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During our interview with Jim Weeks (@jimmyweeks), VP of Information Systems at Yale New Have Health Systems, he highlighted the rapid change occuring in healthcare technology and outlined the compelling trends in Virtual Desktop Infrastructure (VDI) and Cloud Computing. Jim found the trend of “a lot fewer pocket protectors and a lot more stethoscopes at HIMSS11” to be refreshing. With the rapid change occuring in the health IT landscape, it is important to educate the end users of these important technologies.
Archive for February, 2011
Perficient Interviews Jim Weeks, VP of Information Systems at Yale New Haven Health Systems
by Melody Smith Jones on February 28th, 2011
Healthcare Analytics and Meaningful Use with VIDEO
by Melody Smith Jones on February 28th, 2011
Perficient interviewed Janice McCallum, Managing Director of Healthcare Content Advisors, at the 2011 HIMSS Conference and Exhibition. Janice spoke of the impact that meaningful use has on healthcare analytics. Meaningful use creates the infrastructure and content that allow for increased use of business intelligence in healthcare settings.
EHRs dramatically increase both the volume and integrity of healthcare data. This data can no longer just be collected and reported. It should be analyzed to identify and act on opportunities for improvement. This efficient and effective use of healthcare data can ultimately lead to improved clinical outcomes and new forms of medical research.
Accountable Care: The Next Generation in Healthcare Delivery
by Erin Moloney on February 24th, 2011
“Accountable Care Organization” (ACO) was a popular buzz word at HIMSS 2011, which is concluding right now in Orlando, FL. What is an ACO?
An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Under the new law, ACOs would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.
The ACO initiative is scheduled to launch in January 2012, but the race to form ACOs has already begun.
- Source
John White, Director of the Healthcare Practice at IT consulting firm, Perficient, Inc., was interviewed by our healthcare marketing manager, Melody Smith Jones at HIMSS this week (video below).
John discusses three critical trends in Accountable Care Organizations rising as the next generation of healthcare services.
- Meaningful Use
- Bringing all of the people within the healthcare system together and making them accountable, including:
- physicians
- health systems
- care providers
- consumers - Platforms emerging that ask:
- How do we connect and share?
- How do we enable and promote accountability?
- How do we create a smart healthcare system?
John makes an important point that consumers are also being encouraged to become more accountable. We are all consumers, and we are responsible to some degree for our own quality of care where possible, including evaluating costs and comparing providers, as well as managing our own health.
John concludes that enablement is possible. Watch the video below. What do you think? What did you notice at HIMSS 2011 about Accountable Care?
Learn More:
From Our Blog: Accountable Care Organizations: Will we be reading in 2011 “Community ACOs Partner with Large Carrier”? by Christel Kellogg
9 Key Drivers to Enterprise Health Information Exchange (Enterprise HIE)
by John White on February 24th, 2011
Many view the implementation of Enterprise HIE as a technology-based initiative. However, the ultimate goal of the Enterprise HIE is to improve the quality of care for patients across a given area, reduce the costs of providing quality care, and enable clinicians in their care processes. In the Perficient white papers “A Business Driven Approach to Healthcare Reform“ and “9 Key Drivers of Healthcare Enterprise HIE” we explore the concrete organizational drivers of Enterprise HIE in great detail. These drivers include:
1. Ensuring appropriate care is given at the correct time: Enterprise HIE is ultimately driven by the clinical goal of ensuring that the appropriate level of care is provided to patients in a timely manner. As such, a successful Enterprise HIE must be secure, accurate, dependable, appropriate and responsive to the needs of the users of clinical information to ensure that the appropriate care is delivered.
2. Promoting preventive medicine: Preventive medical services traditionally occur within a conglomerate of divergent clinical care settings. An appropriate Enterprise HIE solution must drive disease-management programs to 1) promote preventive medicine services and 2) reduce the costs associated with these critical health care services overall.
