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Archive for the ‘Interoperability’ Category

Includes 4010/5010, Step Up/Step Down, 4010/5010 Remediation, HL7

Market Driven Patient Portal: Integration of Data

In our last conversation about  “What the market says you need in your patient portal” we discussed the needs of integration and interoperability. This is an area that, while interesting to the IT team, often does not get a lot of attention. This is not because this topic lacks interest, rather, it’s just not the most appealing topic to talk about. For example, when you are Market Driven Patient Portal: Integrate Dataremodeling your bathroom, you discuss the fixtures, the new shower, the new faucets, even the fancy commode; but do you get excited talking about the plumbing? Likely not, however it is the ability to move and connect the items of interest together that makes the project all come together. If you do not connect something the right way you get water all over…or worse.

So, what does this have to do with clinical and financial data? For one, the data is generally in various systems and data stores throughout the organization and generally it comes from multiple organizations. For example, if you look at these concepts from a health plans point of view, the clinical data is coming from HIE’s, provider facilities, clinical labs, purchased data sources, and others. The financial data is coming from claim systems across multiple lines of business, GL systems, AR/AP systems, and others. All of this data still has to be aggregated, cleansed and organized to make it useful. This is not an easy task and having the strategy, the information models, the plan and the governance are all key to ensuring success of these efforts.

Another reason integration is important is it helps define the consumer of the information. Typically, financial data has been reserved to back office functions or it is used to help define/negotiate the cost of services whether they be premiums, reimbursements, subsidies, etc. With the advent of consumerism, the patient is demanding more information in this arena. Patients want to know what their total cost of services are. They want to know the details of the fees. They want the ability to compare costs, values, outcomes so they can make a well-defined choice. Patients generally look at the cost as the driver, yet there are behavioral changes that need to be overcome; e.g. the higher priced option must be the best, right?

There is a lot still to overcome in this area as providers have typically held on to this information and patients may not be able to understand the complexities of where the money actually flows. Integrating the clinical and financial data is a stepping stone in the path to a full consumer-driven healthcare model. Government mandates are forcing the need for change, however, breaking down the walls to integrate information will not be easy. Meaningful Use Stage 2 (MU2) will be one of the drivers to help make healthcare interoperability a reality.

Core to solving these problems is having a clear understanding of the business capabilities and processes that drive the solutions. Understanding (documenting) the business capabilities, defining the information needs (again documenting) and then defining the business processes (yes writing it down) that act between the capabilities and information will be the blueprints and guides to setting and achieving the vision. With the vision established, we then can begin the process of connecting the dots of where the information lives to where it needs to go and the format which it needs to be in. There are a number of technical challenges given that interoperability is not just a simple plug-n-play solution. The movement of the information needs to follow standards (which by-enlarge exist) yet all of the connections and the subtleties of the content need to be clearly outlined in the road map of integrating clinical and financial data.

This concludes our “What the market says you need in your patient portal” blog series.

ACA and QRS – Shoot for the stars! Part 1

Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space.  In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few Shoot for the stars!posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:

  • Clinical Effectiveness
  • Patient Safety
  • Care Coordination
  • Prevention
  • Access
  • Doctor and Care
  • Efficiency and Affordability
  • Plan Services

The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.

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The eGate Migraine – A Road Map to eGate Migration

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

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

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

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

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

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

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

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

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

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

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

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

A Blueprint for Managing Drug Shortages

In April 2014, I read a startling article that the United States was importing salt water, saline, from Norway due to a shortage in the United States1. Bags of saline solution are one of the most common items used in modern healthcare and that is why it is amazing that American doctors have been facing a bizarre IV saline shortage that forces the import of heavily, unwieldy bags of salt water from overseas. As a result, hospitals, and especially cancer centers, have been keeping strict inventories of how many bags are on hand and struggling to avoid rationing their use. This turn of events led to a deeper look at the problems caused by drug shortages for healthcare organizations and developing a business intelligence blueprint to help manage shortages more effectively.

A Blueprint for Managing Drug Shortages

The IMS Institute for Healthcare Informatics, in their report Drug Shortages: A closer look at products, suppliers and volume volatility, identified 6 key insights:

  1. The drug shortage problem is highly concentrated to generic injectables or five disease areas including oncology and cardiovascular diseases.
  2. The supply of drugs on the shortages list has been stable or increased overall in the past five years.
  3. There is significant volatility in the suppliers of the drugs, not the total volume supplied.
  4. The recent volatility is a new trend compared to previous years.
  5. The number of suppliers has fluctuated and may be one reason for the volatility.
  6. Some states are feeling the drug shortage more acutely than others.

