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The eGate Migraine – A Road Map to eGate Migration

Oracle’s decision to sunset the eGate HL7 integration engine has been a little bit of a headache for healthcare organizations. In reality, it has been an ongoing migraine for those who have not replaced it.  eGate customer support  is virtually unheard of, and if you are lucky enough to find skilled developers with specific Java and Monk experience you better have a big checkbook.

The eGate Migrain: A Roadmap to eGate MigrationAdditionally, depending on contractors to build, implement and maintain the multiple eGate interfaces results in increased costs, lack of control of interfacing projects and delayed access to important clinical data.

Making the decision to migrate from eGate is only the first step in the process, a process that can seem overwhelming when you consider the hundreds or thousands of application to application healthcare interfaces that need to be streamlined. There are many interface engines available today but when evaluating interface engines it is important to select one that is easy to use, robust, fits in the organizations work environment and aligns with the long-term IT goals.

Your vehicle. Many interface engines are very powerful and require individuals with specific programming skills to design and execute an efficient healthcare integration platform. Typically, these integration solutions are pricey and development time is lengthy. Other interface engines on the market are robust, designed with a simpler approach and require personnel to have basic programming or analyst-level skills. These solutions are usually competitive in price and development time is much shorter.

With many different integration solutions, it is essential for healthcare organizations to take the time to research and identify the one that best fits their environment. Organizations should consider many things including  business model, location, size, areas of expertise, services offered and personnel needs. Failure to take these things into consideration can result in a solution that is very costly in time,  price, personnel and productivity.

When determining the integration engine that will work best for your organization a thorough analysis should be completed. Below are some key attributes you may want your integration engine to include:

  • Universal Connectivity
  • Simplify application connectivity to provide a flexible and dynamic infrastructure
  • Routes and transforms messages from anywhere, to anywhere
  • Simple programming
  • Transformation options include Graphical mapping,
  • Operational Management and Performance
  • Wide range of operating system and hardware platforms supported

Now that you have identified where you want to go and the vehicle you are going to use, it is time to take a look at the map that will get you to your destination. Read the rest of this post »

Market-Driven Patient Portal: Telehealth Beyond the Virtual Visit

Last month I published a post entitled “What the market says you need in your patient portal” that garnered a lot of interest. In that post I addressed the balancing act that healthcare executives face when market based initiatives are sidelined in order to drive focus to regulatory requirements such as Meaningful Use. Sometimes the market and regulatory requirements are in sync. However, when those regulatory initiatives get delayed things get complicated. My advice is that, beyond Meaningful Use, ultimately the market will determine what true patient engagement means, and I highlighted seven features that a market driven portal should have. I will spend time during this series going into detail on those features. They include:google-smart-contact-lens-glucose-sensor-640x353

  • Telehealth that moves beyond the virtual visit
  • Dynamic scheduling
  • Social collaboration
  • Gamification and serious games
  • Avatars for personalized health coaching
  • Health information exchange across diverse care settings
  • Integration of clinical and financial data

Today we will begin with telehealth. The topic has been in the news quite a bit recently – mostly in terms of telehealth reimbursement. The world of telehealth is not only in a state of transition currently, telehealth is also one of the major net deltas that we will see between healthcare of today and the healthcare of ten years from now. So, what does telehealth look like beyond the virtual visit? We are pushing towards a world where technological innovations will make the brick and mortar less and less relevant even in the world of healthcare. One of the more interesting developments in this area is a push by X Prize, by way of multiple multimillion-dollar prizes, to innovate technologies in such a way to diagnose common medical conditions with no intervention from a health care professional. With this drive in the marketplace in mind, telehealth in a market-driven patient portal you would find:

