Platinum Products & Services Guide (PDF opens in a new window)

INTRODUCTION

When President Barak Obama signed the Patient Protection and Affordable Care Act into law last March, 2010 became a watershed year for the healthcare industry. Since that time, many CIOs, policy leaders, and industry observers have tried to gauge its potential impact, and what the industry will need to accomplish within the next five to 10 years to meet the legislative goals. Although some of the new law's impact on health IT development may be indirect, its cost-saving assumptions will affect administration, accountability, and quality measurement. And newly introduced products and services will need to focus on these areas.

As part of this special Platinum Products & Services Guide, Healthcare Informatics provides a perspective on the trends and legislation of the past three years that will affect the development of new IT products and services and how they will be adopted and used across various types of healthcare organizations. The topics covered here span five general categories: clinical information systems, financial systems, administrative systems, wireless technologies, and imaging/PACS IT.

CLINICAL INFORMATION SYSTEMS

Healthcare Provider Organizations Seek More Workflow Capabilities

The term “clinical workflow” refers to the tasks and processes (both care and business-related) in which organizations engage to deliver healthcare to patients. As technology advances, there are increased opportunities for many of the steps involved in clinical workflow to be digitized. Because some tasks lend themselves more easily to IT solutions than others, it is interesting to see what methods healthcare organizations are using to manage their data, and to get their thoughts on the IT solutions they are considering implementing in the future.

Optimal clinical workflow is important for streamlining the care delivery process in any healthcare provider organization, but it is especially important in acute care settings where there is more unpredictability and a potential for increased medical errors and heightened expenses. Efficient clinical workflow can enable hospitals to deliver high-quality care while reducing unnecessary costs, and most important, a well-constructed and tested system can reduce medical errors.

Clinical Workflow Capabilities Most Desired in the Future (In Order of Importance)

• E-prescribing

• Portable EHRs

• Patient Web-access to hospital services

• Bedside/test room data capture

• Biometric access to system (facial, fingerprint, voice recognition)

• Hand-held scanning

• Web-based sharing among different platforms

• Coded problem lists

• Universal patient IDs

• National data sharing network for electronic patient records

• Standardized medical vocabulary

• “Smart” patient monitoring devices

• Remote patient monitoring

• Electronic Medication Administration
  Record (eMAR)

• Smart cards

• Convergent communications devices

• Podcasts for patient information

Source: “Optimizing Clinical Workflows: Technology Trends to Improve Patient Care,” Healthcare Informatics Research Report.

Among other key findings in the report:

• Care provider respondents stated high satisfaction within their organization with current data management practices. However, they still indicated that their organizations were considering improvements in that area.

• Overall, care providers indicated that they were relying almost equally on electronic/digital and paper/hard copy systems for patient and practitioner data managements. Respondents stated that their organizations depended more on electronic digital methods, however, when handling administrative data.

• Respondents from acute and non-acute care facilities declared that they were most often considering the adoption of electronic/digital systems to assist with practitioner-related data. Managed care organizations were more often considering electronic improvements in the management of patient data.

• The majority of care providers stated that they accessed clinical data using seven or more separate applications with multiple sign-ons for access security. Non-acute care organizations used only one to two applications to access clinical data.

• A large number of respondents from provider organizations indicated that a desire to reduce medical errors lay behind their organizations' efforts to improve access to clinical data.

• Respondents indicated that their organizations were making these desired improvements, mainly in the access of patient data for acute care organizations and outpatient/clinic physician practice tasks for non-acute and managed care organizations.¹

  ¹“Optimizing Clinical Workflows: Technology Trends to Improve Patient Care,” Healthcare Informatics Research Report, pp. 5-6, 2007.

Improved Quality Results in Improved Financials

Often “improved quality will result in improved financials,” says Rick Corn, vice president and CIO, at Huntsville (Ala.) Hospital, adding that clinician documentation is a good example. “By improving our documentation, and by using technology and automation, we will often do a better job of the documentation as a result. And I'm predisposed to believe that will result in better quality care and better charge capture as well.”

Corn notes that in his experience, “you start in the perioperative area, and then expand into anesthesia, and now we're beginning to integrate and provide access to PACS within the ORs. We're just bringing more of the IT-related portions of the care closer to the source of care, in this case, the OR suite.”

Corn believes there is growing awareness that automation will be part of the solution going forward. “When you think of where HITECH [the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act] and meaningful use are going to take us as an industry, I think it's pretty clear that whether it's tracking quality measures, or whether it's requirements related to IT integration into the ancillary areas, that we will have to move forward in those areas.”

