Perficient Healtchare Solutions Blog


Archive for January, 2011

ACO: “If you build it, they will come”. Really? Not without a Payor Marketing Plan.

There is an ACO belief out there that “if you build it, they will come.”  This belief is all based on honorable intentions for the patient and our communities.  I just want to know what marketing plan and mobile application was used to contact all the baseball fans to go to Iowa in the movie “Field of Dreams”.  Also, what was setup to make this sustainable for each State resident?   Oh, and who and what system is matching fan to phone number (i.e., record), verifying that the population was managed fairly, with safety as number one, streamed-lined, and fan experience was tracked for opportunities for improvement?
If we continue with reality and the “Field of Dreams”, then fans had to have the money to take this trip, insurance if the trip exceeded what they could afford, or Medicare/Medicaid to cover the trip cost.  There must have been an IT Infrastructure and Financial Operations of some sort.
The good news is that the Healthcare Industry is stepping up to the plate.  No pun intended. Payors, Providers, and Facilities are coming together to develop the organization, IT infrastructure, quality contract, and coordination to “build it”, the ACO.  There is no bad news…. it is just hard IT and process work with a fantastic cross-functional and cross-companies organizational change management plan.
However, I keep thinking about the marketing plan.  Who is developing the marketing plan to reach the fans?  Is it going to be the ACO to get patients… wait is the ACO going to have a health plan?  Is it going to be the health plan that has a network of ACOs?  Is it Medicaid/Medicare or the government?  What is going to motivate the healthy patient to want an ACO as the network for their health plan?  What is going to motivate the patient with a condition to have their life or condition monitored with expectation of their participation level?  Patients will want to become healthy, but what is going to motivate them to change their behavior (e.g., lifestyle changes) to stay at the best possible health level?  Some patients will be fine with only meeting 5 out of 10 outcomes as a positive.

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“Help! We are getting a late start on 4010 to 5010 migration . . .”

If your healthcare organization is getting a late start on 4010 to 5010 migration, you are not alone.  While you should be testing the new 5010 transaction sets with trading partners already, you may just now be getting budgetary funding to pursue a solution.  At Perficient, we understand the challenge of catching up to meet regulatory deadlines and we have created a solution using our partnership with Edifecs.  The approach is to create a “wrapper” around your inbound and outbound electronic transactions with what we call the Step Up/Step Down solution.  This solution will intercept the inbound 5010 transactions and step them down to 4010 for processing with your current healthcare IT applications.  When those same applications generate outbound 4010 transactions, then they are stepped up to 5010 for sending to your trading partners.

This approach has many advantages for organizations that are short on time to implement a full 5010 remediation effort or simply have too many competing IT projects, like implementing a new EMR or claims processing system.  One of the key advantages is the ability to buy your organization time to remediate internal IT systems in a phased or systematic fashion, especially if you have limited IT personnel or budgets.  Another advantage is that the Step Up/Step Down solution will accept either 4010 or 5010 transactions inbound or outbound.  This capability provides flexibility as your trading partners work to meet regulatory deadlines as well.  The third advantage is that this solution keeps all of the 4010 and 5010 transactions in a repository within the tool.  This data repository allows the creation of reports to make sure that billing and accounts receivable are correct and balanced despite the migration.  We believe this key advantage helps the CFO sleep at night.

If your organization would benefit from any of these advantages in your 4010 to 5010 migration, please attend this week’s Perficient webinar entitled “HIPAA 4010A1 to 5010 Migration: Rapid Compliance with a Step-up/Step-Down Approach” on Thursday, January 27, 2011 12:00 PM – 1:00 PM CST.  We plan to discuss the details of this solution, the pros/cons and provide a live demonstration of the solution.  Don’t miss it – it could save your organization stress, time and money.  Register at:

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Posted in Interoperability

Getting Patients and Clinicians to Speak the Same Language

(via ePatientDave)

You know how in science fiction movies the alien/human language barrier is overcome by some tiny electronic universal translator that instantaneously allows each party of a conversation to speak and listen in their native language?  Google’s new voice-enabled Google Translate app (currently available for Android, iPhone likely coming soon) brings us one step closer to that reality.  As the above video by emergency medicine resident Graham Walker shows, the app listens to a user’s words in one language and, once the user has verified the accuracy of the voice recognition, plays back the translated audio.  While not quite instantaneous, it can greatly reduce the communication barrier that arises when patients and clinicians literally don’t speak the same language.

