David Hastoglis

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Healthcare Specific Information Systems

by David Hastoglis on April 10th, 2012

What would healthcare services delivery gain by developing, integrating, and implementing an intricate and complex structural information systems language unique to healthcare? The impending and ever-evolving updates to healthcare regulations and delivery present an opportunity to assess communication standards and information exchange. Similar to existing programming languages, healthcare and information technology professionals can begin to contemplate the benefits of a programming language that would normalize the exchange, storage and reporting of healthcare data. This would range from core data variations to the correlation of definitions and systems requirements.

The Process of Healthcare Information Systems

The process would leverage existing information systems processing and language, with subsequent modifications that are specific to the formatting of healthcare systems. Similar to the commonality in the information exchange of the ICD coding system, a healthcare information systems language would enable a streamlined exchange of disease and procedural classifications across numerous healthcare information processing platforms. The key benefits would include enabling code-specific mapping to healthcare terminology and definitions. Information systems that center around healthcare delivery can be configured to be standard or customized as per organizational specifications.

Healthcare Information Systems – A Consolidated Diversity

A consolidated information system would enable providers and payers to categorize and streamline data processing by provider and disease specific requirements. A consolidated information programming language that addresses disease specific manifestation would present opportunities for active cooperation among provider and payer organizations to facilitate a cyclical processing of information regarding patient treatment. Clinical operations can begin a gradual process of integrating disease specific information systems to enhance overall quality and performance of healthcare delivery.

Tags: healthcare IT, healthit
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Dynamic Data Systems of Healthcare Information Systems

by David Hastoglis on March 13th, 2012

Currently, information systems process a range of healthcare data, inclusive of diagnostic, procedural, public health and research, which are streamlined for efficient processing and storage of data. However, the dynamic evolution of healthcare prevention, treatment and standardization is now merging various key objectives into a conglomerate of healthcare delivery. Chronic and acute clinical practices are integrated with population-based assessments and methodologies. Distinct and unique information systems have been sufficient in managing separate components of healthcare delivery, but this is changing as the definition of separation softens to include the blend of the private and public influences of medical policy and treatment dissemination.

The Customization of Information Systems

It is an interesting paradigm to illustrate that these distinct information systems can evolve into a common hybrid of data systems that maintains the exclusivity of the healthcare data being processed, but has allowances to collaborate with the merging healthcare environment. In a traditional sense, payer information systems and data platforms have been developed to capture and process vast amounts of information ending in reporting and archiving. With the evolving complexities of healthcare information management, there is anticipation that payer data platforms will incorporate disease and provider-specific channeling and storage. Customized data platforms can enhance treatment implications including early indicators for management of chronic diseases while enhancing cost effectiveness of patient treatment and reimbursement. Additionally, this increased provider and disease specification among data processing systems will enable more partnering between private and public healthcare sectors.

Complexity of Information Simplifies Healthcare Communication

A short term perspective of the specification and customization of healthcare information systems presents complex challenges that will entail diligence in monitoring and modifications to ensure that initial objectives match outcomes inherent to an upgrade of informational systems. However, as all organizations share and learn in this process, the long term perspective will present simplicity in collaboration among all healthcare delivery entities. Apparent enhancements will include common formatting of data, efficient methods of information exchange, and baseline of quality and performance indicators that will incorporate public health standards into various types of healthcare delivery systems.

Tags: analytics, data processing, healthcare IT, healthit
Posted in Business Intelligence, News | No Comments »

HIMSS 2012 Trend Watch

by David Hastoglis on February 20th, 2012

HIMSS 2012 is upon us already. Our team will be in Las Vegas for the February 21-23 for the event. With all of the changes we are witnessing in the health insurance industry, this year’s conference promises to address the many needs of conference attendees. Whether it is meeting regulatory compliance issues or preparing for accountable care organizations, the HIMSS conference will be the place to be this week.

Participants should leverage the HIMSS event to attend many of their peer organization presentations to learn what, how and lessons learned from their experiences. In addition, take the time to go down onto the Exhibitor floor and listen and observe what is being highlighted by the vendors as well as what your peers are saying and asking on the exhibit floor. The most important thing is to take this information and start to formulate how your healthcare organization can start to address these major issues.

