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David Hastoglis

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Reconciling the Information Gap Between Upgrade vs Implementation

The rapid progression of the healthcare industry to update existing regulations while introducing technological innovations in the enhancement of healthcare delivery systems is dependent on the efficient translation of current organizational configurations to patient management based on newly defined regulations. The current configurations may or may not have adequate systems for thorough integration of regulation specifications. The apparent issue to present is these changes in a model that compares current upgrade to a completely new implementation of information and technology systems.

healthcare keyboardIn greater detail, a gap assessment should be conducted that will evaluate current capabilities with needs projected with future requirements and future needs. The core objectives of such an assessment are as follows:

  1. What current needs do not match future needs?
  2. If current needs do not exist in future needs, are they no longer viable or are they redefined in future needs?
  3. Define the organizational resources for newly defined needs or those that are re-allocated from the current resources.
  4. Analyze the benefits of the reconfiguration of future systems based on current systems to determine changes in quality of healthcare deliver, efficiency, and cost.

Once all levels of evaluation in the gap analyses are complete, a strategic process of upgrade and implementation can be assessed for changes of current and future system configurations, aligning with the availability of corresponding resources.

The Illustrative Model of Healthcare

It is common practice to develop and assign a visual perspective of the processes and methodologies in organizational change. Can this same approach be applied to the emerging changes of healthcare? An existing example is the food pyramid in describing nutritional foundation. The inherent challenge in developing an applicable visualization in healthcare is applying a design that will allow for periodic changes as regulations are implemented and evaluated. Therefore, it is appropriate to introduce a concept that will bridge the consistent foundations of healthcare delivery systems while allowing for the ever fluctuating environment.

The most applicable example is a wheel, illustrative of the mobile and dynamic nature of the healthcare industry as a whole, while including spokes and inner circular support systems of the wheel account for the layers of healthcare delivery, including but not limited to patient management, provider and payer revenue cycling, and inpatient/outpatient organizational clinical and financial sustainability. The spokes connect the layers of support, therefore fortifying the interdependence of the entire system. For example, the spokes may represent the varying departments in a hospital, while the circular support represents the processing of patient diagnoses and associated treatment methodologies in conjunction with variances in healthcare delivery systems. In summary, the emphasis of any visualized perspective should be focused on the dynamic integration of all aspects diagnosis and treatment.

The Message Link – Patient Experience to Healthcare Delivery

As the advancements, requirements, and transition to highly integrated and technical aspects of healthcare proceed as never seen before, a pause is beneficial to assess what it is truly being said, and how is it being expressed. This is more than the transfer of diagnoses and required treatment through provider claims and payer reimbursement cycling. It also encompasses including the suggestions of specific clinical and business units coupled with demographics and disease specification of a corresponding patient population. The more traditional methodologies include recertification courses for physicians, in-depth training seminars for updated in information technology, and public health education for patient awareness of disease management. However, is the healthcare industry missing opportunities that could link these major categories to enhance overall efficiency and operations?

It is logical to reason that effective patient management is reliant on the continual communication and comprehension of disease manifestation with treatment procedures. Is the healthcare industry still missing basic information that would enhance a patient’s recovery and the subsequent improvement in financial viability? Topics such as patient compliance, effective follow-up, and prevention measures are common in linking the two. What can be enhanced, however, is implementing techniques and information sharing that explicitly gathers and reviews all related components of the entire healthcare delivery process. This entails the combination of data collection templates that can be conveyed to a patient population then ultimately linked to a provider’s submitted claims and corresponding treatment techniques. Some possible options include the creation of software applications that would estimate a patient survey and monitoring system with the intricacies of claims data platforms and reporting mechanisms.

There is no straightforward or established manner to bridge the patient treatment and understanding of detailed medical concepts of diagnosis and treatment. Rather, the healthcare industry would need to establish multiple layers of information integration that would begin with the most basic levels of patient compliance and understanding of his/her own disease manifestation. Terminology, expanded definitions, and an incorporation of medical and information technology expertise would slowly be introduced in pairing the patient experience with professional knowledge. Though it is to be expected that this mapping between patient and professional/technical expertise may render in broader generalizations, it is a place to initiate such a correlation. As time progresses, all aspects of medicine, information systems, and public health standards will enable a streamlined channel of information messaging.

