denials
Short stay medically unnecessary
Problems with postage reimbursement
18
Bob Zimmerman,
of reported RAC process-related
Solutions Analyst,
issues and can be easily rectified
Hyland
through identification of accounts
similar to the automated appeals,
through a unique denial remark code. An alternative would be to
have RAC auditors provide this information electronically through
their websites instead of through paper-based correspondence.
With either of these options, providers can automate the appeals
process in a fashion that focuses on the root cause of the denial
and not on the antiquated means of how we communicate with
RAC auditors.
Secondly, many software applications today are capable of automating much of the work associated with a corresponding denial
code. For instance, upon receiving an electronically identified denial,
a simple workflow can be used to capture and record the release of
information and other data necessary to complete the claim appeal.
Risk assessment dashboards, email notifications and email timesensitive escalations, along with historical follow-up communication and activity reporting and cost tracking, are all features that a
complete audit management solution should provide. This content
enables organizations to monitor and predict processing bottlenecks,
allowing them to determine trends and weaknesses in their ability
to respond to audit requests and requirements.
http://www.cms.gov/Research-Statistics-Data-and-Systems/
Monitoring-Programs/Medicare-FFS-Compliance-Programs/
Recovery-Audit-Program/Downloads/RAC-ProgramImprovements.pdf
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 8:56 AM
Sunquest is the
market leader
in Laboratory.
.
Sunquest provides
comprehensive solutions
that deliver quality diagnoses,
optimize efficiency, improve patient
safety, and respond to a changing market.
Laboratory data accounts for approximately 70%
of the patients’ medical records and affects up to 80%
of clinical decisions. Providers depend on reliable
results to deliver optimal care across their network.
To learn more about solutions from Sunquest, call
(800) 748-0692 or visit www.sunquestinfo.com.
With healthcare legislation and increasing regulatory
oversight, it is vital that your lab be a part of your
clinical team. With more than 30 years of experience,
Sunquest continues to be the chosen partner in
over 1700 laboratories today.
Sunquest has redefined the lab, empowering its
partners to turn results into knowledge.
HMT201501-AD Sunquest.indd 19
Path to the heart of healthcare
12/12/14 3:14 PM
19
● RSNA Show Recap
Last month, the Radiological Society of North America
(RSNA) hosted the world's foremost radiology conference
attracting nearly 55,000 medical professionals and
industry leaders to the largest convention center in
North America, Chicago’s McCormick Place. The
conference attendees represented countless nationalities
and viewpoints of the latest trends in imaging.
Being the centennial celebration of the annual forum,
RSNA 2014 not only presented the key milestones met
over the past 100 years in the field of radiology, but
also showcased the newest technological innovations
that will impact the industry for years to come.
We present some of the technology highlights that
came out of RSNA 100.
20
.
Latest Imaging Technologies
Dose monitoring for patients and staff
Share DR technology
The DoseWise Portal is a comprehensive radiation dose management
software solution aimed at managing radiation exposure risk to patients and their caregivers. This solution enables healthcare providers
to proactively record, analyze and monitor imaging radiation dose
for patients and clinicians across multiple diagnostic settings. Philips
DoseWise Solutions include a comprehensive portfolio of products
and services, including ClarityIQ, IMR and DoseAware, that enable
healthcare providers to implement a broad and comprehensive dose
management strategy. Philips
The RadPRO DELINIA 200 Digital X-ray Acquisition Cart can
deliver high-quality imaging and
help accelerate exams by providing results within seconds using
the installed X-ray generator in
an existing radiography room or
a mobile generator, without the
need for cabling or special interfacing.
ciing.
The cart comes equipped with a computer,
pu
uter, access
point, touchscreen monitor, detectorr holder
and
h
a choice of the Canon CXDI-701C,
C CXDIC,
801C or CXDI-401C Wireless DR
R system.
