Guest post by Karen Conway, executive director of industry relations, GHX
Healthcare cannot afford to keep pushing forward with the old way of doing business. As factors like the medical device excise tax and declining reimbursements impact their respective bottom lines, providers and suppliers are looking for areas where they can remove unnecessary costs, while maintaining high quality care and service. One area gaining increased attention is the implantable device supply chain, which is rife with inefficiencies and lack of visibility. There is more than $5 billion in documented waste, shared equally by providers and suppliers in the U.S., according to research conducted by PNC Healthcare and GHX.
The implantable device supply chain’s (IDSC) problem can only be tackled through a collaborative effort because it relies on multiple parties from hospitals, physician practices, manufacturers and distributors. Its inefficiencies and waste are a result of four main problems.
Error-prone processes: From the moment a case is scheduled, through product delivery and use, until after the procedure is completed, the entire process is painfully manual, disjointed, duplicative and error-prone. Managing inventory, preparing for cases, documenting and reconciling supply usage involves multiple parties — sales reps, surgeons and circulating nurses, just to name a few. Combine the number of parties with manual, paper-based processes and you have a breeding ground for errors and inefficiencies.
Lack of data standardization and synchronization: The lack of data synchronization has historically been one of the barriers for automating the IDSC. For many hospitals, data on implantable devices is not well managed — or at all — in the item master. Unfiled items create confusion about the products used and the correct pricing, which can further delay the process and payment.
Ineffective inventory models: As providers have experienced increasing cost pressures in the past 10 years, they have turned to suppliers to manage their inventory. As a result, a large percentage of devices are either consigned inventory or stock held by sales representatives — so called “trunk stock” — with a much smaller percentage owned by the hospitals. Suppliers report they can have up to 60% excess inventory and write off 7% to 10% due to loss, waste or expiration.
Lack of demand or usage visibility: More timely communication (as soon as a case is scheduled) can help both parties better prepare the required products and instrumentation. Large volume hospitals generally try to keep enough stock on hand to manage a peak day — say five hip cases on average — but what if the patient requires an uncommon size or if each case that day requires the same size implant? Even with good planning, sometimes there are unexpected product needs, which can be harder to accommodate without synchronized product data in item masters.
A group of manufacturers and healthcare systems have been working together to address many of these issues by developing best practices and conducting pilots to measure the value of data synchronization, process automation, case preparation and product documentation. Industry-wide adoption is critical to truly change the status quo, though these pilot projects are the first step to automating the IDSC.
It’s important to help both providers and suppliers leverage their own technology investments for their internal purposes, while looking for opportunities to standardize around shared best practices when they are working together.
Between changing regulations, healthcare reform requirements and the pressures of tight budgets and small staffs — all amid a commendable drive to improve patient care — hospital IT departments are often overwhelmed by the task of providing technology to support existing and new programs.
IT departments must also phase out legacy applications and implement new solutions in order to offer the interoperability, performance and reliability that clinicians and other users demand. It’s no wonder many IT organizations feel stretched beyond their limits with all these responsibilities. Without a clear plan, the result of different IT initiatives can be a mishmash of programs and projects that are puzzling to even the most organized IT project managers.
This all-too-common situation points to a critical need for clarity. IT departments must gain better visibility into IT processes and resources in order to thrive. That’s why integrated IT portfolio management solutions are gaining ground as a smart way to track ongoing projects, organize resources and staffing, and give hospital leadership big picture views of the status of IT projects and an understanding of how they affect key hospital performance measures.
Navigating regulations and supporting strategy
Some hospitals and other healthcare organizations are struggling to deal with EHR and meaningful use mandates. They are working toward readiness upgrades required for ICD-10, and are trying to overcome the challenges presented by the Affordable Care Act. Each of these new regulatory thresholds must be treated as its own IT project, with separate resources, management and analysis. Hospitals can efficiently manage even the most complex projects — such as EHR/EMR implementations — while improving their ability to test projects for meaningful use criteria through the use of project portfolio management (PPM) and application portfolio management (APM) solutions. These solutions also help increase accountability across the dozens of projects and thousands of support hours associated with healthcare modernization.