Integrating the “Other” Healthcare Information

As healthcare delivery systems prepared for a focused period of change, implementation, evaluation, and overhaul from existing systems to rejuvenated processing based on updated regulations and guidelines, the industry can now address the ‘other’ information. By this, we define the coding of medical treatments that are not the primary focus, such as main diagnostic and treatment procedures, and shift focus to the ancillary information. This secondary data also supports and sustains efficiency healthcare delivery. Core modeling and methodology is currently focused on the primary information mentioned, with limited directives towards the processes that complete healthcare delivery. Among these included are laboratory, pharmacy, diagnostic measures, and testing integrated with a patient’s treatment plan.

In ensuring that the mandated regulations and medical treatment methodology updates are fully addressed, these ancillary components should be addressed during the initial stages of system upgrade and evaluation. Laboratory, pharmacy, and diagnostic data must be assessed from numerous angles. This may include measuring quantifiable differences and discerning variations in utilization and gaps in process flow. Standard testing methodologies can be applied to data from a patient’s initial visit to information on the utilization and results of laboratory, pharmacy, and diagnostics. Customized testing methodologies can be applied to specific disease, provider, and patient populations to highlight trends or outliers in utilization. Regardless, thorough and accurate implementation of all upgrades is not feasible without the evaluation of components of the treatment process that occur in the later stages.

Healthcare Delivery Strategy – Goals or Remediation

As healthcare delivery systems are currently engaged in updates and integration of regulations and standards in adherence with Federal and State guidelines, we can begin to address the core perspective of the required strategy. It is common during all relevant discussions of the modeling of the new healthcare delivery system to focus on core strategy and associated methodologies that will enable integration of processes.  It is useful to ponder – what are the foundation of the strategy? Does establishing and reaching pre-determined goals take priority over interim remediation of any gaps in implementation? If it is the latter option, how flexible is an organization in re-establishing goals and their corresponding timeline?

A similar perspective in addressing this concept is the prioritization of preventing challenges before an end-goal assessment is established. There will be inherent variations based on what the determined goals are by organization, provider, and disease diagnosis and treatment. However, there is a core foundation that during the early stages of reorganizing it will be necessary to have assessment loopback methodologies in place to ascertain established goals that are parallel to the process of implementation. If there are nuances that are not in alignment with goals, interested stakeholders can re-evaluate the process prior to key milestones. Based on observed differences, when does this change mandate the discussion of new goals with an appropriate timeline? The entirety of a process is not limited to the initiation and completion, but a comprehensive planning on managing the interim changes and their influence on overall outcomes and expectations.

Changes in Healthcare – Integration or Replacement?

The next several years will be an acute period for the inclusion of innovative medical practices, technological advancements, and efficiency of information systems. Previous periods of change in healthcare were based on expanded knowledge, organizational development, and collaborative ventures. However, present and future iterations are deeply reliant on the shared partnerships with industries outside of healthcare, including but not limited to information technology. Therefore, future iterations of change cannot exactly parallel the processes of the past. Current implementation of new regulations and system processing will be an intertwined methodology where former models of healthcare delivery will be replaced by new ones that are integrated with information technology. The thought can now be presented: is this next stage of healthcare an integration or a replacement?

To advance in this questioning, we will have to base our assumptions on the core elements being changed. Medical academic training has consistently developed and rendered new treatment options to enhance quality and longevity of life. The utilization of information system extends beyond updated medical knowledge to the necessity of understanding and integrating information outside of medicine. Though the levels of knowledge may vary depending on a professional’s position within an organization, the use of information systems at all tiers will be a constant. What was once a streamlined single entity of healthcare delivery systems based on knowledge expansion and sharing, is now a complex paradigm that encompasses industries outside of healthcare to render optimal care for the patient. The question is presented again: is the emergence of new models of healthcare integration or replacement? Unfortunately, the response is not simple, but addressing this topic will enable strategic planning on approaching this new era of healthcare.

