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Archive for the ‘Interoperability’ Category

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

Gearing Up for 2015: 10 Trends Impacting Healthcare in 2015

HITS SNAPSHOT – GEARING UP FOR 2015 10 Trends Impacting Healthcare in 2015Technology is a major player in the evolving healthcare environment, and organizations are increasing their health IT budgets to adapt to the “new” industry. Having the right technology in place can enhance patient experience, help meet regulatory requirements and provide key insights that reduce costs and improve outcomes. In our recently released HIT SNAPSHOT we have identified ten trends impacting the healthcare industry that can help determine which technology investments should be made to achieve the greatest return on investment.

Download the guide now

Top 10 Healthcare Industry Trends Blog Posts from 2014

Top 10 Healthcare Industry Trends Blog Posts of 2014As we wrap up 2014, let’s take a look at the top 10 blog posts from our thought leaders. These blogs were published on Perficient’s Healthcare Industry Trends Blog.

If you missed these you may want to take a look.

#1. What the Market Says You Need in Your Patient Portal
by Melody Smith Jones | June 19, 2914

#2. Connected Health Trend Countdown: #1 Health Plans Go B2C
by Melody Smith Jones | February 5, 2014

#3. Changing Delivery and Spending of Medicaid Through DSRIP
by Priyal Patel | May 22, 2014

#4. Healthcare Gamification: Avoiding Chocolate Covered Broccoli
by Melody Smith Jones | February 4, 2014

#5. How Enterprise Mobility Management can Improve Patient Care
by Kate Tuttle | May 7, 2014

#6. Perficient Ranked One of the Largest Healthcare Consulting Firms
by Kate Tuttle | August 25, 2014

#7. Connected Health Trend Countdown in Review
by Melody Smith Jones | February 6, 2014

#8. Apple: The New Digital Hub for Healthcare Data
by Kate Tuttle | September 9, 2014

#9. Healthcare Benchmarking
by Priyal Patel | July 9, 2014

#10. The Problem with Health IT is in the Definition
by Kate Tuttle | October 13, 2014

 

 

2015 Healthcare ACO Trends and The Key to Success [Infographic]

Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased. In an ACO, healthcare providers take responsibility for the health of a defined population, coordinate care across the continuum, and are held to benchmark levels of quality and cost. In 2015 ACOs will continue to be on the rise! Read the rest of this post »

In Healthcare, Connectivity Is Not Collaborating

Interoperability between different electronic health record (EHR) systems is one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.

However, let’s examine the real goals of interoperability within healthcare: In Healthcare Connectivity is not Collaborating

1) To make sure “information follows the patient regardless of geographic, organizational, or vendor boundaries”

2) To have at least one or more instances in which providers exchange an electronic summary of care with all the clinical data elements between different EHRs. Establishing this connectivity does not insure the real goal of collaborating across the continuum of care for the patient’s benefit.

The debate still rages on the role of the patient in this interoperability process as well. We have all, as patients, had our medical files spread across a family doctor, multiple hospitals, specialists, health plans and today, even multiple pharmacies. The prospect of creating a complete picture is staggering, let alone having all of those healthcare providers really collaborate on our behalf. Is it the patient’s responsibility in this ever-changing healthcare electronic revolution to compile this electronic mess into a coordinated whole or will the industry magically create it as a result of Meaningful Use Stage 2?

It is worth arguing that interoperability in Meaningful Use Stage 2 only creates a baseline of connectivity between two or more systems to exchange information and puts in place the ability of those systems to use the information that has been exchanged. It does not create collaboration on behalf of patients within the healthcare provider community, especially between competing players like local hospital systems or healthcare providers versus payers. Having the ability to connect only trades fax machines for electronic transactions, if tools aren’t employed for physicians for example to collaborate over a single patient.

In advocating for collaboration, let’s examine the reality of an exchange of a set of electronic transactions about a patient versus where the process would need to be for genuine care coordination. Today, a fax from the hospital to the family physician is the notification that the patient was hospitalized and needs follow-up in coming weeks. Based on the type of hospitalization, a call between the attending physician and family physician may be warranted, and a potential referral to a subsequent specialist may be in order. Simply communicating electronic documents doesn’t address the interaction between key people in the decision-making process and the assumption that the inclusion of unstructured physician notes will suffice may be optimistic.

This means that health information exchange is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability, especially to streamline real collaboration on behalf of patients. It is time to examine an expanded view of both interoperability and health information exchange to promote ease of collaboration between the parties involved, including secure physician to physician communications – electronic or instant message, for example, and secure physician to patient communications. As an individual patient having to deal with multiple patient portals today for communicating with my healthcare providers, there is a real concern to address this issue sooner rather than clean up confusion later.

