Healthcare IT Summit
November 14-16, 2010
Gaylord National Resort, Washington DC

New healthcare applications are being developed everyday for the iPhone and Blackberry – from EMR-related apps to prenatal care to chronic disease management.   Online articles and discussions have focused on the new Apple iPad as well, and its usefulness among nurses and other healthcare professionals. 

Some technology pundits question whether the Apple iPad will truly be able to run Windows-based applications from long-time rival Microsoft.   Others wonder if the iPad will fully support web-based applications.   Some healthcare applications are Windows and web-based, so that’s a valid concern.  And there are those that are thinking about how the iPad will work in doctors’ and nurses’ hands in demanding healthcare environments. 

It is my belief that the Apple iPad will handle all three scenarios very well.  Here’s why:

• Will the iPad run Windows-based applications?  That’s one of the biggest objections.  In truth, the iPad is the killer ‘thin client’ device that runs anything, including Windows.   As a thin client, it can run Citrix virtualization software, for example, that enables the device to run any version of Windows so that existing off the shelf applications can be used.  Load the iPad with the Citrix app – it goes back to a server that pushes out Windows 7, Vista, etc. 

• Will the iPad fully support some web-based applications?   –  The short answer is that it will.  Apple’s Safari web browser handles advanced web standards and is leading the way on the newest web standards like (HTML 5/CSS 3) – which means that dedicated, secure healthcare applications need to leverage the best in class available standards, and clearly the iPad is going to be able to facilitate that.  Right now Apple devices don’t run Flash, for example, an application heavily used for gaming and other presentations.  But whether or not Flash will be widely used in healthcare facilities is debatable for now.  Most professional apps are all standards-based, so no immediate access to Flash isn’t a big concern for now.  As more patients begin to use online healthcare applications to communicate with their providers, the demand for using mobile devices will only grow among healthcare providers as well.

• Can the iPad withstand a rugged healthcare environment in which it might get dropped and has to withstand cleaning every day to ward off germs?   Healthcare environments are incredibly demanding and mobile, so devices need to be sturdy and tether-free.   Hospital devices are carried around, occasionally dropped, and healthcare facilities have strict antibacterial and cleaning requirements for all devices.  Devices also need to be intuitive and not impede doctors’ and nurses’ natural workflow and processes.  The iPad is wireless, it can be recharged quickly, cleaned easily, and protected properly like any other mobile device, the iPad can withstand the rigors of the frenetic healthcare environment.  And, if someone is exceptionally rough on it or the device is broken, the good news is that it can be easily replaced within days and the new one can be put back into service without missing a beat.  

Mobile devices like iPhones and Blackberries are becoming ubiquitous and more workers will start to demand the freedom and usability these devices offer.    And with so many people already using smart phones and other mobile devices, the training curve will be low to boot. 

I think this is a situation where some people are focused on what the iPad might not be, rather than all that it is.   Healthcare professionals have long dreamed for a rugged, thin client, inexpensive and easy to maintain system that keeps them in touch with patients and healthcare operations.  The dream is now a reality with devices like the iPad.  I believe it’s a matter of another year or so before the iPad reaches widespread use in healthcare environments.

With today being tax day in the U.S., many of us are focused on what we have paid in taxes, and what we get for our contributions. As our budget balloons to levels that some in both the White House and the Congressional Budget Office call unsustainable, many are thinking about how the country can lower healthcare costs (and therefore lower our collective tax burden). The question is how do we work to control the expansion of the U.S. budget while keeping a high level of care for patients? One answer is telemedicine.

Telemedicine offers a way for patients to use today’s technology to communicate with their doctors. Existing telemedicine communication tools include simple interfaces like phone, e-mail and fax. Newer tools include self-service healthcare websites and live video conferencing such as Skype or Google Wave. Telemedicine also includes home health, web-based medical decision support to self-diagnose, online PDR (physician desk reference), and direct interaction with remote medical resources via electronic collaboration tools. Armed with this technology and better information, patients take a more active role in their health. Care effectively shifts from a passive to a more proactive healthcare model.