Taking a step up one level, I think this is where a lot of the promise of healthcare IT lies–in breaking down communication barriers.  In fact, that’s the one thing that the other cool new technologies we’ve covered recently here–devices for tracking weight and blood pressure, social media for sharing blood glucose readings, iPhone cases for recording arrhythmias–all have in common.  They all help facilitate communication between patients and clinicians, or patients and other patients, or patients and healthcare technology manufacturers.

What are some other great examples of healthcare technology breaking down communication barriers between patients, clinicians, administrators, insurance providers, etc.? More importantly, how is your healthcare technology application breaking down these barriers?

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Posted in News

Hashtag Empathy – Using Twitter to Listen to Patients

We at the Perficient Healthcare IT blog are big proponents of social media.  As Liza recently outlined, social media offers numerous ways to find information and develop and deepen relationships.  Along those same lines, I think social media offers some great tools for cultivating empathy.

What do I mean by empathy? Dev Patnaik literally wrote the book on empathy in business (for an overview, see this video), and his main point is that employees imbued with an empathic understanding of their customers can gain an intuitive understanding for what customers want, and in turn create products that customers love.  Such an intuition doesn’t come from reviewing surveys or analyzing spreadsheets; rather, it comes from engaging with customers and participating (to the extent possible) in the same experiences as them.

Social media makes this easier than ever.  On Twitter, there are thousands (millions?) of Tweets from patients—the ultimate customers of healthcare—talking about how their lives have been impacted by health conditions and the technology they use to deal with those conditions.  Perhaps the most popular example is the hashtag #bgnow, a hashtag used by diabetes patients to share their blood glucose levels and talk about their experience using blood glucose meters.  The company Log for Life has even put together a data aggregation page (pictured above) that displays, in real time, a graph of blood glucose levels tweeted by patients from around the world.  Even without a popular hashtag such as #bgnow (or #bgwed, for blood glucose readings on Wednesdays), with a quick Twitter search you can listen to what patients are saying.  For example, searches for key phrases such as “pacemaker” or “my mri” yield dozens of recent Tweets.  You’ll have to wade through some noise (for example, there’s a portable music player called the “Pacemaker”), but within a matter of minutes you’ll see real people voicing emotions ranging from concern and anxiousness to excitement and even a sense of relief.

To be sure, spending a few minutes on Twitter is no replacement for spending face time with patients, and there’s really no way to truly understand what patients are going through without actually experiencing the same ordeal.  But social media tools like Twitter make it easier than ever to at least get a basic appreciation for how patients are affected by healthcare technology.

Twitter Weekly Updates for 2011-01-16

Posted in News

Consumer-Driven HIE: Start the talk on the Cul-de-sac

I think the largest constituent missing from the Health Information Exchage (HIE) is the consumer, the tax payer.  I am talking about the average person who doesn’t live and breath EHRs, security, technology, and the Healthcare industry. The focus has been on getting providers with a carrot and stick to implement EHRs and Meaningful Use driven by the Federal and State Governments to create the exchanges.  All good, but if you are the average person reading this blog and talking on the cul-de-sac…. I just lost you.  No one has provided the value proposition to the consumer, the tax payer; other then, it is old, archaic, high risk for medical errors, and being forced by the government.

Now that HIEs are kicking off roll-outs at the State level, we should start now with our friends and neighbors, on explaining what is and how an HIE will change our world for the better.  If we are going to move providers to EHRs and Meaningful Use, it is going to take the average person who starts to evaluate the providers on a new criteria which is EHR adoption and the HIE of a person’ medical information for any reason.  The reasons need to be presented as classic business scenarios to our friends and neighbors.

