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Predictions for the Top 3 Trends at #HIMSS15

Sat, 11 Apr 2015 12:00:24 +0000

Holy Cow!! (Little tribute to Chicago legend, Harry Caray!) The Health Information Management Systems Society (HIMSS) Annual Conference has come back to Sweet Home Chicago. Nearly 38,000 HIMSS15 attendees will fill Chicago’s McCormick Place April, 12-16, 2015. It’s a given that there will be many conversations about the Chicago Cubs, deep dish pizza, the crazy winds off of Lake Michigan, Soldier Field, the beautiful Chicago skyline, and other iconic Chicago things.

In addition, to the conversations about the windy city, I predict that there will be infinite conversations throughout the Conference, and thereafter, surrounding three hot healthcare trends:

ICD-10: With less than 7 months remaining till the October 2015 implementation of the new and expanded diagnosis codes, ICD-10, providers and health plans are either embracing it or praying for yet another postponement. The conversation surrounding cost impact will most likely be the fuel that sparks the hot debates among attendees – does it cost more to implement or delay ICD-10?

Population Health Management: This should not come as a surprise. The concept of population health management and discussions surrounding strategies for sharing patient data and accountability, across the continuum of care for more effective delivery of healthcare has been a hot topic issue for the past few years. However, challenges in collecting, storing and reporting the necessary data to achieve this cross collaboration often times impedes its application. The HIMSS15 Conference will surely have an abundance of exhibits and educational sessions speaking to data warehousing, business intelligence and analytics and innovative tools and technology applications that will help organizations tackle these issues.

Patient Engagement: Empowering patients is critical to achieving quality care and lowering healthcare costs. With both clinical and financial impact involving the patient in every step of their care patient engagement has become a top priority among many providers. Through the use of patient portals, remote monitoring and a variety of mobile health tools, patients are able to monitor and take control of their health in ways they were unable to do years ago. The patient-centered movement across the healthcare industry will allow for organizations to hit the triple aim of improved health outcomes, better patient care, and lower costs. HIMSS15 will provide attendees many opportunities to explore some of these advances first-hand through interactive showcases and roundtable discussions on the topic.

Predictions aside, one thing I can guarantee, as always, is that HIMSS15 will not disappoint! Between the thousands of exhibitors and vendors showcasing cutting edge healthcare technology, hundreds of educational sessions on today’s hottest healthcare topics, and the extensive collaboration and networking between healthcare IT professionals, clinicians, and executives what more can you ask for, well other than the Chicago Cubs winning the World Series! Enjoy the conference and the great City of Chicago!!

What do you think will be the hottest topic at HIMSS15? Do your predictions align with mine?

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ICD-10: Nine tips to decrease cash flow disruptions

Mon, 10 Feb 2014 17:53:49 +0000

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 1^st 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.

However, 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

Discuss budgeting avenues for additional cash reserves if material delays in payment occur.
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.
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.
Engage with your high-volume payers to assess their readiness state to process your claims coded in ICD-10
Conduct clinical documentation improvement reviews using ICD-10 code set.
Develop a strategy for coding, billing and claim backlogs to improve cash flow.
Determine strategy for denials management pre- and post-ICD-10 conversion.
Assess readiness state of external vendors who support coding, billing, follow up and denials.
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 1^st 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.

Resources for this blog post:

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The Value in Voice-Natural Language Processing in Healthcare

Tue, 03 Dec 2013 16:24:21 +0000

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 reporting 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.

Benefits to Healthcare Industry

Clinical documentation has valuable information that can drive clinical decision making, impact patient care and reduce healthcare cost. However, often times the information within this important documentation is not leveraged due to the difficulties associated with manually sorting through volumes of text and extracting and analyzing the data.