Healthcare Assessment – Validation, Remediation, Modification

Providers, payers, quality and performance assurance organizations will all need to be actively engaged in a systematic review of newly implemented healthcare standards and regulations. More importantly, all interested organizations will not only be integrated in their own processes in conducting reviews and assessments, but will be influenced by the findings of peer organizations. A conjunction of these diverse processes could enhance or inhibit each organization’s efficiency in approach depending on the emphasis placed on peer collaboration. A collaboration of knowledge and information transfer will enhance the emergence of a three prong approach in meticulous assessment and detailed adjustment to any existing deficiencies. Validation, remediation, and modification are not sequential, but are rather complementary methods to a thorough assessment of results and potential gaps in healthcare systems delivery.

Validation is the checkpoint analyses that all aspects of healthcare patient management are operating under optimal conditions. Remediation is the iterative interjection of corrections integral to maintaining quality and efficiency. Modification is a conglomerate of validation and remediation that will render a system-wide change in processes to ensure that methodologies are current, accurate, and accountable. A comprehensive, yet compartmentalized, manner to assess healthcare mandates and standardization will enable organizational participation at all levels of healthcare delivery systems. Validation is the questioning and answering of whether the system is correct and in order. Remediation necessitates the continual monitoring and alleviation of system stalls. Modification is change at the organizational level to ensure compliance with overall healthcare industry goals and objectives.

Healthcare and Hybrid Costing

Traditional and innovative costing models can enhance or inhibit accuracy and efficiency in costing processing. An introduction of a hybrid system may fortify the acceleration in new regulations and modifications to existing operations and methodologies. Since both organizational costing methods and service line billing and payment systems have intrinsic advantages, a hybrid cost methodology would include the intersection area that would fulfill clinical and financial aspects that are not yet optimized by traditional cost or clinically focused service line modeling. Foundational intersection areas would potentially include the bridge between capturing chronic disease management in conjunction with hospitalizations, prevention of acute disease manifestation in reduction of emergency room services, and provider specific billing and payment that highlights expertise and efficiency of patient management.

In more detail, a hybrid cost methodology can be broken into detailing definitions of what is termed as allowed, billed, and paid, that is accompanied by a continuous process of verification and remodeling. A data modeled bridge between key service line data elements to revenue objectives at an organizational level will have core objectives of improving clinical outcomes, while improving on current cost methodology deficiencies. The initial layers of a hybrid cost methodology system are reliant on mapping core service line data elements with similar elements in organizational financial methodologies. A concurrent mapping enables a real-time assessment of clinical and financial health of the organization, while opening channels for regression, predictive analyses, and implementation.

Diagnostics Markers in Information Systems to Enhance Quality

Provider and payer organizations will be in a position to utilize their information systems in comprehensive organizational health, ranging from patient management to revenue cycling, but will also be able to delineate diagnostics markers to bridge population health with healthcare delivery systems. The most apparent ramification of this is the cross over between actual claims diagnostics and procedural coding with public health data collected that trends disease specific rates. Two main layers are treatment modalities and mortality rates by disease per organization across defined geographic regions. The augmentation of information systems will enable a parallel mapping of real time disease management and treatment by claims processing with population-based measurements of prevalence and incidence.

The short and long term implications include, but are not limited to, addressing the variances of disease specific rates across regions. This can then be refined by patient demographics, provider access, and insurance coverage to determine pivotal points in patient management in preventing chronic or acute management. As a result, with effective markers based on diagnostic and procedural codes organizations will establish milestones in patient care from initial visit through short and long term recovery. Captured claims can be the intermediate point between treatment initiation with the provider and thorough process management. Code markers will entail periodic assessment of viability within the current payer and provider organization, and will continue with modification of healthcare delivery systems operations focused on patient population demographics and disease manifestation. Diagnostic and procedural markers can therefore serve as preventive measures in effective patient management.

