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Archive for the ‘Regulatory Compliance’ Category

Includes 4010/5010, ICD-10, EHR, State-wide HIE

Improve care coordination with direct secure messaging #HIMSS14

Direct secure messaging (DSM) is a transmission standard promoted by the Office of the National Coordinator for Health Information Technology that meets the Meaningful Use Stage 2 requirements of electronic health records (EHRs).  It works much the same way as regular email, but the message is encrypted, which prevents unintended use of the protected health information that is included within.  DSM can be used to send patient information among physicians, among provider organizations and to other 3rd parties, including patients.  

shutterstock_157839875Healthcare providers have been using direct secure messaging for care coordinating for a while but there may be ways to use it more fully to reduce readmissions, reduce unnecessary testing and procedures and even increase provider productivity.  Some benefits may include:

  1. Providers can insert secure messages into any point of their workflow.
  2. Primary care providers can interact with specialists to potentially result in fewer referrals; ultimately reducing costs to the healthcare system.
  3. Hospitals can improve transitions to nursing facilities and nursing homes can improve the communication with providers to reduce the need for readmissions back to the hospital.
  4. Medical records departments can interact with the patient send their records more easily saving them time and money.
  5. Researchers can seamlessly interact with patients on release of health sciences information.

Once HIEs are fully implemented, query based networks will provide robust data exchanges, but DSMs will continue to be valuable especially for smaller practices and hospitals that do not have the means to implement sophisticated EHRs.  Read the rest of this post »

Balancing clinical effectiveness with profitability – #HIMSS14

A former boss of mine, who happened to be the CFO of a large academic medical center, used to say the phrase “no margin, no mission”  all the time.  I’m not sure I really took the time to understand it at that point in time, but I have since then, “grown up”.  My understanding of the intricacies of determining true profitability is now burdened by the awareness of how many different business transactions occur in the hospital setting and how hard it really is to capture each correlated business transaction at the same point in time.  

ON THE (1)Still, producing a monthly income statement is one thing, and there is certainly no shortage of guidance whether considering GAAP or public sector fund management reporting requirements, but how do we merge the clinical effectiveness discussion with the finance and accounting discussion? 

In my view, these two areas converge at the decision support team who have been supporting contract management and costing activities for decades.  Perficient views the costing activity as an enabler for business to deliver strategic advice, moving away from low value transactional activities, through increased focus on:

  • cost reduction and ability to support the introduction of new products/services or new markets
  • understanding spend according to the value a function or activity creates
  • promoting transparency with a wider view to cost data to allow management to better understand spend through driver-based information on “cause of cost”.

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Manage health system costs with insightful analytics – #HIMSS14

Healthcare systems must be able to provide timely and accurate financial information for decision making and planning. Many hospitals and health systems are targeting hefty reductions in their operating budgets to maintain financially viable without interrupting investments in facility, information technology and other areas needed to remain competitive.  This cost management culture requires organizations to fully understand and ensure transparency exists for key performance indicators that drive consumption and reflect service line profitability.

PRODUCT NAMEWhether it is supplies, labor or productivity or clinical effectiveness, the quality/cost/value equation requires the organization to truly understand their data.  This includes not only considering the right product at the right place, but also applying a broader perspective on clinical evidence for resources used and approaches employed.

A hospital can’t just make across-the-board financial target reduction a sustainable approach. Perhaps a place to start would be to identify opportunities to reduce variation in care delivery by standardizing clinical processes.

But how do we understand cost of care?  There are “experts” within the organization for sure, but a better approach would be to couple these experts with technology that enables us to understand the fully burdened margin by service, by patient or by procedure.  Costing software technology and spreadsheets have been around for a while; we must now transform these systems to leverage clinical and financial / administrative data to create transparent costing models that tell us about profitability across service lines, patients and encounters.

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Agile Forecast Planning for Healthcare Providers – #HIMSS14

In today’s rapidly evolving healthcare environment, provider organizations must be able to identify financial performance gaps continuously and quickly change course when needed.   As we discussed in my blog:  Elevating the Role of Finance within the Hospital, this requires a partnership with operations to ensure that the correct metrics are correlated within the budget process, but being agile is also influenced by the mechanism the hospital uses for budgeting.

A rolling forecast model can replace orThe use of a rolling forecast to replace or supplement the annual budget process

What is a rolling forecast?  The rolling forecast is usually a quarterly budget with a two to three year horizon that keeps a close eye on the organization trajectory.  Typically the forecast budget is not prepared at the department level but may instead focus on divisions or even at a hospital level.  Global budget drivers and assumptions will typically be the same as the annual budget but those unique to a department or division may not be line itemed.

