It seems that there isn’t enough time to get everything done that is currently required by HIPAA, ARRA, and state and regional priorities – not to mention the consumer driven strategies that you were *hoping* to deploy to differentiate your business and gain competitive advantage. Although large and numerous projects are required, it is nearly impossible to not run these projects concurrently as any delay creates the potential for missed hard dates. With near term priorities moving full speed ahead, ICD-10 runs the risk of a late start. At a minimum you should consider a full ICD-10 assessment and roadmap to ensure that you clearly understand the impact on your organization as well as a high level timeline and budgetary estimate for delivery.

The number of affected systems, processes and policies is large (…consider claims adjudication, medical necessity, reimbursement policies, Medicare, Medicaid, vendors, provider touch points, preauthorization, interfaces, EDI, reports, P4P/Quality programs, databases and education and training to name just a few….). Due to the expansive reach of ICD codes throughout an organization it is possible that some processes that are impacted by ICD-10 may be overlooked. To mitigate this risk you should look at pulling together a multi-departmental group of stakeholders who are charged with auditing their respective departments to identify potential ICD-10 touch points.

Once you compile that high level list you should be prepared to invest time in the development of a detailed assessment and roadmap which should include a system and process inventory, priorities, dependencies, risks and time lines – your resource plan and budgetary estimate for *required* work will follow from that work.

Strategic business improvements should also be considered as part of your ICD-10 plan – preferably after you have a solid grasp of the minimum required work. The advanced level of detail in ICD-10 offers an opportunity to expand your analytics, consumer wellness, quality and EDI modernization programs. We’ll talk about these in a future post.

The assessment and roadmap process can be a quite a project by itself. If you would like to learn more about our approach please feel free to drop me an email @ marty.frygier@perficient.com as we’d be happy to share.

We’re seeing a lot of interest in using Customer Relationship Management (CRM) software to market to, communicate with, and to track provider interests and relationships in HIE’s and REC’s. If you haven’t thought about using CRM for this purpose yet, here is why you might want to…

1. You need to identify and keep track of your customers. Which providers are in your community? What affiliations/relationships do they have? Where do they refer? What systems do they currently use?

2. Your “sales” team needs to track their communication with these providers and their practices. You need to track who has been contacted, what their needs are, what are your opportunities to assist them…

3. You need a central system that your team can interface with to get a complete picture. Your marketing team & sales team, implementation team, support team…

4. Your leadership team needs to be able to track progress and issues. Who has been implemented?, who has been contacted?, who declined our services?, what are our primary support issues?, what major trends are we seeing?…

Also keep in mind that CRM is modular. You don’t need to put off this decision due to worry about conflicts with your other priorities. Many of these systems require minimal installation and setup. An initial roll out can be as simple as importing a provider list and asking the sales team to utilize this as their tracking tool. As you ramp up implementations you can roll out support modules and administrative reports to expand.

Best of luck to all the busy HIE’s and REC’s out there. Let us know if you have any questions as we’d be happy to share more.

We’ll be in booth 9049 and we’d love for you to stop by to meet our Healthcare Directors/Bloggers John White and Tim Roberts as well as Liza Sisler, some of our technology experts and myself. We’ll be working with our partners IBM, Oracle and Microsoft to share information on their latest healthcare solutions as well as having a few of our customers stop by to share their experiences with Perficient. Feel free to send me an email (marty.frygier@perficient.com) if you would like to schedule some time to discuss a specific topic or solution and we’ll certainly make time to meet with you. We look forward to seeing you then!

Ultimately we all expect that healthcare IT will improve the quality of care and lower costs. I was *hoping* that the Meaningful Use (MU) criteria would help get us there by solving the biggest issue that we have today – low levels of provider adoption of EHR. I was *hoping* that the MU criteria, combined with the financial incentives and future penalites, would make it a no brainer for non EHR providers to drop everything and install technology this year. Here is why it won’t happen…

What has happened is that criteria have instead been created to justify the payments to providers that already use EHR. I say, write these folks a check and congratulate them, they paid their dues and jumped on the EHR bandwagon early. And instead, lets focus on the non-adopters. What would it take to get all the non-adopters who:

• are worried that their productivity will take a hit
• know other providers who have failed and are scared
• do not have the time to search for a system
• cannot afford to implement and maintain a system
• fill in your reason here…

off of the bench on into an EHR? It certainly won’t be implementing a system to track immunizations – which sounds like a fairly simple criteria but in reality is very worlflow intensive. Enter lot number, enter an expiration date, barcode scan if possible, make it easy enough that I can do this a hundred times per day in a pediatric or flu clinic. Have the patient sign a release, get the data into the primary chart (if I don’t have a complete EHR this would mean printing into a paper chart or scanning) and into the billing system, send it to the state registry… The process is just as complicated to utilize a system to track problem lists – is the problem chronic or acute? active or inactive? how does the system track problems across a multispecialty practice where each provider only wants to see their own problems? and again, how would this feature function if part of an “EHR Lite” that had to integrate with other documentation workflows.

My point is that these seemingly simple items impact provider and staff productivity to a great degree. Let’s make it easy for non-users to get into basic functionality like eRx, orders and results. Affordable, web-based products with simple implementations that can actually be supported by a regional extension center and, more importantly, can add value to a providers office. Make it easy for these folks to get into technology, show them how it can positively impact their day, then let’s worry about collecting meaningful data and adding complex functionality.