Don’t forget that telemedicine isn’t about the technology, however. Technology is the enabling tool that allows patients to play a more active part in their healthcare. Telemedicine moves some patient care from traditional settings such as hospitals and clinics to that of the patient’s own home or location, saving us time and trips to the doctor. Today we are already using telemedicine tools such as phone, fax and email. But new more interactive self-service tools are being created all the time to help patients communicate with their healthcare providers easily and quickly, making us better informed and more in charge of our healthcare. Doctors use telemedicine to have access to the latest medical information available, and use aggregated data and baselines of care from a large collective of patients with the same health issue. This gives our doctors better information so they can provide us with the best care plans.

As access to telemedicine tools becomes more ubiquitous, patients will be able to communicate with their doctors on their iPhones, for example, no matter where either party may be located. In essence, telemedicine represents a patient revolution. It is on the path to becoming the leading way patients communicate with their doctors and doctors communicate with other healthcare providers to provide us with better care. Telemedicine holds promise for producing huge time and cost savings and improving care and outcome for patients. We can all benefit in the adoption of telemedicine, by the reduction in costs (which should help control the overall healthcare budget).

While telemedicine helps make patient care more convenient, effective and inexpensive, it cannot cure how we feel about paying taxes, unfortunately. But we can take solace in the fact that as telemedicine is adopted and becomes more common, it will help reduce healthcare costs, which should help reduce taxes for everyone.

Florida joins the rest of the nation in dealing with an epidemic of abuse of prescription narcotics and other controlled substances.  The issue is that although the abuse is illegal, these drugs are being acquired through legal means, unfortunately (written prescriptions are legal – dishonest people are providing them to others illegally).  Many stories exist that give examples of how ‘pill mills’ are nothing more than legalized drug dealing, and the widespread abuse of these drugs can devastate individual families and the community as a whole.  Though long overdue, recent legislation in Florida attempts to crack down on pill mills.  But there is the issue of lack of funding and enforcement.

The ‘fix’ to stop people from getting their ‘fix’
So, how can Florida and other states fight the pill mills for a small cost with a big benefit? It’s simple.  The state can require all controlled substances to be issued only via electronic prescription (e-Rx) through the SureScripts network, even for transactions not requiring insurance benefit checks.  When honest doctors and pharmacists have the ability to see and check controlled substance scripts against other scripts, abuse can be identified and reported immediately.  Plus these doctors and pharmacists have the added benefit of quickly checking drug interactions and drug allergy checks for their patients’ safety.

The state benefits too, because once e-prescriptions are mandated, Florida can partner with SureScripts to provide the overall patient-narcotic database that it currently does not have the funding to build.

Issues
There are some roadblocks that must be resolved, but they are worth a discussion.  First, this will not happen without cost.  Providers will have to purchase an e-prescribe software solution, but incentives already exist from the federal government to help offset those costs.   And second, the rule to allow electronic prescription of controlled substances must be adopted, which should happen soon.  If you can believe it, until now, paper-based controls and processes were considered more secure than electronic means.

More than ‘just say no’
There are huge benefits to e-prescriptions.  Most importantly, legitimate providers will give better, safer care to their patients.  And fewer illegal prescriptions are a good thing for any community.  First things first, however.  Support and momentum need to build for controlled substances to be transmitted securely via e-prescribe.  I have lots of reasons to support e-prescribing in my business, but in this instance, public health and safety is the most important one.  For me, e-prescribing has been a long time coming, and I fully support this initiative — kill the pill mills and have a few side benefits to boot.

While visiting the White House Health Reform website this week, I thought about a statement in a feature piece that stated:

“After nearly a century of trying, and after more than a year of extensive debate, the President signed into law a health reform bill that brings down health care costs for American families and small businesses, expands coverage to millions of Americans and ends the worst practices of insurance companies.”