Canon U.S.A.
www.rsleads.com/501ht-151
Single view of patient records
The Clinical Collaboration Platform uses Carestream’s intelligent
Vue Archive to save and exchange clinical content in DICOM
and/or non-DICOM
formats, managing
multiple archives at
once. This solution incorporates Carestream’s
MyVue patient portal
to give patients secure
data access and sharing
capabilities. Embedding Carestream’s Vue
Motion zero-footprint
viewer into an organization’s EMR gives physicians convenient access to 3D/MPR images,
interactive reports and video streaming from their mobile devices or
workstations. Teleconsultancy and data exchange through HIE are
also supported. Carestream
www.rsleads.com/501ht-153
01ht-153
Coordinated care in full view
The Centricity Clinical Archive is a vendor-neutral archive (VNA)
solution that serves as the foundation for a coordinated care network,
giving care teams across the enterprise access to data to enhance their
efficiency. This newest release unifies and manages patient images and
enterprise content intelligently and includes mobile image capturing
and architecture for compliant accessibility to patient records from an
external system. This solution includes: Centricity Enterprise Archive,
Universal Viewer ZFP, Caradigm eHIE, Centricity Clinical Gateway, NextGate MatchMetrix EMPI and PACSGEAR PacsSCAN.
GE Healthcare
www.rsleads.com/501ht-154
www.rsleads.com/501ht-152
20
January 2015
HMT201501-RSNA MECH JF.indd 20
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 2:07 PM
Next-gen PACS is all about workflow
The latest enhancements to Merge PACS have been specifically designed to support enterprise health systems and teleradiology, aiming
to improve operational workflow and interoperability. By directly
integrating with the iConnect Enterprise Archive, Merge PACS 7.0
provides access to all studies available for a patient, eliminating the
need for pre-fetching. This solution delivers composite worklists for
reading efficiency, cacheless PACS operations on an industry-leading
VNA and workflows that can be accelerated using macros with other
applications. Merge Healthcare
www.rsleads.com/501ht-155
4,000 PACS installations and counting
Fujifilm has reached an important milestone in Picture Archiving
and Communication Systems history: 4,000 Synapse PACS system
installations worldwide. The latest version of the company’s cornerstone Synapse PACS solution focuses on enhanced communication
and optimized productivity in any imaging environment. Enhancements include Synapse Communications, which features Peer Review,
Critical Results, Emergency Department Findings and Pulse to track
all important study activities. Fujifilm is also working on integration
capabilities with other radiology and EHR third-party vendors to
optimize workflow. FUJIFILM Medical Systems U.S.A.
IMAGING
What a radiologist wants
A new study from independent health research company MarkeTech
Group sheds light on the needs, wants and wishes of radiologists when
it comes to reading imaging results. The effort was sponsored by visualization technology solutions specialist Barco.
The survey of 223 radiologists, distributed across Europe (France,
Germany and the U.K.) and North America, aimed to answer the
question, “What makes a good read – and a good reading experience?”
Results focused on image quality, workflow and ergonomics.
While some results seem predictable, such as 91 percent of respondents cite image quality as the single most important aspect of a medical
display, other parts of the study illuminate how radiologists really use
their equipment – and how it could be improved.
The MarkeTech Group surveyed over 200 radiologists
in Europe and North America to find out.
www.rsleads.com/501ht-156
3D viewing gets more accessible
.
WebWorks 3D is an optional add-in for BRIT Systems WebWorks
zero-footprint image browser. The 3D tools include viewing a 3D
rendering that can be rotated, magnification, cross-reference and
locate tools, measurement tools and snapshot tools so an image can be
saved as DICOM to the server for others to view. WebWorks provides
browser-based viewing to any DICOM-capable PACS and VNA, supports federating timelines across multiple DICOM servers and can be
made available via URLs (links) from within EMRs. BRIT Systems
www.rsleads.com/501ht-157
IR and CT in one solution
As the first seamless integration between interventional radiology
(IR) and CT technology, the
all-new Infinix CT provides
clinicians with faster, safer
and more accurate interventions. Using this combination, healthcare providers
can plan, treat and verify
in a single clinical setting
for better patient care – and
significant time savings. This
solution delivers real-time
CT images during interventions instead of CT-like images, improving workflow while providing seamless and automatic transition between modalities. Toshiba
America Medical Systems
www.rsleads.com/501ht-158
www.healthmgttech.com
HMT201501-RSNA MECH JF.indd 21
87%
OF RADIOLOGISTS
EXPERIENCE
PHYSICAL
DISCOMFORT
WHEN READING
IMAGES
66%
experience eye fatigue
56%
suffer from neck strain
52%
struggle with back pain
In MarkeTech’s sample, 60 percent of radiologists overall routinely
use a mix of color and grayscale displays. Of European respondents,
63 percent read both digital mammography and color PACS. In the
U.S., this number is significantly higher (84 percent). To work more
efficiently, 92 percent of surveyed radiologists propose faster image
loading and manipulation. A larger screen surface (78 percent) and
the ability to load both color and grayscale images on one screen (66
percent) are considered important potential improvements as well.