Changes in Healthcare – Utilization of Common Methodologies

As healthcare receives a matrix of needs, and standards in transformation in systems deliver modeling and clinical efficiency, we can introduce the paradigm of focused stages of design, development, and implementation. While incorporating similarities from other processes, such as software development and project management methodology, healthcare can benefit by modeling with these strategies included. This methodology not only enables multiple layers of healthcare to maintain a delineated structure of procedural change, but will also offer flexibility to include additional methodologies as needed and encountered.

An overview of the software life cycle will include core components, such as evaluation, analysis, design, implementation, and testing. The bridge of incorporating these components to the updated healthcare delivery system will be fluid in the potential initiation points of the cycle. In clarification, one healthcare organization may initiate at an internal evaluation, while another will go directly to implementation. Regardless of the initiation point, healthcare as an industry, with the incorporation of a similar cycle and methodology, will be able to establish milestones that promote accurate, timely, and modifiable assessments of current and pending healthcare systems.

Similarly, core competencies of project management skills can be utilized in conjunction or exclusively with the mentioned cycle modeling. Foundational elements include initiation, planning, execution, review, and finalization of project goals and scope. These components can be aligned with the cycle and customized to the healthcare industry at the provider, payer, and patient levels.  Detailed enhancements can be included that will streamline efficiency, malleability, sustainability, and prioritization of planning to completion. The healthcare industry will benefit in immediate and long term viability by incorporating commonly used methodologies that enhance a collective process within detailed segmentation.

Healthcare Changes– Asking the Questions

The healthcare industry is at the threshold of enormous changes to the current methodology and relationship structure among payers, providers, employers, and patients. There are numerous sources that initiate these changes that span coding, data processing, fee structures, quality and performance. These sources include, but are not limited to state and federal governments, quality and performance organizations, and healthcare delivery systems. With the current foundation established, we can now open up the next iteration of the dynamic molding of the healthcare industry. Are there sufficient channels for feedback, questioning, and enhancements to the foundational structure?

Current milestones of assessment and review for all proposed healthcare industry mandates have been established by the initiation sources. There are however gaps in processing and review of changes by the actual implementers and recipients of healthcare systems. These end-stage reviews can include a variety of feedback mechanisms, including real-time question and answering systems, virtual sessions, temporary consulting teams, and organizational review committees.

Overall, there are multiple tiers of feedback channels, including participating professional oversight and information processing and dissemination. While the primary stages include review and collaboration of changes, additional stages will include conveying this message to source initiators and organizing review into a manner that will be comprehensible and most importantly modifiable for future regulatory updates.


Changes in Healthcare From An Industrial Perspective

As the efforts to optimize efficiency while enhancing quality of patient care proliferates through many layers of regional, national, and international healthcare delivery systems, the industry as a whole can begin to develop parallel scenarios to assist in this process. This can include a comparison to other industries that have witnessed similar growth expansion dynamics as healthcare is now engaged in. The advent of the twentieth century had an unprecedented development in transportation and technological advancements that extended from businesses to residences. The main aspect that enabled this bridge from commercial to personal access and feasibility was supported by the pairing of innovation with need. This paradigm is now being witnessed in healthcare.

The mapping of technological advancements in diagnostic and clinical methodologies has implementation in both professional and personal settings. Key examples include inpatient and outpatient treatment of chronic conditions such as diabetes in conjunction with home based self-care regimen. Therefore, true and accurate improvements in healthcare delivery that will expand across hospital and home venues will be comprehensive innovation and practicality.

Additionally, the development and integration of information technology from commercial to personal settings displays the efficient transfer of knowledge and ideas to enhance a matrix across various industries with information technology as the central anchor. This umbrella across industries also has elements displayed in healthcare, from the utilization of employer based wellness programs to exercise and dietary maintenance programs. In summary, healthcare delivery systems can mirror, or at the very least incorporate pieces of historical development and current trends of connecting industries.