3. Avoiding inaccurate person identification for services: The key to making any Enterprise HIE work is identifying and managing a unique personal identifier that can be used to connect one citizen across a diverse network of care providers. An incomplete – or worse, inaccurate – master person or provider index is a source of serious concern. Though it can be difficult to create this unique identifier across diverse systems, there are two broad options for managing unique identifiers in an Enterprise HIE system.
4. A self-sustaining business model: An Enterprise HIE must be born from a strong business model that is self-sustaining and not overtly dependent on grant funding alone in order to be successful. With the advent of healthcare reform, this strong business model will provide an efficient foundation upon which many more citizens can be incorporated into the existing ecosystem as will be required.
5. Decreased reliance on paper: The U.S. healthcare system is run by highly skilled people that are using outmoded forms of communication. Many clinicians still use paper files and faxes to communicate and lack the basic infrastructure to communicate efficiently regarding critical care decisions. Ultimately, an introduction of EMR will lead to dramatically increased efficiency and more exacting communication around critical patient care decisions.
6. Allowing physician practices to focus on core competencies: Healthcare practices should use the bulk of their critical resources to maintain the core competencies that drive their success. It is critical to connect doctors, specialists, clinics and hospitals electronically in order to gain the same level of safety and productivity that other industries currently realize in order to gain competitive advantage and drive efficiency.
7. Electronically moving clinical information among disparate systems: The Enterprise HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. HIE is also useful to public health authorities to assist in analyses of the health of the population.
8. Continuity of care with multiple providers: Enterprise HIE systems facilitate physicians and clinicians in meeting the highest standards of patient care through electronic participation in a patient’s continuity of care among multiple providers. A successful Enterprise HIE effectively pays for itself by decreasing the costs associated with delivering optimal care.
9. Leveraging government focus: As a result of government focus and funding, formal organizations are now emerging to provide both form and function for health information exchange efforts. These formal organizations include both independent enterprises and Regional Health Information Organizations (RHIOs).
Today, there are enough government incentive dollars to consider this as a high priority in terms of assisting a healthcare system in deferring the initial investment. However, the competitive advantages and the alignment with the physician and patient population that are within your service area are a very compelling business case for making the commitment to implement an Enterprise HIE solution. The increase in healthcare services, physician alignment, patient satisfaction and cost reduction while improving the outcomes of the delivery of healthcare services makes the need for an Enterprise HIE solution a necessary and immediate need to help your healthcare system or state government agency become relevant and viable for the long term.
How Social Media is Booming at HIMSS 2011
by Erin Moloney on February 24th, 2011
Perficient Interviews HIMSS 2011 Social Media Center Managers, Cesar Torres and Cari McLean of HIMSS, to talk about this year’s social media trends at the conference, Twitter, hash tags, and tips for getting started in social media.
How are you using social media in your healthcare IT or enterprise technology career?
Healthcare Analytics Come of Age at HIMSS 2011…Sorta
by Michael Faloney on February 23rd, 2011
Looking through the sessions at HIMSS 2011, one can see a wide range of topics related to business intelligence and analytics. From different uses for BI to different types of presentation vehicles to the potential of use predictive analytics, one will not be at a loss for finding something analytics related to sink their teeth into. It finally looks like organizations are truly realizing the power that leveraging their data can bring them.
However, in the rush to pursue analytics, organizations must realize that the value it can bring is directly related to the quality, timeliness, completeness and accuracy of the underlying data. Putting analytics on bad data is like putting lipstick on a pig. No matter how much you dress it up, it’s still a pig. In fact, putting analytics on inaccurate, incomplete or stale data can often be worse than not having analytics at all. Consider the situation in which clinicians are using near real-time analytics to help improve outcomes. Bad data will have a negative effect on the analytics presented, but, more importantly, it can have a negative effect on patient safety.
So does this mean that organizations should be hesitant to pursue analytics? Not at all. The benefits to be derived in a competitive healthcare landscape are far too great not to be using analytics to its fullest potential. What it does mean is that just as much care should be taken to put in place a framework to insure the accuracy and completeness of the data. To this end, organizations should consider the following critical aspects of healthcare business intelligence in addition to the reporting and analytics capabilities.