Control costs and track financial impact
Hospital leadership must be confident that a new technology will save the hospital money — they can’t simply take IT’s word for it. A tool that provides more visibility into the financial impact of IT investments, as well as the ramifications of compliance penalties, is critical in demonstrating the value that the IT department provides to the hospital. Having a better handle on IT financials and resources also means organizations can focus more on deadlines, and keeping much-needed incentive payments coming through the door.
Better visibility fuels innovation
End-to-end visibility of projects, their necessary reporting requirements and resources lets organizations plan for today as well as innovate for a more efficient, effective tomorrow. Developments like integration with consumer devices that capture medical information allow facilities to offer providers the latest solutions to help them deliver quality care to their patients.
The proper APM and PPM solutions offer significant strategic, regulatory, financial and competitive advantages. In today’s complex IT environment, these solutions are a “must-have” to provide a clear picture of where hospital IT projects have been, where they’re going and what value they deliver to the organization.
The Institute for Health Technology Transformation (iHT2) offers a collection of articles detailing the effective use of technology and new initiatives in healthcare. Here, two standout stories examine the benefits of content-gleaning technology and potential consequences of new legislation.
Benefits of health care enterprise content management
Enterprise content management (ECM) encompasses the capture, management, storage, preservation and delivery of content. Though a long-established market, it’s becoming increasingly essential to health care organizations as they look to gain more value and insight from documents, emails, blogs and other types of unstructured data.
In her recent article, “Benefits of health care enterprise content management,” Kim Phan, Program and Marketing Coordinatorr, Institute for Health Technology Transformation (iHT2), says the best ECM software can improve interoperability, create consistent EHR data, and provide an efficient framework to manage unstructured patient data. In other words, the systems ease the strain of satisfying meaningful use requirements and becoming eligible for EHR incentive programs. Read her article, which also features insight from Barbara Walters, senior business analyst at the University of Michigan Hospitals and Health Centers, here.
Healthcare Leaders Should Take Action in Response to Obama’s Cybersecurity Executive Order
Also spear-heading the intersection of healthcare and legislation is Obama’s cybersecurity executive order, Improving Critical Infrastructure Cybersecurity. As the National Institute of Standards and Technology works to develop a cybersecurity framework to establish common digital information security risk assessments and best practices, healthcare CIOs should begin adopting cybersecurity best practices now – before they’re scrambling to get in a good position for potential incentives in the future.
Guest post by Scott Zimmerman, president, TeleVox Software, Inc.
Providers are now using engagement communications, such as educational email campaigns, informational videos, and text messages and voicemail reminders, to help patients manage their own health and give them a more personal experience. Most of us have met with a doctor who took an extra five minutes to ask about our job or family. Doing so can make patients feel connected to their care and motivate them take responsibility for their health. Building trust and a sense of safety with doctors through interpersonal communication is essential to maintaining a solid patient-physician relationship. This closeness is now being widely achieved via new technology.
As digital healthcare technology becomes more widely used, doctors are finally beginning to achieve the appropriate amount of communication that patients desire. Our TeleVox Healthy World research found that 85% of patients in the U.S. felt that digital communications such as emails, text messages, and voicemails are as helpful, if not more helpful, than in-person conversations with their healthcare provider. We also found that more than 35% of those who don’t follow exact treatment plans said they would be more likely to follow directions if they received reminders from their doctors via email, voicemail or text.
We also discovered that trust is crucial when discussing treatment plans, and that doing so ”virtually” can make the process easier and more cost-effective. Our research showed that 34% percent of U.S. consumers said they would be more honest when talking about their medical needs through an automated call, email or text message than in person with a healthcare provider. Another 30% asserted that receiving patient care between visits via text messages, voicemails or emails would increase trust in their provider.
Doctors can maintain a level of trust with their patients by tailoring their message to make sure patients don’t feel overloaded with impersonal “blasts” or junk communications. Patients told us that while implementing digital healthcare can make things easier and faster, they still need communication that relates to them individually and is personalized with their name. More than half (52%) of men we surveyed said the communication they receive from healthcare professionals should be relevant to them as an individual, and 55% of women said the same. More than a third (37%) of men and 34% of women said they would ignore or refuse digital healthcare communication if wasn’t personalized with their name.