The benefits to the healthcare industry are abundant with NLP. Joe Petro, Senior Vice President of Research and Development for Nuance Healthcare, does an excellent job describing just how NLP can positively impact healthcare^. Below are his thoughts on the impact to Meaningful Use, Predictive Care and Effective Billing¹:

Meaningful Use

Petro emphasizes that in order for physicians to qualify for government incentive payments associated with adopting and using EHRs they must capture specified facts, including things such as problem lists, allergies, smoking status and vital signs. These facts are oftentimes easy for a physician to capture through a narrative description (via voice), but can prove difficult and time consuming to capture via a structured EHR system template and more importantly pure structured representation of the patient story falls short of what a care team requires to deliver optimal care. Mr. Petro also points out that in 2009, 96 percent of 1,000 surveyed physicians said they were “concerned” about “losing the unique patient story with the transition to template-driven EMRs,” and 94 percent said that “including the physician narrative as part of patients’ medical records” is “important” or “very important” to realizing and measuring improved patient outcomes. Structured documentation, created via template, is easy to analyze and pull facts from, but has proven to be an unnatural means of documentation for physicians and does not capture the nuances of each unique patient story. Natural speech documentation capture combined with NLP delivers a means for physicians to tell a complete patient story with all its subtleties and makes available all of the clinical facts needed for the EMR to operate in an optimal way.

Predictive Care

The application of NLP to healthcare can be done in a retrospective manner, (after the patient has left the hospital) or in a predictive manner (while the patient is still there). We all know that predictive care is more impactful to optimal, proactive patient care. With advancement that is taking place today, CLU solutions will move toward decision-support that will provide immediate feedback to physicians at the point-of-dictation, whether they are using a digital recorder, PDA, or mobile phone. For example, if a physician is documenting a prescription for a patient within the EMR and CLU technology is running in the background, the system might notify the physician that the patient could have an adverse reaction to that drug and would recommend an alternative.

Effective Billing

When applied to billing, NLP can remove a lot of pain from the billing process, for both the physicians and the medical coders. Petro states that physicians, at times given their busy schedules, can be vague in their documentation which can negatively impact patient care, communication with other caregivers, and can complicate billing. Today, if a physician is vague with documentation they might get a phone call three weeks later from a medical coder who is trying to code their documentation for billing purposes. Chances are the physician won’t fully remember the extra detail that should have initially been captured and the exchange will be burdensome and ineffective. By applying NLP to the documentation process, CLU can scan and understand what the physician is saying and ask for added specificity or severity when necessary. Mr. Petro provides the example of if a physician says a patient had a “fracture of forearm,” did they mean lower forearm, right or left forearm, and what was the severity? By prompting the physician while the details are fresh in his/her mind, the end document will be more complete, which results in improved care, better cross-care communication, more accurate billing, and eliminates that phone call three weeks down the road. The benefits of NLP are also there for the medical coder. CLU can be used to scan and understand electronic medical records and help to auto-code information based on what is documented. For example, what was once dictated as “fracture of forearm,” was appropriately elaborated on to become “torus fracture of lower end of right radius,” and would be coded “S52.521” based on ICD standards, which will greatly increase the efficiency and effectiveness for the medical coders.

If NLP keeps up momentum, the days of manually sifting through countless patient charts to understand and extract vital patient information may be behind us. “By processing text directly with computer applications, an organization can leverage the wealth of available patient information in clinical documentation to improve communication between caregivers, reduce the cost of working with clinical documentation, and automate the coding and documentation improvement processes. Where other applications of technology often require caregivers to change their existing, proven processes to accommodate the technology, NLP allows applications to work with the most valuable form of clinical communication-the clinical narrative³.” NLP will bring the value of the “patient story” in a structured format…we will have the best of both worlds.

What are your thoughts? Do you think NLP has the potential to bring the best of both worlds together to improve patient care and reduce costs?

Resources for this blog post:

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Top 5 Technology Trends in Healthcare – October 2013

Mon, 28 Oct 2013 12:01:34 +0000

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.

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.

Sluggish Adoption of Healthcare IT

The healthcare industry is experiencing an ongoing reluctance or sluggish adoption of healthcare IT by providers. This industry is chronically slow to move to new technologies, as is evident in the struggle to move from paper records to EMRs. Meaningful Use, ICD-10, Accountable Care Organizations, and HIEs have all experienced a pushback from providers and vendors.