Read the rest of this post »

#TexasHIMSS: MD Anderson’s Consumer Driven Cloud Based Solution

MD Anderson uncovered a potential problem.  Their physicians were using non-approved cloud based storage programs that they “may or may not” have been using to share PHI.  I will note that they use a pretty broad definition for “consumer driven”.  I define consumers as the target market that, in this case, a healthcare provider must engage to generate revenue that impacts the bottom line.  The inside of the organization collaborates with “consumers” outside of the organization.  That’s, perhaps, because I come from the business world where “consumer driven” is defined as “offerings, plans, or strategies motivated by customer demand or expectations.” In this case they were targeting physicians and not patients.  Yes, anyone who consumes a technology is a “consumer” of that technology, but that would basically make the entire technology world as a whole “consumer driven” because every technology is created with someone and their problem in mind.

SBEXRF-00017872-001Now that I have stepped off of my soapbox, below you will see the three steps they used to solve their problem using cloud based technology.

Step 1: Analysis and Planning

Used support of network and desktop teams.  Reached out to a few employees and received positive feedback.  Need to establish an appropriate scope.  Decided it was naïve to say that they couldn’t put the data they use in that system.  They went forward assuming it would include PHI.  Worked with desktop and network teams to identify actual target technology.  Engaged Information Security early.

Step 2: Prototype Pilot Implementation

MD Anderson used the following process to implement their pilot

  • Implement gradually and with care.
  • Evaluate surveys and usage data.
  • Pilot with a mixed user base, prototype with power users and set end user expectations

Pilot program tips were to address security concerns early, take the time to test support and administrative tools, and don’t forget about the support staff.

Step 3: Support and Marketing

Partner with key groups for support.  Advertise that these services are available.  For internal collaboration I often suggest you communicate these new tools “7 different times in 7 different ways”.  In MD Anderson’s case this included advertising the tool on their very own television station and using the help desk to document users that they knew were already using cloud based storage (perhaps inappropriately) and targeting those users.  One of the ways definitely need to be a training program that highlights any self-service functions built into the new program.

Analyzing the healthcare industry tipping point using Therbligs

Do you remember therbligs from your Operations Management class? 

The word therblig was the creation of Frank Bunker Gilbreth and Lillian Moller Gilbreth, American industrial psychologists who invented the field of time and motion study. It is a reversal of the name Gilbreth, with ‘th’ transposed. Therbligs are 18 kinds of elemental motions used in the study of motion economy in the workplace. A workplace task is analyzed by recording each of the therblig units for a process, with the results used for optimization of manual labor by eliminating unneeded movements. (Wikipedia)

shutterstock_128890124I remember, and it was a lifetime ago.  But then again, the Gilbreth’s were turn-of-the-century industrial psychologists who invented the field of time and motion study.  I consider them the founding parents of Industrial Engineering.

So why are we talking about therbligs in Healthcare?

Ah, young Jedi, the time has come to learn our lessons much the same way that the industrial giants like Ford, Carnegie Steel and General Electric learned 100 years ago during Teddy Roosevelt’s administration.  These early lessons became the standards of the mid-century boom in manufacturing and production output.

So the healthcare technology space has finally gotten to its tipping point.  In order to survive, the healthcare industry will need to invest in Industrial Engineering principles and it will need to do product line, service line, episodic, acute and outpatient time and motion studies.

Read the rest of this post »

Reframing the ACO Analytics Problem with Malcolm Gladwell

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

Malcolm Gladwell quoteWhile I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely.  One of the key learning points for me from these sessions was this:  “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics?  There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics?  Do we “build vs. buy”?  Depending upon the organizational size, legacy systems and IT support, the decision can be difficult.  What is good for one system may not work in another.  So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step.  Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics.  Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

Read the rest of this post »

ICD-10: Nine tips to decrease cash flow disruptions

T-minus 9 months!  Are you ready for ICD-10?  Are you really ready?

The Health Information Management Systems Society (HIMSS) Annual Conference is being held in Orlando, Florida this year and I would guarantee that the educational sessions on ICD-10 will be packed with healthcare providers seeking the answer to this very question.  On the other hand, some providers may feel very confident that their organization is ready for the October 1st change.  In fact, being so close to Disney World, they may be singing, “Hakuna Matata” (Disney’s The Lion King song, meaning, “no worries”), through the conference hall thinking that because their organization has performed ICD-10 readiness assessments, developed detailed project plans for implementation and begun the remediation process, they are good to go.

ICD10 Readiness - Minimizing Impact to the Bottom LineHowever, before they start hitting any high notes and doing a dance, they should make sure that they have not only taken the necessary steps to fully understand the impact ICD-10 will have on their workflow and documentation practices, but also to their bottom line.  Healthcare organizations need to understand that “As part of a holistic risk mitigation strategy, providers must understand and be able to forecast possible changes to cash flow and engage in advanced planning to protect revenue losses before, during, and post ICD-10 conversion1.”

According to results from a poll conducted by firm KPMG, 76 percent of providers have completed an impact assessment for ICD-10 and 72 percent had set aside a budget to prepare for readiness2.