Can we define collaboration in a way that traverses healthcare’s landscape of emerging connectivity?

Hospital Price Transparency – Step 1: Understand True Cost

Is there a correlation between price transparency and cost? I read an article in the HFMA Strategic Financial Planning Newsletter recently about this and I can relate my personal experiences to it wholeheartedly. My observations are that hospitals segregate these two activities but I believe they are explicitly linked. I know there are many factors that influence Hospital Price Transparancyprice setting, not the least of which is the federal government (Medicare/Medicaid), but I suspect the reason that hospitals don’t more closely link pricing to margins is that they lack visibility into their own data.

When I first started working in healthcare in the late 90’s, my only prior exposure to revenue cycle automation came from the airline industry where pricing is tightly linked to both demand and yield.   I was part of the team that helped Continental Airlines transition into the era of de-regulation. It didn’t take industry leaders very long to identify the metrics that truly informed pricing once the government was taken out of the equation. This taught me very valuable lessons about analytics and instilled in me a drive to use data to improve operations.

To understand and achieve sufficient transparency and maintain a proactive approach to maintaining margins, hospitals must be capable of correlating costs for supplies and drugs, etc. with the cost of providers and overhead costs. Then they must compare this with the payments from payers, individuals and other purchasers. While we certainly can’t take the federal government out of the equation for hospitals, recent expectations have been set for quality performance that may help the affected organizations begin to take a more margin focused view of pricing. Bringing together the necessary data is not simple and definitely should be approached iteratively using a configurable set of analytic tools that can provide the right data to the right individuals in the organization who manage operations and continue or create new services. Read the rest of this post »

Patient Information Really Doesn’t Matter

We live in a world of information, everywhere we turn someone is collecting information about us. The technology advancements over the last 10 years are mind-boggling, but new technology is usually escorted by apprehension as our privacy continues to diminish and security is anything but secure. From cookies on Patient Information Really Doesn't Matterthe internet to a basket analysis at the supermarket, “big brother” is always watching.

The healthcare industry is no different. Healthcare organizations are surrounded by data: clinical, operational and financial; internal and external; structured and unstructured. There is so much information that healthcare providers don’t know what to do with it. The problem with healthcare is not a lack of information. The problem is healthcare organizations often have disparate systems that lack continuity. The absence of interoperability within IT infrastructures ultimately means that the right information is not available to the right people at the right time. Healthcare organizations can have all the information in the world, but if the information is not cohesive and can’t be used efficiently to improve clinical outcomes than information really doesn’t matter.

In order for healthcare organizations to improve outcomes, communication between systems is paramount. Despite industry standards such as EDI/X12, HL7 and CDA, information delivery is not effective. Most healthcare organizations understand the importance of untangling the interoperability web, but those same organizations don’t know where to begin.

Government regulations such as Meaningful Use Stage 2 (MU2) are putting additional pressure on healthcare organizations to improve the quality of care, coordination of care and population health management. A strong interoperability backbone that provides system connectivity is the key to attaining MU2. Interoperability transforms information into key insights that drive better clinical outcomes and improve the lives of individuals and communities.

Do you understand the importance of interoperability but not sure where to start? Perficient will be teaming up with technology partners IBM and Oracle to bring you 2 complimentary webinars:

Tackle Healthcare Interoperability Challenges and Improve Transitions of Care
Thursday, September 25th @ 12 CT
Learn More and Register

Engage Patients, Reduce Manual Processes and Drive Key Insights with Interoperability
Tuesday, October 2nd @ 2 CT
Learn More and Register

ACA and QRS – Shoot for the Stars Part 2

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In this blog, we will take a closer look at the data derived measures and what factors a QHP issuer should consider to achieve high scores.

HC DataFor reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the data derived measures:

Leverage Accreditation Processes

It was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS data measures with HEDIS measures that are typically required during accreditation. So, make sure to leverage current investments to keep initial costs low while jump starting QRS efforts.
Read the rest of this post »

Re-think the Customer Portal Using Cloud

The Affordable Care Act (ACA) has had an enormous effect on health plan organizations. ACA has created choices for consumers,  impacted health plan business models and changed how they serve their members. Health plans are investing in technologies that align with their business strategies and seek scalable and flexible options that improve member interactions and customer service.

In this video, Fernando Acosta, Director of Infrastructure Management, Blue Shield of California discusses the changing healthcare landscape and how Blue Shield of California chose Perficient as their system integration partner because of their healthcare expertise . Perficient’s Doug McCulloh (@dougmcculloh), Director of Business Development is also featured and discusses how Perficient uses portal patterns to speed deployment.

The new robust customer portal allows Blue Shield of California the ability to grow on demand and deploy new environments in hours rather than months and improves customer experience.

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.

Read the rest of this post »

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 »