While it is little surprise that 87 percent of radiologists experience
physical discomfort such as eye fatigue, neck strain and back pain
when reading images for long stretches, they have ideas of how to make
things better. The most popular solutions cited are an easy-to-adjust
stand (83 percent) and increased ambient room lighting (81 percent),
followed closely by reduced screen glare (72 percent) and keyboard
task lighting (69 percent).
HEALTH MANAGEMENT TECHNOLOGY
January 2015
21
12/15/14 2:09 PM
21
● Solutions Guide: ICD-10
Transition Strategies
Small Physician Offices
5 steps to improve
documentation accuracy
Conversion costs ‘dramatically
lower’ than estimated
By Bess Ann Bredemeyer, BSN,
R.N., CHC, CPC, Senior Director of
Consulting, McKesson Business Performance Services
22
.
According to a July 2011 HealthLeaders Intelligence Report, 60
percent of respondents expect the transition to ICD-10 to negatively
impact cash flow. The No. 1 reason cited: incomplete physician
documentation.
With 68,000 diagnosis codes and over 79,000 procedure codes,
the ICD-10 code set is far more detailed and complex than ICD-9,
which means accurate coding will require more thorough patient
information. Successful ICD-10 implementation must begin with
better documentation.
McKesson has identified five essential steps to help hospitals effectively engage physicians, support clinical documentation improvement requirements, maximize productivity and be fully prepared for
a successful ICD-10 transition:
Step 1: Evaluate current documentation
McKesson recommends a three-step gap analysis to evaluate current
readiness:
A. Determine the most frequent types of medical claims submitted.
B. Code samples of these claims in ICD-10.
C. Identify gaps in the supporting documentation.
Such an analysis might focus on the top 25 ICD-9 codes used and
include a review of the group’s current documentation. If gaps are
identified in only a few of the 25 areas, focus training on improving
those areas. If gaps are discovered across the board, focus training on
improving two or three each month instead of all areas simultaneously.
Step 2: Train physicians
The amount of training required will vary from one organization
to another, depending on the type of medicine practiced. Physician
education is done best in a face-to-face environment. The key is to
provide personalized education so physicians can apply the appropriate level of detail based on their documentation. They do not need
to be overwhelmed with details about the staggering scope and scale
of ICD-10.
Step 3: Build a safe testing ground
Give physicians and coders a way to hone their skills – a safe testing
ground. As the compliance deadline draws nearer, hospitals may
benefit from a dual coding program that enables coders to practice
in ICD-10 while generating claims in ICD-9. Such a program can
be costly, but the right partner will help you keep costs in check and
limit the need to increase staffing.
Step 4: Conduct ongoing audits
As physicians and coders make the transition, watch for a tendency
to submit claims that include “unspecified” ICD-10 codes, which
can trigger third-party audits. In-house monthly or quarterly audits
provide immediate feedback about documentation and accuracy,
and they identify areas where additional training may be required.
Step 5: Measure impact
Expenses will likely increase initially. Conducting a benefit-cost
analysis helps hospitals and physicians account for the investments
made and the amount of monetary gain realized. By measuring how
clinical documentation improvements impact productivity, compliance and cash flow, hospitals are able to demonstrate the complete
financial benefit to physicians and the organization.
22
January 2015
HMT201501-SolutionsGuide MECH JF.indd 22
Costs for small practices to convert to the ICD-10 coding scheme
may be tens of thousands of dollars less than originally projected,
according to new data published online in the Journal of AHIMA.
The difference may be attributed, at least in part, to physicians and
their office staffs doing more with less.