There may not be enough time to fully engage and motivate a patient during a face-to-face visit, but through mobile devices and other technology, doctors are able to personalize their communication with patients to provide regular information, support and encouragement to help them take more responsibility for their health. As it continues to shape other areas of our culture, a higher prevalence of digital technology usage should be expected within our healthcare system. High tech communication is a fast, cost-effective and personalized ways to reach large audiences. This combination helps make patients feel engaged and supported.
Guest post by Susan deCathelineau, associate vice president of healthcare sales and services, Hyland Software
There is a growing need to address the storage and access of medical images. From wound care photos to DICOM CT and medical records studies, medical images are prevalent and their storage requirements are intensive. To derive the most clinical value from medical images, a careful taxonomy and content management strategy should be applied.
Today, many healthcare providers are working to solve the challenge of medical image management through the deployment of a vendor neutral archive (VNA). These systems are capable of providing a single repository for medical images and they will also typically provide basic support for associated unstructured clinical content.
While medical images are often stored, viewed and managed on separate systems; these images are simply another form of clinical content which can benefit from an enterprise content management (ECM) system.
ECM systems play a key role in completing the electronic medical record (EMR) by integrating and incorporating the vast amount of health information that is not otherwise captured by the EMR. ECM provides integration of unstructured clinical content in a way that most physicians and clinicians are unaware that this important clinical information is actually being captured and displayed by an ECM solution. This can include access to content which has been converted or archived from legacy picture archiving and communication systems (PACS), EMR and practice management systems.
Making the transition to centralized medical image storage is often challenging because of the many sources of medical images and other relevant content. Not surprisingly, health providers often choose to embark on a stepwise deployment of their VNA. Some ECM solutions are serving as a bridge to enterprise VNA, by offering the ability to ingest DICOM studies, integrate to departmental VNA solutions and to display medical images along with the traditional ECM data.
ECM solutions provide a path to achieve VNA adoption while immediately improving the clinical experience for physicians and clinicians by presenting data from disparate sources together in clinical context. It provides the right information in the right place within the EMR, including access to medical images.
In addition, achieving meaningful use stage 2 attestation and HIMSS EMR adoption model stage 7 require evolved healthcare information workflows and interoperability. While EMR image enablement is currently optional within these standards, it is almost certain to become a requirement in the coming years. An ECM solution can provide immediate efficiency gains and enhanced access to clinical information.
Healthcare providers are utilizing a smaller number of enterprise-class IT systems and deploying them with creativity and consistency. They are insisting upon significantly higher returns from their IT investments than was achieved in the past. This necessitates that healthcare technology companies form strategic partnerships to meet the broadest possible range of customer needs with the lowest possible recurring cost. A world-class ECM solution provides an ideal technology platform to empower this transformation. ECM seeks to make other systems better, to replace systems and consolidate clinical content behind the scenes.
By leveraging the combined strengths of ECM and VNA, medical images become an integral part of a singularly accessible and significantly more complete medical record.
Each item here has the potential to become a large-scale strategic exercise for any CIO and their department, though it isn’t a complete list. That prospect that should make all CIOs ask themselves, “Exactly how many of these exercises can my people handle in 2013 and 2014?”
A CIO’s initial reaction to that question might be to simply address the most feasible items on the list — a strategy I expect most CIOs will have trouble executing, as all of the items are critically important.
This means they’ll have to face an even more daunting prospect: Addressing all of these items simultaneously, regardless of budget or time constraints. They’ll have to resort to a previous method they’ve had success with, and deploy solutions that:
Don’t conflict with their need to protect healthcare records
Align with their clinical and back-shop revenue-cycle-management workflows, teams, and individual users
Offer some productivity advantage over the status quo (to encourage end user adoption)
CIOs will be challenged to:
Increase the efficiency and effectiveness of internal support roles
Cost-effectively deliver superior access and service to those outside the organization (e.g. customers, colleagues, and end users)
Deploy more of the enterprise’s systems on mobile devices for those inside the organization (e.g. physicians, nurses, care coordinators, and claims processors)
When addressing all of the pressing items on the first list above, will CIOs give their in-house health IT professionals the same qualityoftools and solutions? CIOs must recognize that while clinicians inarguably do the most important work (patient care), IT professionals and those in supporting roles enable clinicians to do that work well.