  • Socially Enabled Patient Portals: In a socially enabled patient portal, physicians and patients can work together toward their combined goals of better health using tactics like dynamic messaging, activity feeds, blogging, and open question forums.  These technologies are particularly effective in rural and low-income areas and are being used to enhance the quality of care for diabetic populations in low-income areas, for example.  These technologies show great promise for providers and health plans interested in managing chronic disease in a cost-effective fashion, especially for the uninsured.
  • Robotics:  Children’s hospitals have been the early adopters of telehealth technologies. Some innovations of interest are in the realm of robotics. Boston Children’s Hospital has an impressive telehealth program with a video-monitoring robot. These 4-foot-6, 17-pound, two wheel robots help with post-operative consultations and care primarily as a means of videoconferencing, giving the families of hospital patients a way to keep in touch with doctors and nurses in between post-surgical appointments. Equipped with cameras, audio gear and a video screen for a “face,” the robots are operated remotely by Children’s Hospital staff. In addition to facilitating communication, they can take video and close-up photos of surgical scars or other key areas of interest to help medical staff monitor recovery.
  • The Smart House: When it comes to uncovering issues early, the tracking of vitals, combined with analytics that readily alert clinicians when those vitals show potential for problem, have been crucial to telehealth outside the virtual visit. We are seeing innovations that embedded fiberoptics into carpeting that can track the activity of patients in and out of their bed while at at home. There is also an innovation called the Health-e-Chair that incorporates a vast array of biosensors to measure vital signs including weight, blood pressure, temperature, ECG, auscultation of heart and lung sounds, blood oxygen saturation, motion analysis and reflex response time. The chair incorporates a communication unit with a remotely controlled camera.
  • Nanosensors: Taking the tracking of remote patient monitoring microscopic is no longer just something we will get to eventually. There are innovations on the market now that can make a big difference in population health. Diabetes is a serious issue in the world of healthcare (understatement of the year award nomination). One of the leading causes of blindness in the world, diabetes patients have a risk of developing retinopathy, which could ultimately lead to blindness. Nanotatoos have already proven out in diagnostic efforts to track blood glucose levels, for example. Google and friends are also innovating around embedded camera functionality into contact lenses to find early signs of diabetic retinopathy.

One in five Medicare patients are readmitted to a hospital within 30 days of discharge, and one in three are readmitted within 90 days. It’s estimated that 75% of all hospital readmissions are preventable. Telehealth provides many benefits as a virtual visit. However, it is taking telehealth beyond the virtual visit that the market will push towards as we work to bring down the cost of care and reduce readmissions. Stay tuned for a future post on how the integration of all of this data takes this effort a giant leap forward.

Anything you think I’m missing? I’d love to hear your thoughts in the comments below.

Transparency: It’s about the patient

I’ve talked a lot lately about cost vs. quality but this time, I want to talk about why all this is important by telling a little story.

A few years ago, I was visiting a CFO for a large academic medical center and he was interrupted for a discussion about a chronically ill international patient with a rare form of cancer. The patient and the diagnosis were not verbalized but the discussion was about whether the services needed could (and whether they should) be provided at no cost. This discussion was not only about the pricing or what the expense to the patient’s family would be (no insurance discussion here) but also about whether the institution really understood the cost and impact of providing the service from a margin perspective. The real truth is that they only knew what they charged for the treatment.

Properly allocating costs to understand them at the patient level is the subject of the this video by Oracle’s William Bercik, Director of Healthcare for Oracle and a former CFO.

Properly Allocating Healthcare Costs: The Key to Understanding Profitability

Join us as our team of industry experts discuss how to “Align Patient Outcomes with Financial Data: A Formula for Correlating Cost and Quality” on August 13, 2014. Using a case study discussing multiple scenarios for activity based costing for Pediatric Care Transitions, this webinar will explore how the Perficient High Performance Costing Expressway extracts clinical cost data, consolidates and allocates across the system to discover true patient costs.

Register Now

 

 

 

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The “Yellow Brick Road” to Value-Based Care

“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?The “Yellow Brick Road” to Value Based Care

Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.

As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician.   This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?! Read the rest of this post »

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Healthcare Benchmarking Part 2 of 2

In my last blog post, I introduced the fundamentals and importance of healthcare benchmarking. I highlighted the benefits of benchmarking as well as the advantages and disadvantages of various types of benchmarking. The main point I hope you took away wasHealthcare Benchmarking - Part 2 of 2 that regardless of the type of benchmarking, the purpose is the same – to help healthcare organizations identify ways to improve their overall performance.