The forecast is built using historical trends, current conditions and future assumptions for budget drivers.  Some forecasts may be primarily driven by revenue drivers with expenses flowing from ratios defined to the model.  The forecast feedback process fosters the partnership between finance and operations to allow the healthcare organization to course-correct sooner and reinforce the cause effect relationships that effect reality.   Some organizations use the rolling forecast process in conjunction with the annual budget and others have moved to using the forecast only.

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The Role of Finance Within the Hospital has Elevated – #HIMSS14

Performance monitoring within the hospital can be accomplished through strategic partnerships between finance and operations.  These partnerships serve the organization well and lead to financial steadiness.  Let’s examine how this might work.

Data-driven decision making has (3)A recent case study within the November issue of HFMA Magazine explores how Mary Lanning Healthcare in Nebraska showcased how data-driven decision making has elevated the role of the hospital finance department from a back-office operational function to a more strategic, advisory one. The article goes on to discuss how finance can strategically deliver data that drive informed business decisions that support sound strategic and tactical planning and execution.

Mary Lanning is a 183-bed acute care facility which offers 29 medical specialties. Embracing data-driven decision making requires agile thinking to pinpoint and respond to the short-term and long-term needs of the organization. This shift requires finance to transcend from the typical focus on aggregating data to a value added analytic team that could provide greater visibility into changes in variables and assumptions.

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Trends to Watch in the Healthcare World in 2014

What’s transforming the ways in which healthcare is provided?

  • legislation
  • new competition
  • innovative incentives
  • a call to refocus on priorities
  • a more empowered and digitally engaged consumer, who has more and greater expectations for quality of care and convenience of care.
  • a renewed attention on healthcare by the consumer market thanks to ongoing press about healthcare.gov and the Affordable Care Act
  • new services and business models in healthcare that we’d never seen before recent reform

Susan DeVore, Premier healthcare alliance…and much more.

Susan DeVore, CEO of our partner and client Premier healthcare alliance, wrote a post yesterday fro HealthAffairs.gov titled, “The Changing Health Care World: Trends To Watch In 2014.” In the article, she introduces the new trends she expects to see in healthcare this year. We are also seeing each of these trends impact conversations about investments our clients need to make this year and next year.

I have summarized the trends below.

1. Investments in Chronic Care -

  • Chronic conditions increase costs by 3X, so, “The biggest health care consumers are those with multiple chronic conditions.”
  • We should see more investments in Ambulatory ICUs and patient-centered medical homes as providers work to improve their shared savings payments and better manage chronic conditions within primary care facilities.

2. New Job Roles in Healthcare

  • DeVore has seen an increase in the popularity of hiring “health coaches” who are there to listen, inspire and motivate and spend time getting to know the patient’s family and life situation as it affects their ability to both access care and to care for themselves.

3. Home Health Care

  • Back to the days of the house call.
  • “Marketing firm BCC Research predicts that the market for remote monitoring and telemedicine applications will double from $11.6 billion in 2011 to about $27.3 billion in 2016.”
  • Technology is increasing access and convenience of healthcare from outside the traditional care setting, especially for rural, hard-to-access locations.

Read the rest of this post »

Healthcare CIOs are carefully moving to the cloud

Recently our company has increased our focus on what healthcare organizations are looking for when it comes to cloud computing, in large part due to our acquisition last year of two fantastic Salesforce partners (ClearTask and CoreMatrix). I found this article in Healthcare Informatics to be very interesting. It’s titled “The Many Flavors of the Cloud” and includes interviews with some key CIOs regarding how they view private vs. public cloud solutions and the sensitivity – and often the mandated security requirements – around health data when stored in the cloud.

There are some obvious advantages to providers moving to private cloud storage for all types of data across the organization, but also some critical considerations for any CIO or CMIO. Here are the key takeaways I got from this article.

MedicalImaging_AndroidTabletApp

Medical imaging takes up a lot of storage space in the healthcare space. Imagine a 24 hour study of your heart that takes up a terabyte of space. The cloud can enable better scale for this type of need.

Key insights about cloud computing in healthcare:

  • CIOs interviewed prefer “private cloud” solutions over public cloud solutions like those of Google, Amazon and Microsoft – more control around access & rules
  • CIOs don’t want to deal with power issues, cooling issues, and capitalizing hardware over time – 3 reasons they enjoy Cloud
  • They enjoy reduced costs in scaling a storage room, servers, etc..
  • CIOs take personal ownership over creating their own stringent security requirements for their cloud vendor, making them feel better about storing PHI or other sensitive healthcare data in it.