Meaningful Use Stage 2 Struggle

In order to be eligible for federal subsidies, providers must meet meaningful use regulations. Hospitals and physicians have less than one year to meet the MU Stage 2 requirements, which many are contesting due to the aggressive schedule. Additionally, many vendors are encountering problems getting their EHRs certified for Meaningful Use.

HIPAA and Privacy Challenges

Over 15 years ago, in response to an increase in the abuse of personal health information (PHI), HIPAA was established to protect the privacy of patients and prevent improper disclosure and use of information. HIPAA rules set limits and conditions on uses of PHI, establish national standards to protect electronic PHI, put in place standards for notification of breaches, and improve patient safety. Violation of these rules or a breach can result in a fine or lawsuit.

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Top Technology Trends in Healthcare – June 2013

Wed, 26 Jun 2013 12:55:46 +0000

ACOs and Patient Centered Medical Homes

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Patient Centered Medical Homes (PCMH) focus on improving the quality of care delivered by creating a health care environment that facilitates communication between the patient and their physician, allowing patients to receive and understand the care they need when they need it.

Telehealth and Remote Patient Monitoring

The healthcare industry is experiencing revolutionary changes stemming from the rapidly shifting role of the patient within the continuum of care. This is resulting in high demand for easier access to healthcare professionals, access to online medical information, and alternatives to traditional care. Telehealth allows for the transmission of medical images, video, audio and information related to diagnosis and treatment can be stored and sent from the provider’s computer or mobile device via secure data exchanges. Remote Patient Monitoring allows patient’s health data to be sent electronically to a provider who then can analyze it and respond with appropriate recommendations.

Health Insurance Exchanges

Exchanges are organizations that will encourage a more organized and competitive market for buying health insurance. They offer different health plan options; certifying plans that participate and providing information to help consumers better understand their options. These exchanges will open in October 2013 with a required start date by 2014, and will assist individuals and small businesses in comparing and purchasing health insurance coverage.

ICD-10

Starting in October 2014, the U.S. healthcare system will begin mandating the use of ICD-10 codes to replace the ICD-9 coding system. The updated ICD-10 codes will be more specific and allow for more precise billing and address advances in medical knowledge and technology. While ICD-10 implementation can be challenging and places new demands on the provider community, it also opens up the opportunity for deeper data, which can be a tool to improve care and lower costs.

Social Media

Social networking and collaboration tools provide one-to-one streams of interactive communication which enable patients to seek out information about diseases and treatment options. Social tools can also be used to facilitate collaboration within the enterprise between clinicians, researchers, and partners. Social media has been used effectively for patients with cancer, diabetes, congestive heart failure, asthma, obesity etc. to help patients manage chronic disease and prevent readmission.

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ICD-10 Impact on Productivity – Offensive vs. Defensive Game

Mon, 20 May 2013 14:46:42 +0000

Chicago Bulls win the NBA Championship and ICD-10 has been postponed! Just kidding. However, as much as I am hoping for the former, I am sure many healthcare organizations are hoping for the latter. Unfortunately the chances of that happening are as slim as me becoming a Miami Heat fan! One thing is certain, when ICD-10 kicks in on October 1, 2014, productivity will take a hit. If you want to come out winning (least impact), you better come prepared with your offensive game.

Areas of Impact

Clinical Documentation – With the increase in granularity of the ICD-10 codes, there will be an increase in the amount of information that a provider must include in the patient record. This will directly impact the time spent on each patient encounter. Things that a provider may not have needed to capture with ICD-9 are now being required with ICD-10. For example, things such as¹:

Type of encounter (initial or subsequent)
Applied specificity (did the patient lose consciousness?)
Acute versus chronic
Relief or non-relief (intractable versus non-intractable)
External cause (what caused the accident?)
Activity (what was the patient doing when she was injured?)
Location (where was the patient when she was injured?)