“Worst practices” jumped out at me. While worst practices of healthcare insurance companies and other payers has been the focus of much of the debate over the past year, I like to look at what insurance companies need to do to focus on best practices: on reducing their costs while providing better information to hospitals and patients to improve care.

For 10-15 years, most payers have been in a state of turmoil as they deal with multiple compliance measures and increasing amounts of data to maintain, control and exchange. These changes have included electronic data interchange (EDI) regulatory mandates such as HIPAA EDI 5010, NCPDP, ICD-9 to ICD-10 conversion, meaningful use, HITECH (PHI), etc. Each of these mandates will require massive effort so that payers can meet all requirements (which by the way will come in rapid fire order over the new few years). Insurance companies and payers have started to really feel the pain that can accompany change.

Add to that the ‘burden’ of the new health reform laws, which call for an expansion of EDI standards along with uniformity of EDI usage between entities and some insurance companies can quickly go from turmoil to overwhelmed.

I maintain that it’s time to start managing the chaos. If insurance companies and payers have not begun to find technology solutions that help collect, control and manage data, they will soon be hit with penalties. The time to evaluate one’s organization’s data and practices is now.

The good news is that the additional burden is based on the CAQH organizations recommendations which press for uniformity, much like their CORE certification. Organizations can evaluate their systems now, because the test data and certification requirements are all openly published, without having to pay for certification. We at BridgeGate used their test data (Phase I and Phase II) and found that compliance is not tough at all.

The only way to solve this is massive data onslaught is to relook one’s approach. This is a business issue, not an IT issue. What will win the day for the payers is not how much money or programmers can be thrown at the problem, but how successful a flexible and business-oriented approach can be. One path to get there? Use an integration platform where the business can configure and control at the hub, and let IT program at the periphery where needed. The business side has to be actively involved in the change, or all of this burden on top of turmoil will bury the IT groups within insurance companies worse than Y2K.

Change is here, and integration helps manage change.

AHIMA National Convention & Exhibition
September 25-30, 2010
Gaylord Palms Resort, Orlando

See you there!

www.ncpdp.org

Meaningful Use (MU) in the U.S. healthcare industry is under attack from many groups.  The key take away is that most of these groups want MU requirements watered down.  Providers have done their assessments and know that their vendors cannot get to 100% compliance – all or nothing.  With that, groups are joining together with the same mantra – all or nothing MU is bad.

American Academy of Family Physicians (AAFP)

Perspective: Partial Incentives vs. ‘all or nothing’ for MU
“We strongly believe that offering a partial incentive for partial Meaningful Use will vastly increase the number eligible providers who will make the attempt to become meaningful users.”

Read more…

http://bit.ly/912LCL

American Hospital Association (AHA)

Perspective: Incremental and flexible plan vs. ‘all or nothing’ for MU
http://bit.ly/aLXRxH

Certification Commission for Health Information Technology (CCHIT)

Perspective: Drop billing criteria (incompatible standards)
http://bit.ly/bScueD

Premier, Inc. (Provider Alliance)

Perspective: Roll-out MU in stages vs. ‘all or nothing’ for MU
http://bit.ly/c5WJXh

http://www.edward.org/body.cfm?id=87&action=detail&ref=269

Edward is not alone in marketing its features in this way.  While driving back from HIMSS 2010 conference in Atlanta, I saw a billboard that listed the wait time electronically.  I can’t recall which hospital or system it was.

While novel, this electronic wait time is not entirely useful, as it’s hard to determine when the clock starts.  What is true in a McDonalds fast food drive thru system is true in claims processing as well as ER wait times.  The trick is to define or bend the rules as to when the clock starts.   The definition when the clock should start can sometimes benefit the hospital, not the patient who will still end up waiting to be seen perhaps longer than expected.