Read the rest of this post »

Positive evidence that Health IT improves patient outcomes

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies) Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome. Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

This is a fascinating report on a study by RAND researchers about meaningful use. It shows strong evidence that Health IT improves patient outcomes, specifically quality, safety, and efficiency outcomes.

Michael Furukawa Director at the ONC , and Meghan Gabriel, Economist at the ONC, presented the results from this study in a blog post on HealthIT Buzz. They asked RAND to:

…examine recent evidence on the effects of meaningful use functionalities on quality, safety, and efficiency outcomes. The study was the largest and most comprehensive assessment of the health IT literature to date.

The Value in Voice-Natural Language Processing in Healthcare

Guilty!  I text while I drive…eek!  I know, I know, it is really bad and those anti-texting and driving commercials get me too.  That is why I am making a concentrated effort to ease up this one vice (stop laughing those that know me!) of mine.  Instead, I am beginning to use the voice text option and good ole Siri on my phone, which when I speak like a robot and articulate every word, does alright.  But old habits die hard, which is why I understand and sympathize with physicians constantly having to change their behavior in light of all the regulatory demands in recent years.

One behavior that physicians are being asked to change is their practice patterns of dictating or handwriting clinical notes and discharge summaries.   The change comes from the desire to move away from unstructured data to more structured data for consistent, easily minable and extractable information for more robust and quality NLPreporting and analytics.  80% of clinical documentation that exists in healthcare today is unstructured and is buried in electronic medical records (EMR) and clinical notes1.  Many healthcare providers are looking to natural language processing (NLP) technologies to assist in taking their valuable unstructured data, and turning it into meaningful and actionable structured data to improve patient care.

Natural Language Processing and Clinical Language Understanding

In its simplest definition, NLP is the interaction between artificial intelligence and linguistics.  It encompasses anything a computer needs to understand typed or spoken language and also generate the language2.  More specifically, NLP applied to the medical domain is called Clinical Language Understanding (CLU), with the main difference being that CLU works off of a complete, highly granular medical ontology, which has been tuned to relate and identify all kinds of medical facts so that the underlying NLP engine can “understand” what the caregiver is saying1.  NLP has been around for years, but it wasn’t till recently that healthcare industry took notice of the value of this effectively powerful technology.

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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.

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Two Keys to Success for Healthcare

Healthcare reform, ACA, Business Intelligence, Enterprise Portals, predictive analytics, pay for performance, the Triple Aim, total cost of care, patient safety….these, and many more,  are the buzzwords in healthcare and medicine these days.  Install this system, connect that system, run these reports, use this “intelligent program”… Do you ever wonder if we can solve all of these problems with just technology?

As a clinically oriented physician working in a technology world, I need to take a step back and look at behaviors and workflow.  How can we mentor the next generation of physicians, nurses and allied health professionals, teach them skills and foster their curiosity while encouraging them to be technologically savvy? I believe there are two twisted stethescopecritical keys to success: critical thinking and decision support.  Both are crucial and neither should exist without the other.  Here’s why.

Critical thinking is an essential tool for physicians.  Physicians who have this innate ability are often the most successful at diagnosing and treating their patients well. It is part art and part skill but ultimately, it affects patient safety and wellness.  I was pleased to see that medical school curriculums are now focusing on this as a fundamental skill. According to the recent Wall Street Journal article, “The Biggest Mistake Doctors Make,” the program at Dalhousie University “aims to help trainees step back and examine how biases may affect their thinking. Developed by Pat Croskerry, a physician known for his research on the role of cognitive error in diagnosis, it uses a list of 50 different types of bias that may lead to diagnostic error”.  Couple this with technology driven decision support at the point of care, which assists but never negates clinical judgment, and you have a winning combination.  These basic building blocks allow clinicians to concentrate on their craft: diagnosing and treating patients safely and effectively.

Healthcare reform is necessary but it does not have to undermine the knowledge and experience of our clinicians.  Adding technology, such as Natural Language Processing (NLP), real time decision support, predictive analytics, patient entered data via portals, mobile healthcare management apps and yes, even Watson, can only enhance and advance healthcare, streamline treatment and decrease costs.  Simple?  Let me know your thoughts!

Top 5 Technology Trends in Healthcare – October 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

Mobile Medical Applications

Last month, the FDA released its final guidance for developers of mobile medical applications. The FDA will focus on regulating potentially harmful apps instead of policing applications that pose minimal risk to consumers. These more harmful apps include those which are using mobile technology to make a specific diagnosis and those which transform mobile devices into a regulated medical device.

Patient Engagement and Connected Health

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified-self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

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