Here are three points CIOs should consider in order to ensure they’ve got everyone covered.
1. Self-provisioning solutions
Solutions that facilitate connecting applications, partners, and mobile devices — both inside and outside the organization — go a long way to reducing our team’s process-management workload. Organizations should take advantage of these tools because they increase customer satisfaction and speed time-to-value for the key applications we need to deploy.
2. Policy management
Simply bolting applications, especially mobile and cloud applications, onto your infrastructure creates a security nightmare, as the healthcare industry is replete with transient workers, ever-changing security rules, and patients moving throughout its networks. Middleware and identity management tools that offer centralized management consoles are essential here, as they reduce the time it takes to: Deploy an application in the cloud or on a mobile device, align a patient portal with your enterprise capability, and create the common structure that enables you to authenticate and validate the roles of users, like physicians and clinicians who work remotely.
Many downstream systems can be adversely impacted if something goes wrong with a legacy system (e.g. a data breach due to improper redaction). Smart monitoring tools that identify potential mishaps empower health IT professionals to reduce the time it takes to resolve those mishaps.
There’s no latitude for picking and choosing — all of the 2013 and 2014 pressing items must be addressed, regardless of whether the CIO’s people have the time to address them. Any CIO who tackles these items without considering how self-provisioning solutions, policy management, and governance will impact their teams’ chances for success will miss the opportunity to focus their teams’ efforts and make short work of these items.
But a CIO who recognizes these three points cut to the heart of the pressing items list actually stands to abbreviate the amount of effort required by their support teams, freeing them from the drudgery the list would normally demand. This provides them a chance to let their creativity and innovation servethe organization, rather than see it forfeited as they tackle tasks that don’t require their expertise.
Guest post by: Anita Karcz, M.D., chief medical officer, IHM Services Company
Meaningful use is the phrase of the decade in healthcare. Federal incentive payments have been a powerful motivator to attest as rapidly as possible. Hospitals are challenged by constantly changing requirements and threat of audits as they scramble to meet meaningful use requirements. Many simply don’t have time to accomplish the goals of the program itself — to change care delivery processes and support improved care standards — amid the ongoing race to meet attestation standards. Gathering data for meaningful use has become “teaching to the test,” a mechanical exercise that consumes time and energy without obvious benefits for care delivery.
Meaningful use not solely an IT initiative
Meaningful use qualification is impossible without an IT infrastructure. However, complying with the core and menu measure thresholds and the clinical quality measures requires coordination from historically independent hospital departments. Consider, for example, one stage 1 measure requires that a patient who requests an electronic copy of their record must receive it within three days of the request. The request may be made to a nurse at the time of hospital discharge, with the medical records department charged with fulfilling the delivery. Documentation and notifications touch multiple individuals in nursing and medical records departments. Creating multidisciplinary teams for planning workflow and monitoring performance is essential for compliance, since every core and menu measure and every clinical quality measure have similar criteria.
Using real-time data to guide care
While retrospective data is important to identify trending and overall process compliance, changes made based on retrospective analysis only affect care in the future. While this can certainly be useful, hospitals need to go beyond retrospective reporting and trends to access information in real time, guiding the delivery of care toward when the patient can receive the most benefit.
More immediate information allows for delivery of better care while the patient is still hospitalized, which is key to enhancing patient safety, treatment quality and outcome.
Real-time data needs to be easily and consistently accessible to front line staff. Keeping hospital staff engaged with ongoing patient care data is critical for incorporating best practices into everyday routines.