For example,

Dad and/or Mom and the kids move and the primary insurance carrier has changed since the move is generated because of a new job and company.  Thus, a new provider is required and all the patients history has to be requested from the old to new provider with Mom and/or Dad wishing this could be complete before the first appointment or emergency room treatment..  Remember we are talking kids.  What else is Mom and/or Dad worrying about?  Read the rest of this post »

The iPhonECG – Empowering Patients with Specialized Medical Data

The above video is a sneak preview of AliveCor’s iPhonECG, and is brought to us by, a brand new site devoted to categorizing, describing, and organizing medical apps.  The iPhonECG has gotten a lot of well-deserved press, with many commentators remarking that the device is “proof that we are living in the future.”  Indeed, the iPhonECG has a lot of potential and is an example of a technology that can help patients participate in their own healthcare.

The brilliance of the iPhoneECG is that, since it’s coupled to the one device people tend to bring everywhere, it dramatically increases the odds that a person who may be experiencing some abnormal heart rhythms will actually capture a recording of it.  Once the rhythm is recorded, patients are empowered with data that they can present to their physician and ask, “Please take a look at this rhythm–is there anything going on here?”

I think that the iPhonECG, like less-specialized connected health and wellness devices, could help drive the adoption of PHRs and EHRs. However, I think that there’s an even greater potential for specialized devices like the iPhonECG to directly demonstrate their clinical value.  For example, the iPhonECG may allow a patient who is taking an active role in her own health to document an arrhythmia earlier and with less cost and hassle than relying solely on traditional means (a physician-prescribed Holter monitor or 12-lead ECG).  This could in turn lead to earlier intervention and treatment and maybe even improved outcomes.  In this respect, the iPhonECG is not so much a replacement for traditional means of arrhythmia detection but rather a supplement that gives the person that spends the most time with the patient–the patient herself–the tools to monitor her own heart rhythm and ultimately improve her own health.

With powerful yet easy-to-use specialized tools such as the iPhonECG, patients have yet another incentive to get involved in their own healthcare.

Healthcare IT and the iPhone Effect

Today’s big news is that the iPhone will soon be available on the Verizon network, and Verizon was quick to reassure potential customers that its 3G network is ready for the onslaught of new iPhone users. The chart pictured above shows the impact of the iPhone 3G on the AT&T network (source), an impact that was not anticipated by AT&T (as anyone with an AT&T iPhone can surely attest).

The reason I bring this up is simply to point out that when a product like the iPhone comes along, a product which helps users do not only the things they need to do but also the things they hadn’t yet realized they wanted to do, the adoption rate (and usage rate) of that product can exceed even the wildest expectations of industry observers.  People who didn’t even think they wanted a smartphone were enticed into buying (and then exhaustively using) an iPhone.  Not convinced, but enticed—an important distinction.  The iPhone didn’t rely on marketing gimmicks or slick salespeople—its compelling user experience sold itself.  This is what I mean by the “iPhone effect.”

Contrast that with the state of healthcare IT, where policymakers—frustrated with the slow adoption of EHRs—have resorted to paying health care practices (via HITECH incentives) to use EHRs.  While the adoption curve is certainly moving in the right direction, I believe the best way to increase the rate of EHR adoption is to leverage the iPhone effect. Make life easier and more enjoyable for clinicians through an EHR that is intuitive, useful, and engaging, and the EHR experience will sell itself.

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Posted in News

Microsoft Surface live at Perficient!

Microsoft Surface wowed at CES and there’s been considerable buzz about the technology, new form factors and reduced price ever since. I initially had the opportunity to see Surface in action at the Microsoft World Partner Conference in 2009 and had the opportunity to learn about some Surface Healthcare applications when the Texas Health Resources team shared what they are doing with Surface with me.

Next week I head out to Costa Mesa to meet with new colleagues from Perficient’s speakTECH acquisition and will have the opportunity to check out the Surface in the office!  My new Perficient colleagues have been working with Microsoft’s Surface technology for some years now across multiple applications & industries including Education, Transportation, Media & Entertainment & more.

I’m looking forward to learning more about Surface from my new colleagues and to seeing what Surface projects are on the horizon – with the new form factors & price point I’m guessing we may start to see increased interest it what can be accomplished using this neat technology!