Now that you are aware of what healthcare benchmarking is and why it is important, in this blog post, we will focus on the key steps to implementing an effective benchmarking project to begin reaping those benefits.

Benchmarking Process and Key Steps

It is not secret that a well thought out process is essential to the success of any major project. Implementing a benchmarking project is no different. Below are the key areas of focus to consider before undertaking any benchmarking initiative. I have derived many of the specifics using a variety of resources, such as Six Sigma, the Juran Model, etc., to provide further context around each step. You might say, I have taken the “best of the best” from each resource…coincidence, I think not.

Plan and Prepare
Identify Opportunities and Prioritize1 – Top management must decide which processes are critical to the success of the organization and select projects from these. Once a shortlist of processes to be bench-marked is ready, the processes need to be prioritized as per a predetermined set of criteria to fulfill the requirements of all customers (stakeholders), especially the end customer1.

Deciding the Benchmarking Organization1 - The next step in the process is to decide the organization whose processes will serve as the benchmark. The benchmark can be a single entity or a collective group of companies, which operate at optimal efficiency2. Information on their processes should be gathered from various sources and the most suitable organization selected1. It is always important to ensure that more detailed information about the selected organization will be accessible and that comparison with the organization’s process will be relevant and useful1.

Organize a Benchmarking Team – The most successful benchmarking projects involve a team approach3. The organization should leverage existing teams that may be involved in similar topics to those that are being bench-marked, if possible. In the event a new team needs to be created for a benchmarking project, The Joint Commission, suggests that the organization seek the following when building the team3:

  • Individuals closest to and most knowledgeable about the process or issues under investigation
  • Individuals critical to implementation of any potential changes
  • Individuals likely to be directly affected by any changes that result from a project
  • A respected and credible leader who has a broad knowledge base
  • An individual who has the authority to make decisions
  • Individuals with diverse knowledge base and strong analytical skills
  • Individuals familiar with benchmarking and how it can be used in performance improvement
  • Individuals who are skeptical, resistant or even opposed to certain ideas and who can service as sounding boards or provide alternative viewpoints.

Collect Data
This step is perhaps the most important, most difficult and most time consuming activity in the process1. It involves creating a plan for collecting data from selected targets, conducting site visits and creating a site visit report4. Many times the information on processes and procedures followed at another company are confidential, and it is not always easy to gather authentic information, even after making a planned and approved visit at another organization1. The preparation for collecting necessary information and documenting this information in a systematic way has to be carefully planned and executed.

Analyze Data
Validation and Normalization5 – The key activities here are the validation and normalization of data. Before any meaningful analysis can be performed, it’s essential that all data be validated to establish its accuracy and completeness. Some form of data normalization is usually required for direct comparisons to be made.

Identify Gaps5 – To be of value, the analysis must indicate the benchmarker’s strengths and weaknesses, determine (and, where possible, quantify) gaps between the benchmarker’s performance and the leaders’, and provide recommendations for the focus of performance improvement efforts. Based on this thorough analysis, an improved process(s) should be developed. Properly identifying the gaps will result in a clear picture of the organization’s processes in comparison with others within the business or industry.

Communicating Results – Communicating the benchmarking results and their implications to significant audiences in the organization and motivating them to carry out changes is vital4. It will result in a complete understanding by the target audiences of the necessity for changes in the processes involved and a desire to carry them out4. The communication must be delivered in a very clear, concise, and easily understood format via an appropriate medium5.

Implement
Create Goals - The project team’s next step is to set/revise goals for the improvement of the organization’s existing process, close the performance gap(s) identified in step 3 and create realistic and unambiguous new standards for the processes involved1&4. These goals can, and probably should, be stretch goals that will result in a process even better than the other organization’s best-in-class process1. Make sure management has approved and that all in the organization/business area understand.