FINANCIAL

Healthcare Organizations Struggle with Their Financial Health

In a reversal of most observers' forecasts and expectations, healthcare provider organizations have found out the hard way that they are not immune to recession economics. The long-held assumption that the population's need for healthcare will safeguard hospitals and practitioners from any economic downturn has faded fast. Shrinking pools of consumers ready and able to pay for urgent care and treatments, as well as discretionary elective procedures, and the high-volume of unemployed who have no insurance coverage or are unable to pay for services are affecting the financial health of many organizations. Even with the passage of the Patient Protection and Affordable Care Act, it will take several years before organizations will see positive financial results.

Over the past two years, more hospitals have been witnessing declining financial health compared to previous years. Like businesses in other industries, it isn't just decreased income that is creating problems. Investment portfolios and philanthropic donations have also shrunk. Many hospitals and integrated delivery systems are finding it difficult to get the credit needed to finance operations as well as carry on with projects in the works, according to the Healthcare Informatics Research Report, “Trends in Financial Strategies and Technologies.”²

²“Trends in Financial Strategies and Technologies,” Healthcare Informatics Research Report, 2009.

Cost-cutting measures have been undertaken by most organizations, and personnel have been among the first to be targeted. And many organizations are evaluating how to best maximize spending, outsourced services, and hardware purchases, and are examining service and maintenance agreements. For example, many outsourced services are being brought back in-house and consultant services have been curtailed. IT and tech-related projects have been affected, depending on the type of project.

Hardware and equipment purchases are usually the first to be cut as many organizations plan to defer purchases and prolong use of existing equipment. However, most clinicians can expect to keep their handheld devices. Very few organizations are withdrawing from equipment offers that have been made to them.

Legislation's Impact

ARRA-HITECH provisions provide funding for healthcare providers to acquire HIT systems, as well as adoption incentives. Earmarks included funding for the development of a nationwide health information technology infrastructure to support the use and exchange of electronic health information. Essential to this proposal, and to the transformation and modernization of the U.S. healthcare system, is the adoption and use of enterprise-wide electronic health records (EHRs) by 2014. The HITECH Act supports that goal, which was first set by the former Bush Administration.

In addition to financial incentives aimed at luring care providers to use EHRs and data sharing technologies, HITECH also includes provisions for decreased Medicare payments in 2015 and subsequent years for care providers who are not “meaningful EHR users.”

Although strategies such as mobile computing are being integrated at most care provider organizations, the Healthcare Informatics Research Report³ showed that new financial systems were not in the plans of many organizations. More than half of those surveyed planned to continue using their current system, but will be making improvements to optimize reimbursements and improve revenues.

³ “Trends in Financial Strategies and Technologies,” Healthcare Informatics Research Report, 2009, pp. 9-10.

Organizations planning to purchase a financial system or upgrade the existing one in order to increase the functionality are focusing on point-of-service (POS) patient identification and collection tools and specific financial systems. Most important are POS tools to collect essential patient information and identify insurance eligibility and benefits. Billing and revenue cycle management (RCM) systems are targeted to support back-end financial operations. Hospitals are more likely to plan to acquire a RCM system; ambulatory centers are more interested in billing systems.

The largest portion of organizations planning to purchase, upgrade, or add functionality to billing systems want more information about insurance status, co-pays, and uncovered costs available.

Making the Switch to EMRs

How successful have some practitioners been switching to paperless electronic medical records (EMRs) to analyze billing and claims processing? When Ron Press, M.D., Unity Medical Family Practice, started his Santa Fe, N.M.-based private family practice in April 2004, he immediately opted for a paperless solution to his medical records. He contacted the Academy of Family Medicine (the Leawood, Kan.-based American Academy of Family Physicians), and spoke with the person in charge of IT, who told him to start looking at products that interface the EMR with practice management and billing and scheduling. “I began looking at a few of his recommendations that were affordable for someone going into private practice, at a time when everyone is going into salaried positions and where insurance companies are making it so hard to make a living,” Press explained. “I found one, and it fulfilled all my needs.”

According to Press, EMRs changed the way he practices. “Now I am looking at the computer screen in a location where I can still make eye contact with the patient. I can send all refills electronically while I'm in the room with the patient. Or I can send a note to a doctor for a referral while I'm in the room with the patient, just by electronic fax,” he says. “It's so much more efficient. I can show patients their lab results and x-rays on the screen. I can print out health education materials right there apropos to the patient's visit.”