According to a study conducted by Nachimson Advisors, LLC, the move from ICD-9 to the ICD-10 will increase documentation activities about 15 percent to 20 percent². This is not just an implementation or learning curve increase. This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10². Those providers thinking that their electronic health record (EHR) will eliminate extra documentation time are sadly mistaken. Many templates within in the system itself will need to be changed to accommodate the new codes sets resulting in additional work.

Coding – There is no doubt, given the sheer increase in the number of the codes from ICD-9 to ICD-10, there will be an impact on coder productivity, but as Angela Carmichael points out, the important question we should be asking ourselves is “how much” of an impact. She highlights some of the main reasons for the direct impact to coder productivity³:

An increase in the volume of codes available for assignment
An increase in the number of characters comprising a valid code
An increase in the specificity of approximately 20 percent of diagnosis codes and 99 percent of procedure codes
An increase in the number of physician queries
An addition of alphabetical characters to what was once only a system of numerical codes;
A complete overhaul of the procedure reporting system
Changes to coding guidelines

In her article, ICD-10 and its Impact on Coder Productivity, Ms. Carmichael explains³, “The increase in the volume of codes available for assignment coupled with the enhanced clinical nature and specificity of these codes will require a more intense review of documentation, leading to more dialogue between coders and providers. As a result, it could take twice as long to code and finalize billing of an inpatient record using ICD-10-CM/PCS as compared to ICD-9-CM. But as with all new things, there will be a learning curve with ICD-10, and this one is predicted to last approximately six months (this is based on Canada’s and Australia’s experiences in transitioning to ICD-10). This is not to say that on April 1, 2014 our productivity losses attributed to ICD-10 magically will be reversed, as many expect a long-term loss of inpatient coding productivity ranging anywhere from of 10 to 30 percent.”

The American Academy of Professional Coders, (AAPC) points out that “today the diagnosis codes are mostly numeric (with the exception of V and E codes), but with ICD-10 the codes are alphanumeric. The process of entering the new codes alone will slow productivity because we will no longer be able to rely solely on a number keypad to enter all the codes. Also, it will be very important to distinguish between letters and numbers when a diagnosis code is written as opposed to a narrative description. For instance, depending on penmanship, it may be easy to mistake a number two for the letter Z or the number zero for the letter O.”⁴

Payment – Coder productivity will not be the only impact on cash flow resulting from ICD-10. Payers are expected to take longer to pay claims, and the payment error rate is expected to rise to as high as 10 percent as a result of an increase in coding, billing and payment errors³. Again, the importance of documentation cannot be overstated as this directly impacts coding and billing. “About half of all allegations of inaccurate billing arise from insufficient documentation in the medical record, resulting in denials based upon lack of medical necessity or due to alleged upcoding. Two particular problems frequently cited include the review of patients’ medical and personal histories, and failures to provide adequate supporting documentation for diagnoses and procedures.”⁵ Organizations will also be tasked with determining how payers interpret the new coding system, and employees will have to analyze payer responses to claims over the first few months to identify deficiencies⁶. It is very likely that payers will end up denying more claims due to improper coding. Many payers are expecting providers to continue to code the “unspecified” option of a diagnosis. However, this will result in a payer either (1) rejecting the claim outright or (2) pending the claim and asking for more information⁵. Both of these outcomes result in extra work and decreased efficiencies for both the payer and the provider⁵.

Approach: Offense vs. Defense

We have all heard the old adage, “the best defense if a good offense”. This same phrase that applies to sports and war, applies to ICD-10. An offensive (proactive) approach vs. a defensive (reactive) approach will prove to help alleviate some loss in productivity. What better offense, then proper preparation and planning. AHIMA provides the following to assist providers and coders with their offense⁸:

Coding

Conduct gap analysis of coding staff knowledge and skills for ICD-10 environment.