Delivering best practice care
The journey from identifying and understanding existing gaps in care to meeting meaningful use standards is challenging. The goal is to improve care performance by helping hospital staff quickly and efficiently find the gaps in care. Daily review of real-time data can also point managers to the reasons behind failure to meet the requirements. For example, one hospital’s data may show that the third floor is not documenting all vital signs on all patients during the evening shift. Rapid cycle improvement through staff education and/or workflow changes can then be implemented, with results measured immediately.
Meaningful use isn’t going away
Meaningful use is a program that will become more intensive and pervasive as time goes on. Involvement and engagement of all hospital staff now, in the early stages, will provide a strong base for continued future compliance. Delivering data in real time engages staff and provides the important link to clinical care from a high level regulatory mandate. This is key to meeting and sustaining compliance and having meaningful use mean something more than just checking a box.
Saying goodbye to manual abstraction?
Hospitals have been reporting compliance to CMS for years by manually abstracting data from patient records. Abstractors diligently go through file after file to see if patients meet the required standards. This practice cannot be utilized for meaningful use because reports require codified and structured data that is collected electronically and extracted from the electronic medical record (EMR) system itself.
This shift from a manual to a fully electronic process has led to a burdensome workload for hospitals. There are mountains of regulatory documents that must be reviewed in detail just to understand what meaningful use requires. From an IT perspective, those requirements then need to be translated into a series of programming queries to extract appropriate data out of the EMR system prior to incorporation into the patient record for analysis and, ultimately, creation of the reports.
Next comes the most challenging phase — data mapping. In order to create the reports, hundreds of thousands of data elements must be created and/or modified in the electronic record to create the meaningful use reports and all too often, just when a hospital believes the data mapping is complete, they run their reports only to find meaningful use thresholds are not being met and that more modifications are required. This is a major problem for most hospitals because it’s often difficult to find the specific reasons behind the failure to meet thresholds and information on how to change processes to improve results. Identifying a specific attestation issue is often like finding a needle in a haystack. Even if problems are found, hospitals still have to make modifications to the reporting system, processes and workflows to be sure that data used to create the reports is entered accurately.
The process is truly exhausting. Unfortunately, in the race to meet deadlines, and with so many other competing priorities, process improvements and changes to care management fall to the bottom of the list. Hospitals must find a way to attest while also doing what meaningful use was intended to do: Improve care quality.
Dr. Anita Karcz is chief medical officer and co-founder of the Institute for Health Metrics. She is responsible for clinical research and supporting product development goals. She has prior experience with research and product development in clinical outcomes and decision support and was vice president of clinical product development at InterQual Inc. She holds a B.S. and an M.D. from the University of Massachusetts and an MBA from Northeastern University.
The benefits of health care enterprise content management (ECM) are clear to those who have invested time and effort into it, though it has been relatively slow to catch on throughout the industry. In addition to improved interoperability and medical record storage, using ECM software to manage unstructured patient data encourages interoperability, addresses meaningful use and provides an efficient framework for document management and consistency within an electronic health record (EHR).
What goes into a provider’s decision to switch to a new ECM product? Barbara Walters, senior business analyst for medical center information technology at the University of Michigan Hospitals and Health Centers, explains the process, elaborates on the challenges and sheds some light onto what is still keeping her up at night regarding the system’s ECM software conversion.
Q. What was the process like to switch from IBM’s FileNet to OnBase’s integration with Epic for enterprise content management?
Barbara Walters: We converted 29 million documents over a ten month period, focusing first on clinical documents, then on revenue cycle docs. It took four months of planning with On Base and Epic, with the biggest obstacle being ourselves. Between 2005 and 2012, we had 22 million clinical images and 9 million revenue cycle images, but we also had over 3,500 different document types, so it was a considerable job for health information management to consolidate down to approximately 700 document types. They wanted to be as specific as possible. We then took all of our data fields and created new keywords in On Base, with category and document names organized by groups and validated through a homegrown process.
Q. What are some of the challenges you are still facing?
Walters: Now, registration, revenue cycle, base applications and Epic ambulatory are converted, with inpatient coming next. But, what’s the best way to do inpatient transitioning? We want to narrow it down based on time sensitivity. Another challenge is file transfer. Getting scanners for all hospitals is nearly impossible and lots of documents still come through fax. It’s an antiquated process.