One of the challenges that Press faced starting his private practice was billing with insurance companies, which he says his system makes easier by enabling him to see which insurance company is denying certain codes. And, he has plans to apply for the 2011 meaningful use reimbursements.

Administrative

Streamlining the Business Functions of Healthcare Delivery

Although the majority of healthcare providers and health plans use various types of administrative and financial systems to streamline the business functions of healthcare delivery, the Healthcare Informatics Research Report, “Trends in Healthcare Information Technologies,” found that they were still planning to invest in business intelligence and disaster preparedness.⁴

⁴“Trends in Healthcare Information Technologies,” Healthcare Informatics Research Report, 2008.

According to the report, for hospitals that made investments in business-centric technology, disaster preparedness was a priority. Ambulatory care clinics, physician offices, and other outpatient service centers were also planning to invest in disaster preparedness and business intelligence.

The report also found that health plans, as a group, were more interested in adding or enhancing business intelligence applications and disaster preparedness. This group was also twice as likely to plan investments in data sharing projects such as health information exchanges and regional health information organizations.

Breaking Down the Resistance to All-Payer Claims Databases

According to the U.S. Department & Human Services' Agency for Healthcare Research and Quality Web site, there are approximately 20 states in some stage of developing or that have an existing All-Payer Claims Database (APCD). The information from APCDs, which include health claims data from public payers and insurance companies, can be used to determine healthcare patterns, identify gaps in disease prevention, and promote public health services within a geographic area.

Utah starting building its All-Payer Claims Database (APCD) three years ago to bring public transparency to the cost of healthcare. In September 2010, the APCD started collecting claims data from four commercial payers, and is now analyzing episodes of care ranging from maternity to chronic disease management. Utah's APCD has more than 2.2 million unique Utahans identified, linked, and grouped, and more than $10.5 billion Utah healthcare claims charges represented.

According to Keely Cofrin Allen, Ph.D., director of the Office of Healthcare Statistics at the Utah Department of Health, the state's payer database system was initially met with resistance and skepticism. To build consensus for the project, Utah led with the security and privacy issues related to the data. “However, we did not struggle with it as much as some other states did. We had enormous backing from the legislature because they asked us to do episodes of care analysis across an entire course of care,” Allen explains. “And because we were initially asked to do episodes of care, we were able to go back to the legislature and say, ‘if you want a complete episode on people, you don't want to lose people every time they change plans; we're going to need identified data in order to link people.' And we were given leave to do that. We have the highest encryption protocol there is available. We keep the data secure and encrypted on a separate server with no ties to the outside world.”

Asked to describe some of the goals for this payer database, Allen commented that “the public health benefits of a data set like this were very apparent to the Utah Department of Health from the beginning. Given the spending of $615,000 of the public's money, the public health benefit needs to be there.” Working very closely with the Department of Health, Allen believes that “once we get public health data, this will be very useful from a public health perspective to look at disease prevalence by area and by time.” The next series of things that Allen's office will examine are chronic diseases, such as diabetes, hypertension, and hyperlipidemia, which are driving costs in Utah.

Allen predicts that estimated cost savings from this project will be found in a variety of places. “The low-hanging fruit is obviously patient safety, and we're reaching out to patient safety groups to look at that. Another low-hanging fruit is duplicate tests, and I think we can show evidence of that unnecessary care.”

IMAGING/PACS IT

Diagnostic Imaging's Dramatic Transformation

Only four years ago, when the Healthcare Informatics Research Report, “Diagnostic Imaging: PACS and Radiology Information Systems,” was released, the key findings showed:

• All hospitals and health networks with large bed counts had radiology and PACS implemented, and a large majority of all types of care providers had diagnostic imaging departments and were able to capture digital imaging data and use PACS. Standalone businesses with four or more physicians were likely to have such a department.

• Although radiological studies were an important diagnostic tool, clinicians were increasingly relying on additional types of diagnostic imaging procedures, such as magnetic resonance imaging and ultrasound studies.

• One-third of the organizations participating in the Healthcare Informatics Research Panel said they planned to upgrade or replace their diagnostic imaging system or purchase a new system. Most of these already had a diagnostic imaging department.

• Costs for both hardware and software were the greatest challenges for all types of organizations and for all considerations in conversion to digital imaging technologies, including PACS, as well as purchasing and upgrading plans. However, those surveyed were also highly concerned with lack of integration between systems.⁵

  ⁵“Diagnostic Imaging: PACS and Radiology Information Systems,” Healthcare Informatics Research Report, 2007, pp. 8-9.