So how much less are we talking about? The article estimates
that the ICD-10 conversion costs for a small practice are in the
range of $1,900 to $5,900 – a far cry from the 2014 update of
a widely referenced 2008 report by Nachimson Advisors to the
American Medical Association (AMA), which estimated the cost
for a small practice to implement ICD-10 was in the range of
$22,560 to $105,506.
The authors of the November 2014 AHIMA article, “Cost of
Converting Small Physician Practices to ICD-10 Much Lower than
Reported” (Thomas C. Kravis, M.D.; Susan Belley, M. Ed, RHIA;
Donna M. Smith, RHIA; and Richard F. Averill, M.S., 3M Health
Information Systems), put together their estimates based on results
from recent surveys, published reports and ICD-10 conversion
experience with hospitals and physicians. A small practice was
defined as three physicians and two impacted staff members (such
as coders and/or office personnel).
The AHIMA article considered the costs for training, software
upgrades, superbill conversion, end-to-end testing and productivity.
Increased knowledge and readiness for ICD-10, combined with the
availability of low-cost ICD-10 activities and resources, are cited
as reasons for the new, lower estimates.
Reasons cited for the wide discrepancy between conversion
costs include:
• Costs related to EHR adoption and other healthcare initiatives such as Meaningful Use are not directly related to the
ICD-10 conversion and were sometimes included in previous estimates.
• Online clinical documentation and coding training can be
purchased relatively cheaply for $50 to $300 for three hours
of training in a particular specialty.
• ICD-10 diagnoses code books can be downloaded for free or
purchased for between $70 and $300. An ICD-10 iPhone
app for $1.99 is available with a word-search function to
find an ICD-10 code.
• Many vendors are including the ICD-10 software update
as part of their routine annual software update. Physician
office costs are not expected to be charged for basic software
services.
• For those physician offices that use a superbill (an itemized
form reflecting rendered services), an ICD-10 superbill conversion is not substantially more involved than the current
ICD-9 update process. AHIMA converted a primary superbill and reported that it can be done easily in less than a day.
• Since the primary responsibility for end-to-end testing is on
the billing, electronic medical record (EMR) and clearinghouse vendors, physician participation is minimal.
• Previous estimates of additional documentation requirements and associated reduction in productivity were based
not on studies of physicians’ offices but primarily on data
from inpatient hospital documentation coding and billing
activities and the potential risk of disruption in a hospital
environment. Improved documentation is not simply an
added cost, but can increase revenue for physicians.
Source: AHIMA
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 11:04 AM
ICD-10 Preparation
Solutions
How does your readiness stack up?
If you are a provider dragging your feet on making the ICD-10
transition, you are in good company.
Findings from the Workgroup for Electronic Data Interchange
(WEDI) August 2014 ICD-10 Industry Readiness Survey, the ninth
in a series of such studies conducted since 2009, indicate that only
about 35 percent of the 324 providers surveyed have begun external
testing, while in the October 2013 survey about 60 percent had
expected to begin testing by the middle of 2014. About 50 percent
of the providers indicated they have completed their impact assessment, which is essentially the same number as in the October 2013
prior survey.
“The lack of progress by
providers, in particular smaller ones, remains a cause for
concern as we move toward
the compliance deadline,”
said Jim Daley, WEDI Chairman and ICD-10 Workgroup
Co-Chair. “Delaying compliance efforts reduces the time available for adequate testing, increasing
the chances of unanticipated impacts to production.”
Eighty-seven vendors and 103 health plans were also surveyed.
About 40 percent of vendors indicated they have completed product development, which is an improvement over the October 2013
survey, but more than 25 percent of vendors said that their products
would not be ready until 2015 or responded “unknown.”
Health plans are the most on track. Nearly 75 percent of health
plans had completed their impact assessment at the time of the survey.
More than 50 percent said they have already begun external testing,
a doubling of effort since the last survey (25 percent).
“It appears the delay has negatively impacted provider progress,
causing two-thirds of provider respondents to slow down efforts or
place them on hold,” wrote Daley in a September 24, 2014, letter to
Health and Human Services (HHS) about the latest results. “While
the delay provides more time for the transition to ICD-10, many
organizations are not taking full advantage of this additional time.”