Assess coding staff knowledge in biomedical sciences (anatomy and physiology, pathophysiology), medical terminology, and pharmacology.
Refresh coding staff knowledge as needed based on the assessment results.
Communicate with contract coding services to ensure their coding staff is being prepared similarly to meet the demands of ICD-10 coding and to determine their strategy and timeline for ensuring their coding staff achieve professional ICD-10 competence.

Documentation:

Assess quality of medical record documentation
- Implement documentation improvement strategies to address areas where documentation is found to be lacking.

Evaluate samples of various types of medical records to determine whether documentation supports the level of detail found in ICD-10.
- Sampling techniques could include random samples, most frequent diagnoses or procedures; diagnostic or procedural categories known to represent documentation problems with ICD-9-CM.

Consider changes in documentation capture processes (such as prompts in electronic health record systems) to facilitate improvements in documentation practices.
Educate medical staff on findings from documentation review and the documentation elements needed to support ICD-10 codes, through the use of specific examples, and emphasize the value of more concise 15:21 10/2/2012 data capture for high-quality data.
Designate a physician champion to assist in medical staff education and promote the positive aspects of the ICD-10 transition.

Assess training needs

Keep in mind that multiple categories of users of coded data require varying types and levels of ICD-10 education and it will be needed at different times.
Determine who needs education, what type and level of education they need, and when they need education.
Determine the most appropriate and cost-effective method of providing ICD-10 education to the different categories of individuals (e.g., traditional face-to-face classroom teaching, audio conferences, self-directed learning programs, web-based instruction (self-directed or instructor-led).
Determine whether education will be provided through internal or external mechanisms, or a combination of both.

“Preparing coders, physicians, and other staff for the ICD-10 transition may seem like a daunting task, but early, comprehensive education will be the key to a successful October 1. A thorough organizational assessment will help prepare every necessary department to receive the proper instruction, and investing in education will prevent a lapse in productivity once ICD-10 finally arrives” states Jennifer Bresnick of EHR Intelligence⁷.

The ball’s in your court. Get your game faces on and prepare for victory!!!

Join us tomorrow for the webinar, “ICD-10: Short-Term Challenges and Long-Term Gains.”

Resources cited in this blog:

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Webinar: Maintaining Revenue while Implementing ICD-10

Mon, 06 May 2013 12:47:09 +0000

The Centers for Medicare & Medicaid Services have spoken: October 1, 2014 remains the deadline for ICD-10 transition. Counting on another one-year extension is no longer a viable strategy, and delaying implementation can cause your organization to miss out on the cost and care improving benefits.

While ICD-10 implementation can be challenging and places new demands on the provider community, it also opens up remarkable opportunities for providers. Deeper data means better tools to improve care and lower costs.

Join experts from Perficient and Edifecs for an informative discussion of ICD-10:

ICD-10’s real impact to the provider community
How analytics can help achieve intelligence in ICD-10
Ways to identify, mitigate and prioritize risk
Best practices for achieving ICD-10 compliance
Assuring revenue up to and beyond the October 2014 deadline

Register Now!

Want to learn more about ICD-10? Download complimentary white papers from Perficient and Edifecs: The HIT Trifecta: Meaningful Use, 5010 and ICD-10, Implementing ICD-10: Hard Work Brings Rewards and Achieving ICD-10 Compliance from Any Stage.

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Top 5 Technology Trends in Healthcare – April 2013

Mon, 29 Apr 2013 12:38:11 +0000

Mobile Health

Healthcare organizations have embraced mobile technology, as it streamlines healthcare, provides immediate access to important patient information, and allows for increased coordination across the continuum of care. Patients and members are able to easier access healthcare professionals, online medical information, and care alternatives to contain costs and improve quality by using mobile technology.

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.

Health Insurance Exchanges

Exchanges are organizations that will encourage a more organized and competitive market for buying health insurance. They offer different health plan options; certifying plans that participate and providing information to help consumers better understand their options. These exchanges will be required by 2014, and will assist individuals and small businesses in comparing and purchasing health insurance coverage.