Most importantly, enjoy the educational and collaborative nature of this event and network with your colleagues and solution providers so you can see the potential that can be achieved. Take advantage of having everyone in one area to enable your healthcare system to be among a few world-class organizations.

We would love to meet with you at the conference. Leave a comment, catch up with us in person at Booth 1274, visit our HIMSS page, or contact us on Twitter (@Perficient_HC) to discuss what you think the hot topics will be on the show floor. Here is what we think:

BUSINESS INTELLIGENCE

Health BI offers healthcare organizations accelerated compliance to Meaningful Use and ACO quality reporting requirements by using state-of-the-art BI and analytics tools to enhance clinical decision support, performance benchmarking and persona-based dashboards using data from a wide range of clinical and financial systems.

Enterprise Data Roadmaps: The creation of an enterprise roadmap provides the framework for the creation of a world class data environment.
Analytics: Focused analytical applications can provide a quick return on investment and provide the foundation for the use of analytics across the enterprise.
Data Governance: New EMR’s, 4010/5010 and ICD-9/ICD-10 conversions, standardizing technology platforms and integrating data for analysis all require an enterprise view to truly realize the benefits of technology investments.
Master Data Management: As healthcare organizations move towards an enterprise view of their data, ensuring the consistency of such things as master patient indexes, physician masters, diagnosis codes and procedure codes will be critical.
Centralized Data Environments: Implementing a true centralized data environment requires a balance between process, best practices, organizational constructs and enabling technology.

ICD-10 IMPLEMENTATION

Perficient’s ICD-10 solution begins with a phased roadmap of coordinated projects beginning with a careful analysis of your healthcare IT applications and ending with the cultural transition of using the expanded code set.

Impact Analytics: Automates the identification and visualization of relationships between ICD-9 in historical claims data and corresponding ICD-10 code matches with eight separate levels of complexity and risk.
ICD-10 Code Management: A medical ontology based code management system that allows modeling and mapping of ICD-9 codes into ICD-10 equivalents, and vice versa.
ICD-10 Test Management Automates the creation of large volumes of ICD-10 test data and shows the differences between results processed in ICD-9 and in ICD-10.
ICD-10 Code Translation A scalable, high-performance translation engine that enables ICD code translation (forward/backward)
ICD-10 Consulting Services: Provides expert support for the software toolset and services.

PORTAL COLLABORATION SERVICES

The healthcare industry faces constant pressure to improve quality of care while reducing non-value-added costs. Perficient helps healthcare institutions design and implement business-driven technology solutions that provide instantaneous access to patient and clinical information, streamline core business processes such as eligibility, referrals and claims, and improve communications/interactions with patients/members, physicians, administrators and partners. Portal solutions include:

Member portals for healthcare plan enrollment and services.
Patient portals for disease and drug information, prescription services, special government subsidized programs.
Physician portals for patient information, clinical information, prescription services, drug interactions, etc.
Broker portals for sales support and plan design.
Employee and supplier portals for plan administration, services request handling, etc.
User Experience in Healthcare Collaboration.

Tags: Accountable Care Organization, ACO, analytics, business intelligence, collaboration, EHR, healthcare IT, HIMSS, ICD-10, portals
Posted in Business Intelligence, Collaboration, News, Regulatory Compliance | No Comments »

Global Dissemination of Healthcare Technology

by David Hastoglis on February 16th, 2012

The dissemination of healthcare treatment through the developed world is at the inception of extending successful implementation strategies in the developing world. The implementation of healthcare is now pairing clinical expertise with technological advancements. Standard treatment in developed countries can be transferred to countries that lack in comparison efficient channeling of clinical management, but have a basic foundational infrastructure conducive for technological implementation. Technological application such as data processing, data storage, portable medical devices and telemedicine are appropriate clinical interventions in developing nations.