Flash forward four years later, when imaging IT consultants are predicting growth in image mobility and platform integration. “Image mobility is really taking off at a high rate of speed,” says Scott Grier, a top consultant in imaging IT, who predicts that in “less than two years, it will be possible not only for primary physicians to work remotely, with conferencing capability, but this will also extend to the referring physician, as well as to the individual patient, who will be allowed to see their own images, with the individual patient being allowed to see his own PHR.”

Joe Marion, another leading consultant, says he is noticing that “handheld devices are almost universal” in terms of what the image accessibility solutions are offering. He also believes that: “Advanced visualization really seems to be catching on,” with a lot of new companies starting up.

Meanwhile, more broadly, Marion and Grier see indications of a thaw in what was a rather grim situation last year, as signs of new contracts for PACS and RIS systems-in most cases, legal system replacements or upgrades-begin to gain momentum. This would be quite a positive development, weighted against the final rule on meaningful use that came out in July 2010, but with no direct mention of image management.

WIRELESS TECHNOLOGIES

Wireless Networks Having a Greater Impact on Healthcare

Wireless networks and wireless-enabled devices are everywhere, with hundreds of products to choose from. Driven by maturing technology and widely available public and private networks, new types of tools and new ways of using them are becoming more prolific, and having a greater impact on healthcare.

Although many of these products were originally developed with healthcare workers in mind, a vast number of them were largely aimed at knowledge workers-and there are plenty of those in healthcare-including laptops, tablet PCs, personal digital assistants, cell phones, and tracking and identification devices.

But there are also plenty of tools that have been specifically developed for use in healthcare, and particularly for use in delivering direct care. Among these are patient monitor and point-of-care diagnostic devices, many of which are subject to technical and regulatory requirements as determined by the U.S. Food and Drug Administration.

⁶“Trends in Wireless Healthcare Technologies,” Healthcare Informatics Research Report, 2008, p. 6.

Why go wireless? Convenience is certainly one advantage, but two out of three participants in the Healthcare Informatics Research Panel in 2008 believed that the adoption of wireless applications was primarily driven by the desire to improve the quality of care. Those who reported not having a wireless network at that time (which, for the most part, included ambulatory care clinics and physician offices), were more inclined to consider mobile computing more of a convenience than an aid to care delivery.

Across all types of care providers, EMRs were the application that was driving wireless implementation. In hospitals, applications closely associated with EMR and patient safety scored the highest.

Among organizations with a wireless network, two-thirds attributed specific improvements to care delivery as a result of implementing wireless-enabled devices. For hospitals, the benefits focused on patient safety and improved productivity. For non-hospital providers, the greatest benefits were financial-fewer denied claims and lower liability costs.

Non-clinical workers-including IT, administration, and clinical management-benefit most from wireless access. Typically, highly mobile IT managers are the biggest beneficiaries of wireless networks. Communication tools were said to provide the greatest benefit.

Patient Data Going Mobile

Pilot projects under way in the state of Washington to create personal health record (PHR) banks in three communities have found that many consumers don't have a computer and Internet access; but almost all of them have mobile phones. By simplifying the interface and using text messages, the health record banks have enhanced the interoperability of their system and increased participation, according to Juan Alaniz, the Health Record Banking Project manager with the Washington State Health Care Authority in Olympia.

That development described by Alaniz is exactly what Paul H. Keckly, Ph.D., executive director of the Deloitte Center for Health Solutions, Washington, D.C., has been seeking to understand. His research center, which follows disruptive innovations in healthcare, recently published an issue brief, “The Mobile Personal Health Record.” It states that the “personal health record embedded in mobile communications devices is the ‘killer app’ that may change the game for providers, consumers and payers.”

According to Keckley, the key is that relatively inexpensive and widely used mobile communications devices could both send and receive patient data. In addition, the mobile personal health record could provide patient-specific information such as medication reminders and healthy eating tips.

Although there is some resistance to widespread application, Keckley believes that “the change may be driven by consumers, employers, or insurers-not by providers.”

Product Watch

• Medical Devices, EMR/EHRs HL7-DICOM Interfaces

• Bi-directional HL7 ADT/Order/Result/Billing Interfaces

• Interface with: McKesson, Meditech, Epic, Cerner, GE Centricity, AllScripts

• Can include Base 64 Hex Format inside HL7 Messages

• Build Table Data, User Delimited, or Transcription Interface Easily

• Converts DICOM, XML, Report Files to HL7 and vice versa

• Absolutely No Software Programming Skills Needed

Visit us at HIMSS Booth #5869

LINK Medical Computing, Inc.