ICD-10

Starting in October 2014, the U.S. healthcare system will begin mandating the use of ICD-10 codes to replace the ICD-9 coding system. The updated ICD-10 codes will be more specific and allow for more precise billing and address advances in medical knowledge and technology.

Big Data

The healthcare industry generates massive volumes of data, which often isn’t leveraged to its full potential. In an industry where competitive pressures and regulatory demands are intense, information is a critical business asset, and healthcare organizations can’t afford to stay behind. Analysis of Big Data can help proactively monitor the health of the community population and respond to conditions such as potential illness outbreaks.

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Investing in Change Management to Drive Healthcare Outcomes

Wed, 06 Mar 2013 13:36:25 +0000

I attended a session at the HIMSS 2013 Conference yesterday entitled, Healthcare Kaizen, Daily Improvement, Not Just Events that Mark Graban, MSME, MBA, presented. At a technology conference it was refreshing to hear how technology should not be the only focus to improving care.

In today’s healthcare environment, big strategic initiatives are all the rage. Business Intelligence, ICD-10, Meaningful Use, Patient engagement, ACO, pick your flavor. All these things have one common goal-improve healthcare outcomes, be it patient care, cost reduction or increase in operational efficiencies. Given the financial incentives tied to many of these larger healthcare initiatives, many organizations are investing millions of dollars in technology to help them achieve the aforementioned. But what most organizations don’t realize is that you need to invest not only in technology, but in the people and processes within the organization to drive optimal care.

You can implement all the latest and greatest technology in the world but until there is some level of change management associated with people and processes the true goal of improved outcomes will never be fully achieved. Just as technology needs to be updated, people and processes need to undergo continuous improvements. As Mr. Graban pointed out in his presentation, the practice of Kaizen and Lean Healthcare is encouraging and offering structure to this much needed change.

Though change is inevitable, it is never an easy task. Just as it is difficult to implement technological change, so is changing behavior. Peter Scholtes once said, “People don’t resist change, they resist being changed.” Therefore, it is up to healthcare organizations and its leadership to understand the positive impact of investing in its people and processes. Without doing so, in a non-threatening manner as Mr. Graban pointed out, optimal patient care is just a mere thought.

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Top 5 Technology Trends in Healthcare – February 2013

Thu, 28 Feb 2013 13:11:33 +0000

Will you be attending the HIMSS 2013 Conference next week? Come see us in Booth 1555!

Patient Engagement under Meaningful Use

A key theme of Stage 2 meaningful use is engaging patients in their own care. Building on the Stage 1 requirement that 50% of patients be able to view their documents electronically, Stage 2 mandates that 10% of those patients actually do so. Clinical summaries must be provided following each office visit and select patients will receive notifications and reminders for additional care. Secure messaging to patients, another Stage 2 requirement, can connect them with helpful care information.

Population Health Management

PHM is a concept that includes the healthiest and the sickest individuals by improving the overall health of high- and low risk patients by addressing personal health behaviors that may contribute to health through care, communication and education. PHM places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.

Interoperability

Mobile Health

ICD-10

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Providers and the Adoption of ICD-10

Wed, 16 Jan 2013 13:49:32 +0000

There are two areas of focus in the ICD-10 conversion, each of which must be remediated/completed by October 1, 2014. Our initial thoughts, urges and efforts are towards technology or those systems that we must now use to do our jobs. Said another way, we need to update/upgrade the transactional systems, applications, and data repositories we use to conduct business and exchange transactions with our various business partners. This approach is typical. Dust off or complete (the latter in most cases) an inventory of all impacted systems, vendors, reports, databases, files, etc… Review the lists to determine the impact, work with vendors, and deploy updated versions of software and so on. Not necessarily the easiest thing to do, but we’ve all had to do this multiple times in the past and the IT folks will take care of it. Wait a minute you say! Backup, I just covered a great deal of ground too quickly on something that can weigh heavily on most organizations, given everything else going on, to handle. You’re right, I could devote blogs to just this topic alone. But I think that’s the easy part, or at least it should be.