Inherent Strengths through Optimization

As the implementation of healthcare technological systems in developing nations progresses, there are opportunities for lessons to be learned in establishing enhanced efficiency, quality and performance that may then be reconfigured back into a developed healthcare delivery system. Common challenges may include lack of professionals with appropriate programming and information technology skills, consistent and adequate power supply, digital storage and transfer equipment and thorough knowledge transfer. The inherent environmental challenges of technological implementation in the developing world may render a necessity to sustain operations and processing systems that utilize clinical care, technology, and information channeling in an optimal manner. These optimizations may offer insight into improved efficiencies in developing nations, inclusive of but not limited to refined data storage architecture, streamlined data processing systems, adequate and accurate clinical definitions and treatment methodologies.

The Long Term Process of Technology Transfer

The long term implications of a circular transfer of knowledge in healthcare information dissemination methodologies entail increased communication flow that accompanies a matrix of complex and streamlined information systems infrastructure. This unique blend that couples operations in environments that are abundant and environments that are lacking in required supplies and infrastructure will render cross-communication that will highlight the strengths of each.

Tags: healthcare IT, healthit, telehealth
Posted in Health Information Exchange, News | No Comments »

Information Systems as an Extender of Personal Medicine into Disease Management

by David Hastoglis on January 19th, 2012

Information Systems – the Customizable Disease Specific Moderator

The increased utilization of information systems and technology in enhancing personalized medical management once had its main focus in optimizing delivery of care beyond traditional healthcare delivery settings into environments where the patient would have increased access to treatment regimen. Another segment of healthcare delivery that is increasingly incorporated with personalized medicine is the implementation of disease management programs.

Many facets of information systems can be used to channelize efficiency and accuracy in merging the specialties of personalized medicine and disease management. Common modalities of personal medicine include a streamlined manner of prescription and intake of pharmaceutics, provider consultation, follow-up and review of treatment response, and intermittent modifications of treatment as required. Inherent to the dynamic and closely monitored advent of personal medicine, information systems serve as the conduit of clinical processing that enable the variability of a patient’s self-care. This conduit no longer needs to be limited to personal care, but can also serve as an effective connection that engages the patient in disease management programs, allowing for comprehensive short and long term treatment.

The Link Between Personal Medicine and Disease Management

Current modeling of disease management programs includes cooperation with an individual’s healthcare provider, employer, and community clinics. Common goals include maintenance and promotion of health, while preventing acute care episodes. With a robust perspective, the implementation of information systems in enhancing a patient’s disease management would range from adaptable processes that can be configured from personal computer systems to web-based systems.

Information Systems and Time Efficiencies of Patient Treatment

The incorporation of software applications, internet based interactive programs, and monitoring devices not only offers a systemic manner for a patient to manage diagnostic and pharmaceutical treatment, but also delineates the appropriate timely dissemination of all inherent treatment factors. Provider and payer systems may now view this time based therapeutic management as a bridge to chronic disease management programs through the creation of information channeling, based on architectural data capture, delivery, and storage. The link between personal medicine and disease management will evolve as patient care is monitored. The proficient use of information systems not only enables the proper continuation of patients currently engaged in disease management programs, but has the potential to engage patients not already enrolled in programs for chronic health management.

Have you integrated information systems into personal medicine? What about disease management?

Tags: EHR, Electronic Health Record, EMR, healthcare IT
Posted in Interoperability | 1 Comment »

New Models of Care Delivery Fuel Health IT Discussions

by David Hastoglis on July 26th, 2011

New models of care delivery are inevitable. Whether it’s accountable care, or another favored form, the current incentive structure is evolving. This is occurring in hopes that waste can be eliminated and quality can improve.

Although there is still much uncertainty, the inevitable truth is that the need to streamline and share information is central to this effort. Health IT systems will 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. In the very near future, providers must be able to identify, access, and seamlessly share patient information to drive efficiencies.

Health IT enables accountable care by:

Providing a Strong Analytical Foundation: The accountable care approach must be based on a strong information management foundation including enterprise data warehousing, advanced analytics and data governance. If organizations want to track outcomes for judging quality and episodic care management, then near real-time, holistic and integrated information will be critical to success. A roadmap must be developed for technology to support the new world of accountable care. Business Intelligence also makes it possible to analyze a patient population to study a disease state, such as diabetes, through clinical studies of a narrow geography. Healthcare organizations then have the ability to handle care issues across the geography and the public health questions that result.