Governance
This is a term that often receives bad press. Many organizations have tried to implement enterprise governance and failed, while others don’t know how to get started. To understand how critical this is, find someone at HIMSS 2011 who works for an organization that has successfully implemented this. I suspect they will tell you the effort was well worth it. Governance provides the enterprise view necessary to truly implement work class analytics.
Master Data
This is another area in which many organizations have either neglected putting the effort into or have done so with a very narrow focus. Master data is the glue that binds organizational data. From common definition for core functional domains (ex. Patient, Physician, etc.) to enterprise hierarchies (roll-up or aggregations of data) to standard reference data (Ex. diagnosis codes, procedure codes, etc), having enterprise master data drives improved analytics.
Data Integration Framework
Having high-quality, timely and accurate data is the foundation for analytics. Data is being derived from more sources today than ever before. From internal clinical, financial and administrative systems to industry organizations to HL-7 messages to manual data, the integration of data in healthcare can be a daunting task. Many organizations are feeling the effects of building so many point solutions in the past. However, the integration of data does not have to be as complex as some make it out to be. Having a strategy in place that clearly defines an integration roadmap and implementation framework, doing the proper analysis and quality checking and taking an incremental approach to implementation reduces the effort and risk.
Phased Roadmap
In the rush to implement analytics, many organizations bite off more than they should. The big-bang approach doesn’t work. It is a much better approach to create a strategy and roadmap that allows for a phased implementation of analytics based on business priorities. This not only allows for the faster realization of critical analytics capabilities, but also provides the flexibility to react to changing priorities and business conditions.
Analytics are an essential component to any world class healthcare organization. However, care should be taken to ensure the proper foundation is put in place to ensure you realize the full benefits.
Is Tokenization the solution for Protected Healthcare Information (PHI)?
by Martin Sizemore on February 22nd, 2011
One of my favorite things about the yearly HIMSS conference are the discussions that occur around new ways the healthcare technology community is dealing with the issues that arise as a result of increased innovation. With medical identity theft looming, issues of the transmission of personal healthcare information over the Internet or the desire to share detailed medical records between medical institutions – a health information exchange, the time has come to find a solution besides encryption which simply may not be enough. The credit card industry has addressed the issue of protecting credit card and e-commerce transactions with a process called tokenization. Tokenization technology can, in theory, be used with sensitive data of all kinds including bank transactions, criminal records, vehicle driver information, loan applications, stock trading, voter registration, and, most importantly, medical records.
Tokenization is the process of replacing sensitive data with unique identification symbols that retain all the essential information without compromising its security. Tokenization has become popular as a means of bolstering the security of credit card and e-commerce transactions while minimizing the cost and complexity of compliance with industry standards and government regulations. With increasing regulation of protected healthcare information, tokenization is the right technology to address the transfer of sensitive information over public or private networks.
In a credit card transaction, a token typically contains only the last four digits of the card number. The rest of the token consists of alphanumeric characters that represent miscellaneous cardholder information and data specific to the transaction underway. When an authorization request is made to verify the legitimacy of the transaction, the actual card number is used only in the initial request. The token is returned to the requester instead of the card number along with approval or rejection of the transaction. The token is stored in the point-of-sale (POS) system but the credit-card number is not.
Tokenization makes it more challenging for hackers to gain access to cardholder data, as compared with older systems in which credit card numbers were stored in databases and exchanged as visible text over networks. Tokenization improves on encryption technology by keeping sensitive information out of the data stream. With the proliferation of identity theft and the consequent increased risk of ruinous civil and criminal proceedings, many corporations are turning to tokenization to minimize exposure and cost while maximizing their own security and that of their customers. Healthcare needs to adopt the same technology for protected healthcare information (PHI).