*Let the record show that I am a proponent of EHR’s and believe that anyone can obtain success in their EHR implementation if they have the right expectations, a lot of patience, an experienced implementation team, a solid scalable product, and a committed leadership team.

Many thanks to Feisal for his comments on security. I am noticing a new awareness in healthcare regarding security and privacy of PHI. The original HIPAA regs on these topics were enforced (look here for enforcement and resolution data) when a complaint was made. But no proactive procedure was in place to ensure that you were compliant with the regulations. I didn’t sense an urgency prior to 2009. That is changing now with the new guidelines and updated HIPAA for HITECH. Fines and exposure are increasing and we are seeing an increased focus on privacy and security. Business Associates (BA) also beware – you have new liability and your covered entities (CE’s) also have liability for your disclosures. With more vendors offering SaaS models, it is very likely that CE’s will start taking a deeper look at your systems, policies and procedures.

A few unintended, public PHI disclosures have highlighted the liability associated with unintended exposure. And if you have worked anywhere in the healthcare arena, then you understand the vast number of potential holes that need to be plugged to reduce your risk. All organizations have different systems, policies, procedures, processes, information needs …and therefore different weaknesses. And every time you change your systems (that new EHR, server, admin policy…..) you may be adding new risks. No single solution, policy or update will protect you.

From a personnel standpoint, there are two ways to approach your new focus on security. I am seeing increased hiring for security specialists as more HIE and EHR technology is being deployed. Bringing expertise in house makes sense for large organizations. Although, whether you are a small provider practice, a BA or a large health plan, I might suggest that you also think about bringing in an experienced outsider to evaluate the security of your technology, policies and procedures. Having someone who hasn’t created and isn’t responsible for your systems and policies, taking a second look often adds great value and peace of mind.

Working at Perficient gives me the benefit of seeing what other industries are doing with technology and allows me to incorporate those best practices into healthcare solutions. I see information management as one particular place that the experiences of other industries can add a lot of value to healthcare.

The financial, manufacturing, telecommunication, airline, eCommerce, banking… industries have been using quality data for years in order to run their business. In fact, you wouldn’t think of starting a new business in any one of these industries without the ability to collect and evaluate high quality information daily. However, in healthcare, information management expectations are set fairly low. We need to see more of the BI, ECM and SOA knowledge and tools of other industries incorporated into healthcare. It’s not worth stating the benefits here as I think that any healthcare leader understands the value of this information to their business as well as the global value to patients and the healthcare system in general.

I regularly meet with healthcare executives to discuss information management, data, analytics, BI….. call it what you wish. And two common concerns that I hear are:

1. My financial and clinical data are not tied together
2. I don’t trust the quality of my data

These specific issues have solutions available today – IBM, Oracle, Microsoft, even some open source solutions are readily available – which specifically allow healthcare organizations to bring together information from disparate systems and display that information using a number of different methods (reporting tools, portals…). I will avoid the technical aspects here – you can see what the smart folks at our additional Perficient blogs have to say about BI, ECM, SOA and Portals to learn more.

I’ll close by stating that I have seen these solutions implemented and adding immense value in other industries as well as healthcare – it is truly amazing. If you have set low expectations for the data collection capabilities of your current systems, it is time to take another look.

Having devoted 10 years of my life to the Electronic Health Record (EHR) space, I have seen many EHR product vendors come full circle backwards. And in my opinion this is great for Health Information Exchange (HIE), hospitals, provider groups and patients.

Early EHR (EMR, CPR…) development focused on delivery of complex products that were designed to manage every task in a provider setting. Work flow features were especially complex and have had a lot to do with the large number of early failures in this space. The design process at that time revolved around a “do everything” philosophy. Not to say that there weren’t some folks preaching a different religion – but for the most part you saw complex products, requiring heavy duty hardware and large implementation projects.

And before I make my point, let me say that I was one of the people driving those complex products. In my market at that time, those products were and still are a great fit for medium to larger size provider groups looking for ways to transform their practices. Implemented correctly, those products provide immense value. And groups using these systems are certainly a large part of the connectivity plans for HIE’s.

Today however, we are seeing these vendors either acquiring or deconstructing their products to deliver the modules that users desire. These modules vary among vendors, but you typically see ePrescribing/Formulary, Results/Orders, messaging, patient portals… that are easy to implement, browser based and low cost. This is what the small provider groups were asking for 10 years ago. They want technology that allows them to run a better business and to improve care without taking out a second mortgage. And remember that these small groups make up over 50% of our providers.

I also find it interesting that these types of modular products fit very well into the current HIE development plans. Rather than select complex products that will limit adoption and prove costly and time consuming to implement – a simple web based product, consisting of modular features can be deployed cost effectively which will allow for higher levels of user adoption, better use of limited financial resources and due to the high levels of user adoption, the quality of care benefits that are driving the HIE funding.

I think it it would also be useful to replace the term “HIE” with “Hospital” or “Health System” as it relates to providing technology to non-owned ambulatory providers. Rather than try to force feed complex systems onto smaller provider groups, give them what they need to get them connected to your organization. You’ll save money, the providers will get what they want and patients will benefit.

Of course it is never easy. You still need to invest in a solid system framework to support scalability, analytics and integration. And the number of vendors that need to be evaluated can certainly be confusing. But once you get through the planning, you can expect more success by sometimes going with less.