Develop and Execute Action Plan1 - After the improved process and goals are accepted by all concerned or likely to be affected by it, a formal, detailed action plan is drawn with all key activities taken as inputs as well as the organization’s culture. The detailed action plan should carry the important things like a time line, individuals responsible for carrying out the tasks, any short-fall in the completion of tasks and what stretch targets are taken to compensate the short-falls. Those responsible should be committed enough to ensure that the tasks and assignments are completed on time.

Measure
Monitor Process – As with most projects, in order to reap the maximum benefits of the benchmarking process, a systematic evaluation should be carried out on a regular basis2. Senior management must be committed enough to ensure proper coordination of various activities, monitor the progress of implementation of the plan and work as a barrier-remover in the implementation process1. When the revised process is in place, a complete report has to be prepared, showing the benefits of the revised process compared with the expectations at the time of approval of the proposed revision of the process1.

Recalibrate as Necessary4- The organization needs to ensure it remains on the cutting edge by continuously evaluating the bench-marked practices and re-instituting the benchmarking process when necessary. This will prevent complacency by creating the habit of evaluating procedures to identify opportunities to improve.

Benchmarking is a very powerful performance improvement tool. However, it is vital to understand the basis behind it, follow a proven implementation methodology and gain organization-wide commitment to the cause. Benchmarking is critical for healthcare organizations to achieve and sustain the clinical effectiveness and operational performance they so desperately need.

Does your healthcare organization benchmark? Does the organization have a process that is followed similar to the aforementioned process? Has it proven successful?

Resources for this blog post:

  1. http://www.isixsigma.com/methodology/benchmarking/benchmarking-ten-practical-steps-review-points/
  2. http://www.tutorialspoint.com/management_concepts/benchmarking_process.htm
  3. http://books.google.com/books?id=2mQpVORlulEC&printsec=frontcover#v=onepage&q&f=false
  4. http://www.qualitydigest.com/feb/bench.html
  5. http://businessfinancemag.com/business-performance-management/7-steps-better-benchmarking-0

Reduce Hospital Re-admissions with Business Intelligence Tools

Steven Gregor, Microsoft Business Intelligence Consultant at Perficient,  has been working with a client to help reduce readmission rates, a key component of the Affordable Care Act. Often times healthcare organizations have a difficult time analyzing readmission data because it is located in multiple systems. The use of business intelligence tools allows data to be filtered and analyzed to help reduce re-admissions and improve quality of care.

One way to drive such a reduction strategy is to enable analysts and providers with business intelligence tools that put various re-admissions metrics at their fingertips.  Additional value is garnered when those metrics can be filtered, sliced, diced and compared against a number of useful dimensional attributes.  Developing and automating such tools helps business users avoid having to write monotonous queries, piece together disparate data from various sources, and manually compile things like month end readmission rates.

In his post, Steven explains the process he followed and the solutions implemented to help the client analyze their re-admissions data.  You can read his full post here.

Apple HealthKit: A Game Changer

I have been an athlete all my life, but since I’ve reached my 30′s, had 5 reconstructive surgeries, and moved back to the Midwest to a completely sedentary job, staying fit and healthy has become more challenging than ever before.

As an Apple lover for years, I have a myriad of Apps I enlisted to help. Between TargetWEIGHT, MYFitnesspal, MapMyFitness, myWOD, and Nike Fit Band, I have been unsuccessful in maintaining the health and fitness level of my satisfaction.Apple HealthKit: A Game Changer

When I heard about the Apple HealthKit platform and the ability for it to sync with third party application data, the question I posed to myself was, will this help me? I have no chronic illness. I’m not sick. I just want to be healthy. After doing some primitive research, if Apple can pull this off as they say they can, it will revolutionize not just my health technology experience, but the way any doctor in my future will diagnose and treat me.