The second area of focus, and the one of greater impact and importance, is that which covers a provider;s standard of care, clinical document standards and practices employed by its healthcare professionals in the delivery of care. It’s that which we have deployed technology to enable! What is captured in patient records and clinical documents today is driven by what’s needed in order to submit for reimbursement. Healthcare Reform has something else in mind, something longer term. We’ve begun the effort to turn the Titanic away from an instance of care focus to the longitudinal or continuum of care and the accompanying outcome. I would challenge each provider to examine their standards and to compare the current requirements for documentation of an encounter or patient services against what will be needed to adequately code a claim for ICD-10. I would be surprised if more than half the encounters coded to a bill in a hospital today under ICD-9 will have sufficiently detailed records to do so under ICD-10. The current “system” has been unduly constrained around the ICD-9 code set due to its longevity and focus on the here and now. Very few healthcare professionals can recall anything other ICD-9, nor the challenges that were experienced when it was adopted so long ago.

How to tackle this challenge? A place to start is needed. So how do you identify one? There are processes and tools in the marketplace that enable the leveraging of bills/claims for analysis looking through and ICD-9 to ICD-10 “viewer.” An organization can be enabled to use this approach to develop/refine their ICD-9/ICD-10 cross-reference, understand and examine the most frequent activities and areas of greatest revenue impact, establish priorities for Clinical Document and other standards initiatives, develop, schedule and deliver communication, training and education to the organization and drive the remediation of the supporting technology platforms and systems.

The first step is developing your organizations ICD-10 Cross-Walk. Remember, the published GEMs are fairly ambiguous “off-the-shelf” and need clarification with respect to your organization’s norms. The use of GEMs shouldn’t include on-going operations unless a partner is late in compliance and you have no choice. Even with a well-vetted cross-reference, much is still lost. Many organizations are dependent on a mix of EHR, Billing and BI solutions, each needing to use the Cross-Walk in its own way. A good solution facilitates the distribution to the point of consumption and, as needed, can provide an audit trail when use of the Cross-Walk is required in one of those urgent situations.

Long term, there will be an ability to derive benefit from the efforts required to comply with ICD-10. I would suggest that the refocus and refinement via Clinical Document Initiatives will drive better quality billings out the door, reduce your receivables with quicker reimbursements, reduce rework, particularly the amount of time lost when billing has to go back to the clinical folks for clarification, and, lastly, the diagnosis code will now be infinitely more useful for analysis and measurement, with an eye toward outcomes and the long-term well-being of the population.

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The Top 5 Healthcare Posts of 2012

Thu, 03 Jan 2013 13:43:48 +0000

The past year was very busy for the Perficient Healthcare team, and our blog reflects the time and hard work our group has put in. Throughout a year of healthcare reform, regulations implementation, and numerous deadline changes, we’ve worked to keep our subscribers in the loop. As we start another busy year, here is a look back at the top 5 most viewed blogs from 2012:

Is it time for Open Source in Healthcare? As several key players in open source software develop, do we need to re-evaluate potential IT architectures? These solutions hold the potential to reduce cost pressures in healthcare IT.
From Little Data to BIG Data – One Step at a Time One of the key building blocks to creating an ACO is data analysis. So how do we get from the unorganized data we have to the big data we’ll need?
Clinical Documentation – The Make or Break Component of ICD-10 With the ICD-10 deadline determined this year, implementation was high on many people’s minds. The Clinical Documentation Assessment is a great building block to start these looming projects.
ICD-10 Revenue Neutrality: A Strategic Approach ICD-10 was clearly a hot topic for many in 2012. In order to achieve Revenue Neutrality, Health Plans and Providers must work together to set up reasonable objectives.
Data Governance vs. Data Management The terms Data Governance and Data Management are closely related but still very different ideas. So what are they, and how do you know which is which?

In addition to these top 5 viewed posts, we have also published several successful Monthly Trends Reports, which we will continue to do in 2013. Stay tuned for another great year of content!

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