Laws were created to state when a claim must be processed with various windows of expectations of 3, 7, and 14 days, etc.  Now, insurers use ‘pre-adjudication’ systems and other techniques so the clock does not start ticking until a time more beneficial to them.  Likewise, McDonalds and others dropped the marketing and ‘user experience’ indicator of ‘drive thru’ time to consumers.  All groups measure internally the metric of time, but the usefulness to the consumer is always a bit distorted.

Want to know how good a hospital is or how long you might have to wait once you are admitted into the Emergency Room?  Maybe compare one hospital against another?  Perhaps a better metric than ‘wait time’ is this hospital comparison tool.

Check out their HCAPS score at

http://bit.ly/aQaGEI

Every item you buy has worked its way through a supply chain to get to you.  From the manufacturer to the distributor to the retail outlet to you, and many stops along the way, the supply chain is something that many companies have studied for years to optimize transportation, decrease costs and use data to streamline operations.  Each part of the chain is studied, and the parties involved with that action try to decrease costs and get paid for their part of moving the goods.

In healthcare, there is also a supply chain centered on you, the patient.  Who gets paid for what and how much should each piece in the process get paid sounds easy enough for healthcare.  Simply match up cost of procedures for an associated diagnosis of an individual at a given time.  Truth is, we all know that is difficult.  If we look for examples of where other industries have been successful in reconciling costs related to a customer, a typical supply chain makes the most sense.

Henry Chao, chief technology officer at the Centers for Medicare and Medicaid Services (CMS) stated “Now, we’re part of a supply chain.  We have to teach people how to use our claims data and it’s not an easy thing.”

At the Financial Systems Symposium at the HIMSS 2010 conference Chao also spoke of the need for enterprise integration and a need for a national patient identifier to replace the use of a social security number.

Those two items are important, but what is really at issue and has yet to be resolved is who owns the data?   And how will that data be connected and shared?

Though Chao is correct in seeing CMS as part of a supply chain, the biggest gain in driving down cost, increasing quality of care while reducing risk to providers is to have the caregivers behave and perform like a supply chain.  Technologies that optimize operations of providers’ staff and resources while accounting for appropriate payment in addition to the other concerns is where healthcare as supply chain will make the biggest impact to both patient and the economy.

http://bit.ly/coTiNj

Greg Gillespie of Health Data Management has the best ‘round-up’ that captures the essence of what was so… ‘meaningful’ at HIMSS 2010.

http://bit.ly/cL38xD

Including Y2K and the dot-bomb era, I have never attended more vendor product sessions that preached something new, but did not do anything different than before.  What I witnessed were some existing vendor offerings (pigs) with some ‘meaningful use’ (lipstick) slapped on them.

I liked Greg’s article because I wondered who else caught on to the fact that answering ‘how’ and ‘what makes meaningful use work’ was the real underlying message at HIMSS 2010.

Push ARRA ‘meaningful use’ and ICD-10 aside and Greg hits on the realization that “All this stimulus/EHR talk is driving home the point that electronic records now must be the center of a spider web…”  Interoperability is the glue that can weave together the myriad of vendors and solutions that will enable organizations to not just grab ARRA dollars, but build a framework that can share patient-centric data inside an organization’s four walls as well as external to those four walls.

Granted the ‘spider web’ in its previous incarnations (interface engine, integration engine, interoperability, etc.) have been the focus of HIMSS past; yet, many providers bought the single solution set which houses siloed information.  They were not wrong in doing so, in fact, they should keep what they have and augment where needed, be compliant with all of the criteria in the ‘meaningful use’ objectives.

The bottom line is that there is no ‘single bullet’ when it comes to meaningful use.  I truly hope “that CIOs and other decision makers … are effortlessly poking holes in that pitch” as Greg states in his article.  He continues to say that these same decision makers should be demanding “Show me the data exchange…” So we hope.

Oh, and to the HDM team, thanks for the HDM shirt.  Very nice.  I’m shooting for the Vespa next time!