The Apple HealthKit in addition to the Myhealth App promises to connect Apple Applications & other devices to one another, and to your physician if you choose to. Alleged, my myriad of applications will update one another automatically so I can work (at my nutrition & fitness) smarter and more accurately. Or, if I choose to use the Myhealth, this data will aggregate within the application in a single profile to use and share. Myhealth has 47 different tracking options to help me reach my goals, along with tracking my health milestones and medications/allergies. Furthermore, in case of an emergency, this historical account of my vitals, fitness level, and health milestones such as a chronic illness diagnosis are logged and can be shared with the ER Doctor. This may be critical in saving my life.

I am very conscious however that many folks are extremely uncomfortable with having this type of data in the cloud. I believe this will be a large barrier for Apple along with other 3rd party development partners to overcome. However the technology to keep this information secure exists, and I believe it can be done right. The challenge for Apple is to relay to the public the capabilities of internet security. Now educating Baby Boomers, Generation X, and Y’ers on Cloud Security and gaining the trust to make this Application helpful to all generations may be a challenge and will come with time.

Luckily, as a thirty-something that needs to keep track of my own family’s health along with my aging parent’s health, having health information at my fingertips may not just be convenient but literally may be a life saver. The Mayo Clinic thinks so, they have partnered with Apple along with Epic to make this endeavor successful. You can read more at:

http://www.imedicalapps.com/2014/06/apple-partnership-epic-game-changer/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+iMedicalApps+%28iMedicalApps%29

Connect with Consumers as People, Not Numbers

It is a tumultuous time for the healthcare industry, and health plans are not immune to the disruption. The Affordable Care Act has raised a new level of consumer awareness about the purchase of healthcare and the competitive health plan environment. Battles for market share drive the need to understand member demographics and behaviors in order to more effectively communicate with them. Health plans are trying to differentiate their services and offerings to gain a competitive advantage. Additionally, a newer, younger Connect with Consumers as People Not Numberscustomer segment has higher expectations of speed, information and mobile accessibility.

Despite this new focus on consumer engagement, health plan infrastructure and systems are typically inadequate to meet user demands. New levels of integration are required between front-end portals and back-end systems, so health plans’ growing social and collaborative relationships with customers can be maintained. To keep costs low but yield improved customer service and satisfaction, scalable cloud-based applications are becoming increasingly viable solutions.

Having a customer relationship management (CRM) solution at the center of the overall business strategy allows health plans to adapt to new regulatory requirements while meeting the needs of the connected consumer. Tools that enable personalized user experiences in a secure, yet flexible, environment, make connected health a reality.

A comprehensive CRM solution includes marketing, customer acquisition, retention and overall care management. CRM systems help healthcare organizations have a more personalized approach when reaching consumers (they are people, not numbers) and enable patients, providers and health plans to share information easily – creating an integrated experience and improved patient outcomes.

The consumer-centric approach is all about empowering consumers to be more involved in their health journey. In order to connect with consumers, healthcare organizations must engage with them in new ways using a more personalized method. Customer relationship management (CRM) technologies allow healthcare organizations to do just that; they are a natural fit for the healthcare industry that has adopted the “retail” model.

The food, retail and healthcare industries are going to continue to merge as we head toward a more holistic health model, and CRM will be an integral part in the success of this evolution.

Is your organization using a CRM solution? How have you seen CRM solutions evolve in the healthcare industry? Share your thoughts with us on Twitter @Perficient_HC

Managing a Patient Experience Program with PressGaney

Greg Seeman, Lead Technical Consultant at Perficient, has been working closely with ProHealth Care in Waukesha, WI to bring their data warehouse online and integrate reporting within a Microsoft SharePoint  2013 BI system.

This would be the 2nd phase of this year-long project. On deck was the task of improving workflow through the Patient Experience program. The Patient Experience program is an internal program common to any healthcare system that focuses on patient satisfaction and quality. Surveys are a key component of the data gathering processes many healthcare institutions use to manage patient experience.

In his post, Greg explains the solution used to manage their data overload where they were spending countless hours downloading reports, creating spreadsheets and number crunching. You can read his full post here.