If only it were more portable it could bring a whole new dimension to interactive homework… What do you think about Microsoft’s Surface technology & it’s applications?

Is HIPAA 5010 Compliance making you feel like this guy?

Join us Thursday, January 27, 2011, 12:00 PM CT for HIPAA 4010A1 to 5010 Migration: Rapid Compliance with a Step-up/Step-Down Approach

Register at:

As part of the final rule for HIPAA 5010 implementations, CMS has defined specific milestones that help healthcare organizations evaluate their progress towards compliance.  Many organizations have just now begun the work needed to achieve Level 1 compliance — the ability of an organization to test externally by January 1, 2011.  This entails an organization sending and receiving HIPAA electronic transactions without impacting payments to providers.

Healthcare organizations are looking for ways to achieve HIPAA 5010 compliance while controlling scope, cost and risk. A “Step-Up/Step-Down” strategy is a viable approach to achieving this. With a step approach, organizations accept a valid inbound 5010 transaction, map to their version of the 4010A1 (the “Step-Down”) and allow the current healthcare applications to process the transaction as they do today. For outbound transactions, the solution will take the file as processed by the core systems and map back to the 5010 version (the “Step-Up”), leveraging data from the original transaction.

Join Perficient as we discuss how a Step-Up/Step-Down implementation approach can help meet urgent migration needs:

  • The business case for Step-Up/Step-Down 5010 migration as a solution that is cost effective and allows application remediation for ICD-10 in controlled phases
  • Assess a market-leading EDI 5010 software product that supports Step-Up/Step-Down for rapid implementation
  • Justifying an investment with examples of how EDI 5010 can address other needs within the healthcare organization

Presenter Martin Sizemore is a Senior Solutions Architect of Healthcare Solutions for Perficient and has been a trusted advisor to CEOs, COOs, CIOs and senior managers for global multi-national companies and healthcare organizations.

Register at:

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Posted in Interoperability, News

Personal Health Data: Giving Patients and Doctors Something To Talk About

One of the most intriguing movements in the healthcare industry today is participatory medicine. Participatory medicine holds a lot of promise and seems to be gaining momentum among both patients and healthcare professionals. Nevertheless, participatory medicine is far from the standard of care, and one of the biggest barriers is actually getting patients interested in their own health.

Personal Health Records (PHRs) seems to be the strategy that insurance companies and tech giants like Microsoft and Google, as well as their partners at hospitals, clinics, and pharmacies have pursued as a way to engage patients. The thinking seems to be, “If you build it, they will come.” And indeed, early adopters have. By April 2010, 7% of Americans were estimated to have used a PHR. This is a respectable number for a relatively new product line, but unfortunately the data on which this number is based doesn’t include details on how often PHRs are used, or how many of those that have used a PHR routinely do so. I suspect the number of routine users of PHRs is somewhat lower.

In retrospect, it seems that the “if you build it, they will come” mentality of PHRs was a little like putting the cart before the horse, especially given the ambiguous nature of the data made readily available to patients. It’s like patients were being asked to go straight from having an occasional curiosity about a medical condition to being completely immersed in every detail of their medical history.

Perhaps a more effective strategy to getting patients interested in their own health care is a bottom-up approach that starts small and then lets patients build from there. Specifically, I think that simple, easy-to-use wellness devices with network connectivity may be one way to get people more interested in their own health. There are some really cool wellness and fitness monitoring devices hitting the market, including FitBit, Basis, and Nike Plus. There are even some exciting devices such as weight scales and blood pressure monitors (the Withings blood pressure monitor is shown above) that combine beautiful design with network connectivity to offer users a vastly improved value proposition to monitor their health. To top it all off, these connected devices are beginning to integrate themselves with PHRs!

An increase in the amount of health and wellness data collected by patients has the dual benefits of (1) increasing the utility of PHRs for patients, as now patients have a reason to routinely login and use PHRs, and (2) increasing the utility of PHR-EHR connections, as now physicians can benefit from viewing the data collected (for free) by patients. In other words, the data gives the patient and physician something to talk about. The data and the patient’s activities in collecting the data provide a starting point for collaboration and shared decision making, two essential components of participatory medicine.