(888) 893-0900

www.linkmed.com

Elysium Express makes your first step to HIE as easy as 1-2-3. Hospitals now have a connectivity solution that fits today's limited budgets and demanding timelines, while helping to achieve Meaningful Use. Elysium Express instantly delivers clinical data to all of your ambulatory physicians and provides physician-to-physician connectivity.

Visit us at HIMSS Booth #1163

Axolotl Corp.

(888) 296-5685, ext. 2

www.axolotl.com

Holon brings a new way of thinking about interoperability. We convert information from disparate systems into consumable formats, automate routine processes, and provide comprehensive workflows to manage all of your information sharing needs. Holon is setting a new standard for delivery of actionable information WHEN, WHERE, and HOW you need it.

Visit us at HIMSS Booth #2475

Holon Solutions

(678) 324-2060

www.holonsolutions.com

The UIU is the only application able to help Healthcare IT create ONE hardware-independent Windows image that can be easily deployed to any laptop or desktop, regardless of manufacturer. ONE hard drive image for every COW, admin, tech, and doctor. Now with support for Windows 7 64-bit.

Big Bang LLC

(414) 369-5027

www.uiu4you.com

The Melissa Data Contact Verification Server is ideal for hospitals and other medical facilities that need to meet HIPPA, Sarbanes-Oxley, and other privacy and compliance guidelines by safely and securely enriching, scrubbing, and validating patient contact data completely in-house. Additional servers can be clustered for increased scalability, throughput, and redundancy.

Melissa Data

(800) 635-4772

www.MelissaData.com

HCS has provided fully integrated clinical and financial software solutions to leading healthcare providers nationwide for 40 years. Our product, INTERACTANT, is specifically designed to support acute, long-term care, and outpatient providers. INTERACTANT integrates healthcare delivery networks through registration, census, billing, and clinical and financial applications on a single database.

Visit us at HIMSS Booth #5354

Health Care Software, Inc. (HCS)

(800) 524-1038

www.hcsinteractant.com

Enterprise indexes and registries for data exchange:

• EMPI

• Provider Directory

• Terminology

• Location

• Relationship

• Consent

• Insurance

• Encounter

• Record Locator Service

NextGate delivers solutions to link and organize master data for improved accuracy, efficiency, and control. Reduce duplicates, create enterprise IDs, and enable panoramic views of data for HIEs, NHIN, and exchanges.

Visit us at HIMSS Booth #738

NextGate

(626) 376-4100

www.nextgate.com

IPayX Online Billing and Payment is the Best Way to:

• Accelerate Cash Flow

• Reduce Invoicing Costs

• Contain Customer Service Expenses

• Improve Customer Satisfaction

Ask about line item support for Combined Billing Statements!

Contact [email protected] or call us.

Internet Payment Exchange, Inc.

(800) 530-7004

www.ipayx.com

MedPlus, the healthcare information technology subsidiary of Quest Diagnostics, provides clinical connectivity for hospitals/IDNs and physician practices. Our Care360 platform, which includes Care360 EHR, is currently installed in 70,000 locations, representing the offices of 160,000 enrolled physicians. ChartMaxx® enables 24/7 online physician chart completion and automates HIM and PFS functions.

Visit us at HIMSS Booth #5543

MedPlus, a Quest Diagnostics Company

(800) 444-6235

www.MedPlus.com

Are you sending sensitive patient information unencrypted through a standard FTP? Are you manually encrypting and exchanging files with trading partners? Don't risk a costly data breach; simplify and secure your file transfers with GoAnywhere Director from Linoma Software.

Visit us at HIMSS Booth #4185

Linoma Software

(800) 949-4696

www.GoAnywhereMFT.com

Exhausted by all the EHR noise? We've got the solution. Drop by booth 1079. See our EHR+PM product demo. Designed for the smaller practice, and to interconnect them into the local healthcare community. Customizable visit notes. eRX. APIs. Affordable pricing.

Bring this ad, refresh your feet with a pair of Dr. Scholl's “gel” insoles.

Visit us at HIMSS Booth #1079

AdvancedMD

(801) 984-9500

www.advancedmd.com

With Rubbermaid Medical Solutions' new Lithium Iron Phosphate battery for computing and medication carts, nurses and IT staff will save time because the battery charges twice as fast as traditional batteries. In addition, the battery has a longer life span than traditional options-five years or more-reducing the cost of ownership.

Visit us at HIMSS Booth #2918

Rubbermaid Medical Solutions

(888) 859-8294

www.rubbermaidmedical.com