Q. What still keeps you up at night in terms of ECM?
Walters: Operations and end users, because the integration with On Base and Epic is so transparent. We need more integration between Epic and On Base’s storage server. If there were ways to make that integration tighter, that’d be good. On Base has great integration for clinical documents, but we don’t have that interface just yet. We’re still going through growing our Epic implementation.
Jenny serves as the senior community manager for SearchHealthIT’s Health IT Exchange. Follow her on Twitter at @HITExchange and @jennylaurello.
If you’ve ever seen Minority Report, think back to the scene where detective John Anderton walks into the Gap and is identified using their eye scanner. Though the use of biometric technology still seemed beyond its years to many at the time the movie was released in 2002, it is now being utilized across multiple industries for security and identification purposes every day – moving into the consumer realm for secure PC and smartphone login, and even into law enforcement, with the FBI aiming to launch a pilot of a nationwide iris scan database for criminal tracking by 2014. And in health care, hundreds of hospitals and health systems have implemented this technology for patient identification purposes, including Hugh Chatham Memorial Hospital (HCMH).
When Lee Powe, Hugh Chatham’s CIO, was pitched the idea to switch from their palm scanning identification system to M2SYS Technology’s RightPatient™ biometric patient ID system — which supports iris scanning in addition to finger print, finger vein, palm vein and face recognition — he was a bit skeptical.
“I was a tough sell, actually. We do a lot of cutting edge things, and I’m an IT guy, but this seemed a bit much for me. But after the decision to implement was made, in three weeks it was up and running in our outpatient area,” Powe said.
A private, not-for-profit hospital in North Carolina, HCMH employs more than 70 physicians servicing 26 specialties or subspecialties, and these clinicians, as well as their patients, had to get on board with utilizing the system. “We started off with palm scanning, but clinicians didn’t ‘get it’ until we went to iris scanning. People understand when you take their picture; it’s not as intrusive or as foreign as a palm scanner. There were also infection control issues with the palm scanner. It had to be cleaned and sanitized after every use, which added a step in the clinicians’ workflows. Now, this isn’t an issue,” Powe noted. “As someone making decisions at the top, your actual users will prove you right or wrong really quick.”
Integration with HCMH’s EHR system is a work in progress, but it’s coming along. “Currently it’s an overlay of our EHR, but we’re working through that so the next software release will have the corresponding pictures and information integrated with each patient record,” said Powe. This is because the system is also able to provide a photograph that can be linked to patient records for multi-factor authentication.
“We’re all waiting for the master patient index for patient identification, and I was in the Army — I get it. But since the industry can’t use social security numbers, utilizing the eyes would be perfect for this.”
Powe continued, “My problem is not using the technology. My problem is deciding where to use it; front end registration or bed side. I have challenged our team that the front end is faster and more efficient. If you can ID someone up front — or similarly if you can avoid misidentifying someone upfront — it becomes a critical factor in ensuring patient safety and fraud mitigation. The majority of the hospitals out there are sending names through multiple systems wrong; there are no automated processes. All these technologies that are interoperable don’t fix the screw ups. They only make them happen faster.”
One reason why iris scanning is growing in popularity is the increased level of specificity it provides for identifying an individual, allowing for more than 200 points of reference for comparison as opposed to only 60 or 70 points in fingerprints. But this doesn’t mean it’s a full proof solution. While iris recognition was found to have an error rate of only one in a million according to a January 2011 study by the National Institute of Standards and Technology, research presented at the 2012 Black Hat security conference showed that it is possible to recreate iris images that match digital iris codes, essentially tricking commercial iris-recognition systems into believing they’re real images.
The potential security threats of iris hacking aside, the technolopgy is currently in use in HCMH’s outpatient admissions and radiology departments, where Powe and his team have plans to expand to the emergency room and all affiliated physician practices in the near future.
What’s HCMH’s main reason for implementing this technology? Powe noted that “By and large, we’re doing this for patient safety.”
Jenny serves as the senior community manager for SearchHealthIT’s Health IT Exchange. Follow her on Twitter at @HITExchange and @jennylaurello.
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