Integrating Healthcare Data – a Success Story from the Front Line
Regency Hospital Company Creates A Single, Shared View of Patients to Contain Costs and Manage Change
Wednesday, April 14th at 2:00 PM EST | 11:00 AM PST

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Like most CIOs, you are faced with many competing requirements and initiatives from your CEO and your board. But you’re still having to tackle more initiatives with fewer dollars. Added to this and a recovering economy, industries like financial services and healthcare have seen reform and new regulations, huge IT initiatives, and mergers and acquisitions, which all add up to massive change for IT.

Handling the crushing weight of some of these technology-related changes can challenge the best CIO. To add insult to injury, CIOs often can’t hire new IT staff required to implement these initiatives and adapt to the numerous changes, because the numbers just don’t add up at the moment. Still, in the midst of all this change and reform, the world’s most progressive companies are adapting, and they have been able to keep their IT costs steady for years.

These progressive CIOs have positioned IT an enabler for business growth and they have proven that time and again through solid IT initiatives and implementations. And the forward-thinking CIOs have had solid successes using integration as a cornerstone to their IT efforts, and have shifted some responsibility for integration to their business colleagues.

Most companies still solve systems integration in the same way they develop their core business applications — using analysis, design, and then handing it over to programmers to develop the solution. The IT solution is tested, bugs are found and sent back to the programmers and then finally deployed. Some CIOs have tried offshore development for their integration efforts — they have their business analysts write requirements and then send those requirements to an offshore company to program, there’s a lot of back and forth, and problems arise around miscommunication / language barriers, etc. In the end, some of these offshore projects have saved neither time nor money. It’s difficult to keep costs steady and quality high when you use these approaches to integration.

Think about this — why not shift some basic systems integration knowledge and tasks to a few of your business folks? This would help free up time for your IT staffers and ensure that these folks understand the basics of integration as they understand the business. You can really save money and time off a project if you get someone who understands the business processes and the data formats, mapping and data conversions. In fact, what if those same business analysts could solve your integration problems WHILE writing new requirements? It is the same level of effort that a business analyst would put into documenting and writing up requirements anyway.

That’s the approach that BridgeGate has taken with integration and how we’ve helped many CIOs with successful integration projects. And with a robust integration platform helping connect your systems and data, you’re on the path to keeping your IT costs steady. That’s a huge deal in this recovering economy.

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.

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