Source: WEDI
Consulting
Next-gen coding, reimbursement system
The 3M Coding and Reimbursement
System Plus (CRS+) offers a dynamic
user display with immediate access to
DRG and reimbursement data, plus a
3M-hosted reporting tool. A patentpending coder workflow combines 3M’s exclusive logic-based
coding paths with an advanced ICD-10 table-driven design. The
new look and feel helps coders easily derive codes to simplify
coding and improve productivity under ICD-10. Coders trained
with the ICD-10 Procedure Coding System (ICD-10-PCS) code
tables will quickly adapt to the familiar design and workflow,
helping to improve the speed and accuracy of their ICD-10-PCS
coding. 3M Health Information Systems
www.rsleads.com/501ht-181
Everything your lab needs
ASPYRA offers a wealth
of services to help your
laboratory make the transition to ICD-10. Preparation services include:
generation of comparative
Current Test Summary
spreadsheets, entry of ICD-10 codes into CyberLAB tables, MNV
validation testing and ICD-9 to ICD-10 mapping. A Scope of
Effort Workshop provides a lab processing and billing assessment,
while go-live readiness testing will ensure all functions and features
of CyberLAB 7.3 are working as expected. ASPYRA
www.rsleads.com/501ht-182
Treat ICD-10 holistically
SSI has got you covered before and after October 1, 2015.
The company’s 10Smart Solution provides smooth ICD-10
conversion and helps protect your financial picture during the
transition to ICD-10. 10Smart includes: ClaimSmart Suite, a
fourth-generation RCM solution; A/Rchitect, a breakthrough
platform that features an Analytics Suite and ICD-10 Assessment
Tool; and ClickON ClearView ICD-10, a claim-validation test
harness. The SSI Group
www.rsleads.com/501ht-183
Best in KLAS ICD-10
consultant rankings
1.
2.
3.
4.
5.
6.
7.
Aspen Advisors
Advisory Board
Ernst & Young
PwC
3M
Deloitte
Leidos Health (maxIT-VCS)
91.6
91.0
90.2
89.8
89.3
88.0
83.9
* Rankings were calculated in January 2014 by KLAS. New rankings will be
released at the end of January 2015.
INDEX OF ADVERTISERS
Advertiser
Page
Clearwave.....................................www.clearwaveinc.com/meetkiosk ......... 3
HealthPort.....................................www.healthport.com/auditrelief .............. 9
McKesson Paragon HIS ................www.mynewHIS.com .............................BC
Quammen Consultants.................www.quammengroup.com ..................... 13
Quammen Consultants.................www.quammengroup.com ..................... 15
Sunquest Information Systems....www.sunquestinfo.com.......................... 19
Time Warner Cable .......................business.twc.com.healthcare................ IFC
Verizon Wireless ...........................verizonenterprise.com/healthcare............ 7
This index is provided as a service. The publisher does not assume liability for errors or omissions.
www.healthmgttech.com
HMT201501-SolutionsGuide MECH JF.indd 23
HEALTH MANAGEMENT TECHNOLOGY
January 2015
23
12/15/14 11:31 AM
.
23
● Thought Leaders
Viewing patient
data holistically
A modular collaboration platform is the key.
By Cristine Kao
W
24
.
e use tools such as Mint.com to get a comprehensive look at the status of fi nancial
information that resides in different, unaffi liated accounts. So why can’t we develop
technology to achieve a single, holistic view of a patient’s
clinical data – without consolidating every platform?
We all recognize that data access at healthcare facilities is
impeded by the storage of extremely large amounts of data in
proprietary archives. While there are some standards of data
exchange and workflow protocols within the healthcare IT
industry, it’s often difficult for clinicians to collaborate with
various stakeholders to provide the best care. Being able to
deliver relevant, timely data is possible if we use intelligent data
management and federate multiple storage platforms.
In addition, a recent HIMSS CIO user group outlined several
other concerns:
• Unifying disparate systems;
• Standardizing imaging systems;
• Moving all technology onto common infrastructure and
common platforms;
• Virtualizing systems and applications; and
• Providing image access from an EMR to authorized users
across the entire enterprise.
Faced with these challenges, where do we start? Here are
five suggestions:
1. Storage needs will continue to grow exponentially, but
maintaining silos of data for each department has resulted
in expensive solutions that limit data communication
and information exchange. Consolidating departmental
archives such as radiology, cardiology, dermatology and
endoscopy using a vendor-neutral archive is a good first
step to unifying disparate systems and creating a standardized data repository.