It’s IaaS not IaaS – Creating a nimble Healthcare organization

I always find industry acronyms amusing. Sometimes they describe new technologies, other times they are a new name for an existing technology (maybe with a slight twist).  And then there are those times when two different technologies, models, theories, etc. end upwith the same acronym. Such is the case with Information as a Service and Infrastructure as a Service. Both are interesting concepts that deserve equal time, but today I would like to talk about Information as a Service (IaaS).

IaaS PicIaaS is certainly not a new concept. It has been around for a while. But it does merit a re-visit every now and then, since many healthcare organizations still struggle with integrating multiple systems and data sources.

At the core of IaaS is the concept of developing a common data model (also known as a canonical model) using schematic mapping and master data management. The common data model that is exposed represents multiple autonomous information sources that organizations use in order to transact business on a daily basis. Read the rest of this post »

Healthcare Benchmarking – Part 1 of 2

I am an avid sports junkie. I literally wake up and fall asleep watching SportsCenter. Last month, while watching the NBA Finals (Go Spurs!), I concluded that sports and healthcare have a lot in common. Sport, is a “physical activity that is governed by a set of rules or customs and often engaged in competitively1.” If we simply swap out the words physical activity for medical practice(s) in the aforementioned definition, we would be describing today’s healthcare organization, no?

For me, the parallel of the two industries really lies in their competitive nature-seeking to be the best. The whole premise of sports is to encourage competition, to be the world’s best Healthcare Benchmarking - Part 1 of 2player, team, or country. Similarly, the healthcare industry encourages competition by seeking the best physician, practice, health system, equipment, outcomes, cost and efficiencies. However, you cannot be the best unless you know what “best” means. What is the threshold you are comparing yourself to in order to be called the best? What are the weaknesses that are holding you back from being the best?  What is the benchmark for best?

In sports it is a little easier to identify. For example, after six titles, five Most Valuable Player awards and 10 scoring titles, Michael Jordan is considered to be the best player of all time. He is the benchmark of greatness in the sport of basketball-he is what all other players aspire to be and what they evaluate themselves against. Unfortunately, in healthcare it is not as easy, as these types of statistics are not as readily available. However, in recent years, in an effort to help define and understand “best”, more and more healthcare organizations are finding value in benchmarking as a tool to assess their current thresholds and a way to improve their process and overall performance in an attempt to be the best.

In this blog post, you will be provided a general overview of benchmarking. In the next blog post we will take a closer look at the actual process of benchmarking. Read the rest of this post »

ACA’s Quality Rating System – An opportunity to gain market share

Starting in 2015 all issuers of Qualified Health Plans (QHPs) on the Healthcare Marketplace will need to provide Quality Rating System (QRS) measurements that will be aggregated and scored to provide consumers with a star rating for each product offered.

How many stars will you have?

How many stars will you have?

Although there are still details to be worked out by CMS, the required measures for the 2015 beta test are in place. All issuers that wish to continue providing QHPs on the Marketplace will need to provide the required measures. There are two different sets of measures included in the beta specifications.

The first is a set of clinical quality measurements that are mostly taken from the current NCQA HEDIS accreditation process. Many issuers already collect the data for these measures; especially, if they are meeting the requirement to be accredited for the Marketplace today and are using NCQA for that process.

The second is set of measures derived from an enrollee satisfaction survey (ESS) that needs to be performed by an accredited third party survey vendor. Most of the questions in the ESS are drawn from CAHPS. The survey processes requires that a sample of data is drawn, audited by a third party and provided to the survey vendor. The vendor then performs the survey and reports the results to CMS. Questions focus on rating an enrollee’s satisfaction with a plan over a six month period.

While the QRS initiative driven by the ACA attempts to provide transparency, it also creates a competitive market that will force issuers to look at ways to increase the quality of care and enrollee satisfaction to deliver better scores. The prize? For consumers, better products. For issuers, a larger share of the market.

Want to participate and win? Then you need a solution that not only provides the required measures, but also provides insight and the ability to drive quality improvements. This can be accomplished with a well thought out solution architecture that provides processes for delivering the measures and the means for analyzing data to drive improvements.