Protected health information (PHI), under the US Health Insurance Portability and Accountability Act (HIPAA), is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. This is law can be interpreted rather broadly and includes any part of a patient’s medical record or payment history. Protected health information includes the following list of 18 identifiers must be treated with special care according to HIPAA:
- Names
- Addresses smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes
- Dates (other than year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
- Phone numbers
- Fax numbers
- Electronic mail addresses
- Social Security numbers
- Medical record numbers
- Health plan beneficiary numbers
- Account numbers
- Certificate/license numbers
- Vehicle identifiers and serial numbers, including license plate numbers;
- Device identifiers and serial numbers;
- Web Uniform Resource Locators (URLs)
- Internet Protocol (IP) address numbers
- Biometric identifiers, including finger, retinal and voice prints
- Full face photographic images and any comparable images
- Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)
The big question is how to implement the tokenization of protected healthcare information? The short answer is make it a “service” in a service-oriented architecture that talks to a tokenization server (redundant, of course). The tokenization server would contain the 18 or more key protected items and their corresponding tokens. The service would retrieve the protected information temporarily for healthcare applications and updates, but would prevent local storage of the information to maintain control. This tokenization process would be implemented in conjunction with an Enterprise Master Patient Index (EMPI) system for a healthcare organization. The centralized server for protected health information would allow stronger security controls within an organization as well.
An implementation of tokenization will be a step-by-step process for a large healthcare organization and it will need to become seamless to key applications delivering patient information within security guidelines. Some of the key steps to implementation will include:
- Data discovery – creating an inventory to discover all of the places where protected healthcare information currently exists
- Legacy data conversion – an examination of the databases, data warehouses and side systems in use throughout the organization
- Token development and format – creating tokens in a way that fits easily into existing systems and doesn’t create confusion for other identifying numbers
- Business rules modifications – modifying existing healthcare or medical records application software to use the tokenization service versus storing the patient information locally.
Will there be challenges from implementing tokenization? Most certainly, however the risks and the potential for costs associated with the loss of regulated data can be exponential. Let’s take a lesson from the credit card industry and address this critical issue before it becomes a legislated issue.
If you would like to discuss this tokenization idea or other healthcare-related topics, please stop by Perficient’s booth (#3681) at HIMSS on Monday, February 21, 2011 from 1:30 p.m. to 3:00 p.m. or Tuesday, February 22, 2011 from 2:00 – 5:00 p.m. See you there!
HIMSS & Health Information Exchange
by John White on February 22nd, 2011
Another hot topic at this year’s HIMSS conference is Health Information Exchange. With the advent of healthcare reform and the passage of the American Recovery and Reimbursement Act (ARRA), healthcare systems and state and local government agencies are being confronted on how to exchange health information to those who can impact the delivery of care while empowering those who receive that care. We also know that stimulus dollars are currently being provided to incent healthcare organizations to store and exchange clinical information via a digital electronic health information highway. Whether you are a state or local government, public health organization or a healthcare system, the exchange of clinical information will be critical to meet both regulatory and business viability in the future.
Many Healthcare systems are finding themselves in an ever increasing competitive environment. The pressure of reducing reimbursements, aligning more effectively with the affiliated physicians and being relevant to the patient population are just a few of the challenges. In addition, with the advent of healthcare reform, the potential changing reimbursement models and the emerging Accountable Care Organizations (ACOs) are creating an environment where clinical and cost information are needed to empower and engage those that are part of your overall healthcare system deliver model.
But healthcare systems should not be the only ones considering how to exchange and consumer clinical information. If you are a state of local government agency, you too need to recognize how a Health Information Exchange (HIE) can be an important part of establishing partnerships with the citizens and healthcare systems within your geographic area. In addition, the empowering the public health agencies for that area can help drive more effective disease management programs and the associated healthcare services to those target areas for most effective results. By establishing such an environment, a state or local government can obtain federal stimulus dollars over the next three to five years and establish an environment to protect against the impending reimbursement reductions to those healthcare providers who do not have such a public exchange network.