2. What if acquiring a new repository is not an option? An
intelligent workflow integration that merges multiple
databases and archives may be a good interim solution.
Creating an intelligent layer of integration that uses
standards-based PIX or MPI to allow information access
from current technology is a viable first step to addressing the challenges of legacy systems. This allows current
departments to keep their autonomy of workflow without
interruption of services, while gaining the benefits of
broader access.
24
January 2015
HMT201501-ThoughtLeaders MECH JF.indd 24
Cristine Kao, Global
Director, Healthcare
Information Solutions,
Carestream
3. Convenient access to clinical content is also a major requirement. The best option is often to image-enable your
EMR by embedding a zero-footprint universal viewer
that uses HTML5 technology. Clinicians gain the ability to access multiple exams and reports for each patient
quickly and easily from the EMR. This eliminates the
time-consuming process of logging into multiple systems
to search for this data.
4. Have you considered offering access to specialists using
telemedicine services? Or expanding your professional services to surrounding communities? A Web-enabled imaging
management solution can equip your specialists to provide
consultancy capabilities without costly HL7 integration.
5. Being part of an HIE or ACO requires complex data sharing.
The same intelligent workflow integration can potentially
reduce the need to duplicate data in multiple systems while
presenting a patient-centric worklist to the end user.
There must be a balance of return on investment, end-user
satisfaction and overall quality of care. Establishing a modular
clinical data collaboration platform empowers executives to
deploy technology to address all these needs.
Just as I can review a report from Mint.com to understand
my spending habits, once clinical data is “accounted” for (but
not necessarily archived in a single platform) then healthcare
providers can begin to leverage Big Data and analytics for quality
compliance, or use business intelligence to aid decision making.
For example, there are solutions today where radiology reports
can include embedded hyperlinks that take clinicians directly to
the region of interest or display advanced post-processing data.
This not only reduces search time and improves accuracy of the
report, these discrete data elements also become minable for
research and teaching purposes and can be used to track clinical
trends within a population of patients.
Rather than just focusing on vendor-neutral archives, there
are building blocks available to help healthcare executives
enable a clinical data collaboration platform that identifies,
manages and shares data efficiently with any authorized
user. Getting the right data to the right user at the right
time sounds simplistic. But that’s the goal – and healthcare
providers need to start moving in this direction to stay in
step with an industry that is dealing with Meaningful Use,
healthcare information exchanges and other initiatives that
HMT
demand these capabilities.
HEALTH MANAGEMENT TECHNOLOGY
www.healthmgttech.com
12/15/14 7:59 AM
.
HMT201501-AD House IBC.indd COVERIII
12/15/14 9:46 AM
III
Running a large
organization?
Rethink your options
to include the
Paragon® EHR
IV
.
Proven to help organizations
of all sizes improve operations
and patient care
Whether yours is a critical-access
hospital or a large multi-facility
system, you owe it to your
organization to explore the
Paragon® EHR. The affordable,
adaptable, top-of-the-line Paragon
system is designed for hospitals and
health systems of all sizes and offers
your organization:
t An intuitive, Windows®-based system
t Comprehensive clinical and financial
applications in one system that helps
simplify IT and vendor management
t A modern, single-database,
Microsoft®-based platform that helps
organizations reduce operating costs
and enhance efficiency to help impact
patient safety
To find out more and hear directly
from Paragon customers, visit
www.mynewHIS.com
©2014 McKesson Corporation and/or one of its subsidiaries.
All rights reserved. Paragon is a trademark of McKesson
Corporation and/or one of its subsidiaries. Microsoft and
Windows are trademarks of Microsoft Corporation.
HMT201501-AD McKesson.indd COVERIV
“We’re a 600+ bed hospital system and have been
running Paragon for a year now. Our experience
has been very, very positive. It’s built to handle
larger organizations. Some of the other vendors
purport it is only for smaller hospitals, but we
really have not found that to be the case.”
Steve Stanic
CIO
Mississippi Baptist Health Systems
Jackson, MS
12/15/14 12:39 PM