Increasing Data Exchange in Health Communities: Fragmented data across healthcare communities leads to increased cost and decreased patient experience. The ability to exchange clinical information will be critical to ACO success. Beyond the important aspects of delivering quality care, there are real business drivers that favor an environment where clinical and cost information are combined into a comprehensive system delivery model. The Enterprise HIE eco-system is one approach that innovative healthcare systems are using to enable them to connect patients and physicians together in a more collaborative environment.

Increasing Collaboration Among Patients, Physicians, and Healthcare Communities: Enabling patients and physicians into the design of care increases the financial effectiveness of an ACO, and there are many smart options available to invite collaboration. Healthcare portals can be used to empower patients by providing meaningful access to their care and connect a patient to the entire health system that impacts their care. Similarly, community portals can be created to connect patients to those with similar disease states for information sharing, support, and advice. This empowers patients to work with ACOs in creating cost saving, and patient centric, clinical care. Organizations can also use physician portals to connect physicians to the critical components of clinical care which can then be incorporated into executive decision making. This would enable stakeholders of a healthcare system to come together to create better services and relationships within the community that they serve and increase an ACO’s success as a result.

Given that the healthcare of today and the models represented under accountable care are vastly different, there is a lot of discussion going on in healthcare circles across the country. I am certain that the ideas shared will continue to flow If you have some thoughts you would like to add to the discourse, then please make a comment below.

Tags: Accountable Care Organization, ACO, healthcare IT, healthcare reform
Posted in Health Information Exchange, News | No Comments »

Using Enterprise HIE to Move Clinical Information in an ACO

by David Hastoglis on July 18th, 2011

An Enterprise HIE is defined as the mobilization of healthcare information electronically across organizations. The Enterprise HIE can be used to move information within a region, community or hospital system. As such, the Enterprise HIE system is a great answer to problems found when forming an ACO. HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. A HIE can also assist public health authorities in the analysis of the health of the population, which aids the cost cutting goals of accountable care. Ultimately, the goal of an HIE is to facilitate access to and retrieval of clinical data.

As a result, the Enterprise HIE data becomes:

Safer: The Enterprise HIE environment is a highly secured ecosystem that ensures authorized users are the only participants and that the patient grants approval only to those whom they wish to have access to their clinical information. In addition, the information is encrypted and when appropriate is made available for analytic purposes in a de-identified basis. The Enterprise HIE adheres to all HIPAA regulatory requirements that have been and are being mandated by the federal government.

More timely: The patient clinical information is available immediately at the time of care or retrospectively for population disease management.

Efficient: The clinical information is made available through a RLS which negates the need to store and duplicate the clinical information and makes the request more efficient and timely.

Effective: Because the clinical information is from all healthcare service provider locations, physicians and healthcare systems can effectively treat and manage the patient from a real holistic point of view.

Equitable: Since the Enterprise HIE does not discriminate patients by any criteria, physicians and healthcare systems can get access to all citizen/patient information as long as they are receiving care at a healthcare provider that is participating in the Enterprise HIE ecosystem. In addition, many HIE business models have considered moving towards a consumption-based pricing model and therefore participants are charged only for what they use. This ensures that the burden on the cost of the HIE is not unfairly or unjustly charged to the physician community.

Patient-Centered Care: The Enterprise HIE ecosystem provides the backbone to enable the long-term goal of an Accountable Care Organization (ACO) structure with the ability to connect the patient’s home to complete the full cycle of healthcare information sources from the citizen/patient point of view.

Creating this common store of knowledge will ultimately feed the best practices that make healthcare organizations both patient care centric and successful at delivering optimum care.