“As October 1st inches closer, healthcare organizations have their work cut out to properly absorb the impact that the new coding will have on their businesses,” said Wayne Cafran, an advisory principal in KPMG’s Healthcare & Life Sciences practice. “A full 50 percent stated that they had yet to estimate the new coding system’s impact on their cash flow. With estimates by those who did measure the impact tallying anywhere from $1 million to more than $15 million, healthcare organizations are in for a rude awakening when they finally realize what the new standards will have on their bottom lines1.”

Tips to protect your bottom line

ICD-10 implementation is fast approaching, and providers need to take aggressive steps to ensure that their efforts focus on adequately assessing the potential cash flow problems that may arise after October 1.  Don’t start panicking just yet.  Here are 9 tips, from Beth Mahan, to calm the panic and help mitigate the potential impact to your bottom line1

  1. Discuss budgeting avenues for additional cash reserves if material delays in payment occur.
  2. Conduct financial modeling to understand financial implications moving from ICD-9 to ICD-10 and determining the revenue impact by provider or system facility, service line and geography.
  3. Review managed care contracts to negotiate protective language relevant to reimbursement in the event payment shifts occur that could have a negative impact on your bottom line.
  4. Engage with your high-volume payers to assess their readiness state to process your claims coded in ICD-10
  5. Conduct clinical documentation improvement reviews using ICD-10 code set.
  6. Develop a strategy for coding, billing and claim backlogs to improve cash flow.
  7. Determine strategy for denials management pre- and post-ICD-10 conversion.
  8. Assess readiness state of external vendors who support coding, billing, follow up and denials.
  9. Review audits occurring that may be impacted by compliant use of ICD-10 over time.

If your organization has truly taken the necessary steps to mitigate the risk to its cash flow, then I would recommend that the organization perform an internal audit for ICD-10 implementation and compliance to assure that when October 1st comes you really are set.  Taking the aforementioned steps plus this extra step can bring your organization peace of mind and save you big bucks in the long run.

Then when asked, “Are you really ready for ICD-10?” you can really sing, “Hakuna Matata!”

 

Will you be HIMSS?

Meet Priyal and the rest of our healthcare team at Booth #2035. Contact us to set up a meeting.

himss14_top

Resources for this blog post:

  1. http://www.govhealthit.com/news/icd-10-revenue-neutrality-9-ways-protect-your-cash-flow
  2. http://www.nuemd.com/news/2014/01/13/providers-lack-understanding-icd-10-revenue-impact/
  3. http://www.successehs.com/item/6-tips-to-protect-cash-flow-during-the-icd-10-transition.htm

Top 5 Technology Trends in Healthcare – November 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Consolidation and Mergers

Healthcare entities, both payers and providers, have been making an increased effort to capture market share and dominate their geography. Smaller players are being picked up by larger players, consolidating physician practices and health plans. These mergers have driven digital strategy projects and paperless environments, with an increased interest in advertising and public facing websites to try to attract market share. 

Extending Your EMR

Healthcare professionals have been very vocal about the challenges that come along with electronic medical record systems. The workflow in many EMR systems was created by a programmer and works the way it was programmed, not the way healthcare professionals work. Several technology tools were made to extend or approve upon EMRs without ripping the code apart, often by putting it into a browser or allowing it to be mobile.

Read the rest of this post »

Key Ingredients to an Enterprise Information Management Solution

EIM Gumbo

1 portion of Data Governance

1 portion of Data Warehousing

A stock of interoperability*

Culture, chopped up finely

Dash of patience

*Measured and added to the extent as needed.  Can be made up of a variety of means, manner and mechanisms to facility the move of data to the warehouse and information from there out to the plate in preparation for consumption

Preparation:

  1. cast.iron_.pot_.on_.stove_.istockMake a roux with Data Governance – let it cook for a good long while, it can’t be rushed and takes time.
  2. As the Data Governance is simmering, you can begin dicing up the Data Warehousing.
  3. Once the Data Governance roux is ready, mix in the Data Warehousing. Give the Data Warehousing a little time to get set up and going.
  4. Slowly begin to pour in the stock of interoperability, stirring to mix as you do.
  5. Throw in a dash of patience, adjusting to taste as the gumbo simmers.
  6. Let cook for 36 – 60 months, with a low initial temperature, gradually increased over time.
  7. You can begin tasting and sampling after 12 months.
  8. Prior to serving, add the Culture, giving it enough time to cook, add more over time as is needed.
  9. Enjoy!  And don’t be afraid to get creative once everything is well under way.

Read the rest of this post »

Top 5 Technology Trends in Healthcare – August 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Personalization of Medicine

Personalized analytics have the power to improve care outcomes for patients by drawing data from a complete view into their care coordination. Healthcare analytics and big data hold the key to being able to provide personalized care and prevention. By integrating personal health records with EMR data, providers have a 360 view into the history of the patient and the care they require.

Interoperability

Interoperability plays a key role in ensuring systems can communicate with each other to share information. It helps to reduce redundant data entry, speed access to information and create a real-time flow of information through an enterprise IT system. The key benefit of creating interoperability is to improve the visibility, sharing and re-use of data collection between disparate healthcare applications and devices.

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