We would love to meet you and discuss how Perficient’s healthcare practice and solutions can assist your organization. It you are interested in learning more about how to become a more viable and world-class healthcare system, please visit us at our HIMSS Booth No. 3681. You can also view Perficient white papers on Enterprise Health Information Exchange.
Experts at HIMSS 2011 Discuss Social Media Use for Providers
by Erin Moloney on February 22nd, 2011
Panelists, From Left: David Kibbe, John Sharp, John Marzano
I attended the “Meet the Bloggers–Provider Edition” session yesterday at HIMSS 2011 where the goal was to understand the experiences of providers with social media. Rich Elmore (@richelmore and @allscripts), VP of Strategic Initiatives at Allscripts moderated the panel. His blog is Healthcare Technology News.
The panelists included David Kibbe, Senior Advisor at the American Academy of Family Physicians
(The Health Care Blog, Kaiser Health News), John Sharp, Manager, Research Informatics, Cleveland Clinic (@johnsharp, @clevelandclinic, Facebook), and John Marzano, VP and Chief Communications Officer of Orlando Health (Facebook, YouTube).
Here are my notes from the session. While these are not direct verbatim quotes from these experts, I think you will find their insights valuable:
Rich Elmore: How did you get started in social media?
David Kibbe: We started by meeting a desire providers had to find another family physician like him or her who had had success using EHR
Primarily used a list-serv via email, and meetings, phone, traditional communications, but the listserv went from 38 doctors to 1200 physicians in 1 year, creating thousands of conversations around EMR each month
John Sharp: Waded into social media over time. Initially independent efforts initially – a physician here, a nurse there, and a few people in IT, doing sort of unofficial things. Our Chief Marketing Officer really saw that this was going to take off. In Feb 2009, he developed a strategy with both public and corporate communication and marketing people and then bbrought in people like myself who were already actie in social media to develop a social media committee – work group – and a social media policy.
Approached doing a top down approach, because until that time had been a bottom up. CMO presented a strategy to the board of directors. Because we’re a healthcare organization trying to have a national presence, he made the case that this would help our national efforts as well. It is worth doing, he proved we could put the safety controls in place. Facebook presence, Twitter for physician chats, and a big emphasis on wellness, which is core to our organization.
John Marzano: Local economy was one of the main triggers for us. Florida was hit harder than a lot of areas of the country. Our local news media was disappearing. Reporters were getting laid off. There wasn’t a good resource there to pitch stories to. What are some other tactical options we can use to get our story out and tell our story.
We began to look at Facebook & YouTube because of the use of video. Our news team then became news producers instead of news producers. They began spinning our story the way we wanted to without having to pitch something in a controversial angle just to get the news coverage. I was blessed to have one of two twenty-somethings on our team.
We don’t look at this as the be-all and the end-all. It’s just another tacitc that we utilize as part of telling our story. We’re blessed at Orlando Health for having some great brands within a brand. To be able to effectively tell our story has been very advantageous for us. We’re just short of 9,000 fans on Facebook. Close to 59,000 hits on our YouTube site.
Rich Elmore: From a provider perspective, are you seeing much patient response?
John Marzano: The biggest hits we get on our YouTube site are prospective patients trying to get an idea of what the facilities are like. You can really show the facilities and really tell our story in less than 4 minutes. These are beautiful videos – this is our most popular type of video. It’s another way to communicate and interact with patients – people who want to learn about your services.
David Kibbe: About 25% of our members now use web portals in their services. With stage 1 and particularly stage 2 meaningful use in the next 5 years, this will grow significantly. What are the safety controls you’ve put in place?
John Sharp: Good social media policy should be in place. Also, limited or controled number of people who have access to the corporate accounts who know the party line and help stick to the party line. Complaints about their billing office, but they say you just have to respond.
Rich: What role will participatory health play in social media?