Tags: Accountable Care Organization, ACO, health information, Health Information Exchange HIE, healthcare IT
Posted in Health Information Exchange, News | No Comments »

Creating a Self-Sustaining Business Model for HIE

by David Hastoglis on July 11th, 2011

It is important for state and local agencies building an HIE solution to have a self-sustaining business model. This will be especially important once the federal government grant money ends. It is just as important for healthcare systems to consider the value proposition they need or want to get out of their HIE solution. Therefore, the 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.

A strong business model must:

Be efficient in order to decrease the total cost of ownership: The HIE needs to be easy and cost effective to adopt but, more importantly must provide consumers of the HIE services a value-added proposition. The HIE must help physicians be more efficient and effective in their delivery of healthcare services to their existing and potential patient population. The HIE must not encumber the delivery of care by slowing down or preventing a physician in delivering patient healthcare services. If the solution does not effectively improve patient services, access and outcomes, the utilization and adoption will be negatively impacted.

Deliver demonstrable value to the key stakeholders in the process: The most obvious benefactors of the HIE are the physicians and patients that are part of the community that is supported by the HIE. Whether it is empowering physicians or patients with clinical information or aligning more effectively patients with physician services, the HIE must enable this relationship to thrive and flourish. In addition, healthcare systems will benefit by aligning these two parties and therefore creating a more cost effective, preventive care delivery system that will reduce costs by minimizing the number of ER and acute care admissions through these preventive care services.

Serve as a platform for enabling additional value-add services that create additional sources for funding and financial support: The HIE can be the platform to which additional services can be added outside of the standard clinical results and care model. Additional services such as ePrescribing, eReferral Management, Medical Home and Disease State Management services are just a few of the features that can be added and drive additional value to the consumers of the HIE solution platform.

Promote cost effective health care services and or materials: Cost-effective measures include discount prescription drug programs, preventive disease-management programs and overall health education programs to promote the wellness of the citizens of that geographic area.

Reside within the context of a flexible eco-system: This flexibility will enable other services such as eligibility checking for citizen’s healthcare insurance coverage. With the advent of healthcare reform, this strong business model will provide an efficient foundation upon which many more citizens can be incorporated into and will drive a more effective use of the HIE ecosystem.

Tags: Health Information Exchange HIE, Health Information Exchanges, healthcare IT, healthcare reform, HIE
Posted in Health Information Exchange, News | No Comments »

Avoiding Inaccurate Patient Identification for Healthcare Services

by David Hastoglis on July 5th, 2011

As we mentioned in an earlier post about Tracking a Single Patient in a Connected Healthcare Environment, the key to making an integrated healthcare system work is identifying and managing a unique patient identifier that can be used to connect one patient across a diverse network of care providers.

In this post we are going to explore the options available for unique patient identifiers in a connected healthcare world. There are two broad options for managing unique identifiers:

Record locator service (RLS): RLS provides the ability for a request for patient clinical information across disparate electronic health record systems to use a set of criteria and rules to query these source systems to identify whether clinical information exists for the individual at that location.

Records bank model (RBS): The records bank concept enables citizens/patients to store and update their clinical information, through consent, from those healthcare systems and ancillary care centers that generate healthcare results. Patients can add and access clinical information associated with them and can grant access to other care providers that are part of that citizen/patient care delivery team.

An incomplete – or worse, inaccurate – master person or provider index is a source of serious concern. As such, ensuring that integrated Health IT project includes a feature-rich master person/provider index is critical.

However, the most important – but often overlooked – aspect of this important index is creating the strategic business processes necessary to maintain an accurate person/provider index. This often requires an organization to venture into the dicey waters of change management. You can find some team-based change management tips in our earlier post Preparing a Healthcare Organization for Change:

Tags: business intelligence, healthcare analytics, healthcare IT
Posted in Business Intelligence, News | No Comments »

12 Things You Should NOT Do on a Portal Project

by David Hastoglis on June 30th, 2011

Yesterday Perficient’s portal experts held a webinar entitled “12 Things You Should NOT Do on a Portal Project”. The webinar was highly entertaining. You can view the entire webinar here.

Considering the growth of social media, collaborative care, and patient engagement in healthcare, I felt it was important to recap the 12 things not to do so that healthcare organizations do not fall into these traps.