David Kibbe: That’s a huge question. As one of the co-founders of the participatory medicine movement. Participatory medicine is more than any particular kind of social media. It’s about real exchange between providers and patients and betweem patients and family members in a way that is real and meaninful. It is something that can be enabled by health information technology, but HIT and social media technology in and of itself is not sufficient to make it happen.
John Sharp: EMR and EHR have not yet converged with social media. I think this will happen i nthe net couple of years, nad I can envision a time when through your EHR you can actually be connected with others of the same disease or condition by decision – you have to choose to connect – a Twitter feed or similar. This is particulalr y in high demand in diabetes.
In rare diseases, we often see a lot of people interacting via Google groups and blogs. Our patient education people were very active in socail media. They connected with these communitieis and actually organized a meet-up at our hostpicatl. Patient meetups around a specific condition is a real opportunity in the future.
John Marzano: People fear coming to the hospital. It’s not always a desirable place to go. If we engage them in their home, it’s going to create a more synergistic relationship before the experience or utilization occurs.
Increased Focus on Governance at HIMSS 2011
by Michael Faloney on February 21st, 2011
As I look over the various sessions and presentations for the 2011 HIMSS conference, I’m excited to see an increased focus on data governance as a topic. At the same time, I ask myself “is it enough?”
Data governance in healthcare (especially in the provider space), has often been a neglected and forgotten critical component for success. Organizations are either too silo’d, have distributed operational authority, or have resources spread so thin to effectively address governance. Unfortunately, not implementing governance is just perpetuating operational inefficiencies, driving up costs and maxing out resources.
So why are healthcare providers in this situation? Taking a look to the past offers a glimpse into their current situation.
Growing Through Mergers and Acquisitions
Often, providers have grown through acquisitions of or mergers with other facilities and organizations. While this provides increased economies of scale, broader/deeper clinical expertise and increased presence/prestige locally, geographically and nationally, it has also created some of the most common challenges providers are experiencing today. Care has not always been given to ensure that all aspects of integrating the acquired/merged organization are addressed. Often, the acquired/merged organization continues to largely operate as an independent entity from an operational, administrative and/or technology perspective. While this offers tremendous benefits in some areas, it does create challenges in others. Duplication of effort, data and applications create operational inefficiencies, drive up costs and even can lead to decreased patient satisfaction.
Narrow Focus of Application Selection and Implementation
As provider organizations have selected and implemented applications, care has not always been taken to ensure that they have an enterprise view and integrate well with other parts of the organization. Even with something as critical as an EMR, it has often focused with only the clinical side of the house in mind (and sometimes with a too narrow focus even within the clinical world). Not addressing the enterprise aspect of applications leads to the same challenged noted above.
Best of Breed Application Strategy
Many organizations have pursued a “best of breed” application strategy in the past vs. an enterprise platform. There are pro’s and con’s to each approach. However, when pursuing a best of breed application strategy, the necessary steps have not always been taken to ensure proper integration and interaction between applications. This has often led to point solution integration, increased manual effort to report and analyze data across systems, redundant processes and increased support costs.
And things aren’t getting any simpler. Healthcare organizations are experiencing change at a more rapid pace than ever. Things such as implementation of EMR’s, EMPI’s, Health Information Exchanges, government regulations, 4010/501 and ICD-9/ICD-10 migrations etc. are pushing organizations to the limit. They are starting to feel the effect of not taking an enterprise view of operations, applications and data in the past. Many organizations have realized the need for governance to drive the enterprise view and reaping the benefits in the form of more efficient operations, reduced costs, increased patient satisfaction and quicker application implementations. Unfortunately, others have not yet gone down this path. They continue to develop point solutions, fail to properly integrate acquired/merged operations and not give the proper focus on the enterprise view.
I’m hopeful that the increased focus at HIMSS 2011 will cause these organizations to see the tremendous benefits that governance can bring. I’m just concerned that the message might not be received. We would love to meet you and discuss Business Intelligence and Data Governance in Healthcare. If you are interested in learning more about how to become a more viable and world-class healthcare system, please visit us at our HIMSS Booth #3681.