#1 My Missing Homepage The portal team started out with a story of an insurance organization that was juggling multiple portal projects. In this particular case, the developers of a latter portal project co-opted the homepage of the earlier portal projects. This caused the homepage on earlier portals to disappear completely. When juggling these portal projects, it is a good idea to set up a shared taxonomy so that this confusion does not occur.

#2 The Business Asked for it! Each organization sees itself as unique. Therefore, when considering their portal needs they end up building custom applications, which are often much more resource intense. There are many “portal in a box” solutions available on the market. Oftentimes, these out of the box solutions can be used to meet 95% of the business requirements you are looking for. By starting with an out of the box solution, you can then add custom components where needed. Your portal project will become far less resource intense as a result.

#3 Methodology for Methodologies Sake This one actually captures what I say time and time again: start with the business problem. IT geeks love technology for technology’s sake. However, it’s not very rational to implement expensive technology solutions simply because they are cool (although they most certainly are). If you don’t lose sight of what is important, then the end result of Health IT will be highly functional for the end user.

#4 The Never-Ending Strategy It is good to start with a portal strategy. The strategy sets the overall direction and approach for your project. According to our pros, the strategy should prioritize the direction of architecture, content, governance, security, development, search, etc. This can be put together within a 2-4 week roadmap. A bad or overly complex strategy will actually slow down or inhibit the launch of your portal. Focus on solving the business problem; don’t become a slave to strategy.

#5 I Built it But Now I Can’t Support It Technology projects can be complicated. A portal project requires knowledge workers with skills in architecture, security, training, web technology, etc. Some organizations choose to cut costs through minimizing the number of people resources they use to build or support their portal. This can often be a recipe for disaster. The problems that surface can end up multiplying the cost of the portal project well above the savings found through cutting corners.

#6 We Can Get a Big ROI from Portal Our portal experts highlighted a story of a company that wanted to cut time from their processes in order to increase ROI. However, they implemented a portal project that actually added time to their processes and gave them a negative ROI of $2.3 million/year as a result! The main issues were: 1) lack of strong technical resources that understood portals and 2) their portal solution lacked user experience capabilities. Mitigating these issues would have informed developers of how end users would use the system, which then directs implementation.

#7 Is Best of Breed Always Best There is a time and place for both best of breed portal or the one vendor stack portal. Stop debating and consider your needs. Sometimes best of breed is best. Sometimes the one vendor stack portal is actually best to meet your unique portal needs. Match your requirements with the available options, and you will be fine.

#8 When Developers Can’t Develop Sometimes a portal administrator puts up a wall to developers. As such, any time developers need to make a change they need to work through this portal administrator, which creates a bottleneck. This is particularly the case when the portal administrator isn’t the best person for the solution at hand. There is oftentimes creates stand offs between portal administrators and development teams during a portal project. Decision making silos occur, and the parties lack insight into what the other is doing. Everyone should work as a team.

#9 When Not to Use a Portal There are times when portal is not the correct solution. Sometimes a “side-by-side” approach is best. Side-by-side is an approach were portal and other complex applications live side-by-side. Don’t use an overly complicated portal as a full interface when a side-by-side solution would be best.

#10 When Web 2.0 is 2.Much Once upon a time there was a company whose implementor decided everything should be done using Ajax. This didn’t work out for them since their portlet simply served content. According to our portal experts, any portlet that only servers content should never be implemented with Ajax.

#11 Infinite Loops on the Homepage Portal implementation team members can lay awake at night hoping their server doesn’t crash under the weight of resource overload. The key to a restful night’s sleep in this case is testing. You should perform a series of tests to catch any and all possible errors that could cause a rogue portlet to bring your entire site down.

#12 Building My Own MVC Our portal experts told the terrifying story of an architect who felt that Java Server Faces, Spring MVC and Struts were not good enough so he designed and built a custom Model View Controller (MVC) framework for development in WebSphere Portal. All went well until he left the company. You do not want a single source of failure. As such, it is best to first look at what is available when development needs come up.

Tags: collaboration, healthcare IT, portals
Posted in Collaboration, News | No Comments »

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