Survey provides “snapshot” of health IT jobs

Health professionals believe that between 50,000 and 200,000 new jobs will be created in health IT by the year 2015, according to a recent survey.

The American Society of Health Informatics Managers (ASHIM), a nonprofit healthcare organization for health IT professionals, conducted the survey in response to data from the United States Bureau of Labor Statistics, which indicated a national deficit of qualified health IT workers. ASHIM officials said the survey’s purpose was to provide an early stage snapshot of the jobs activities taking place around health IT in the United States.

The Salt Lake City based organization surveyed 135 health professionals, 20 percent of which were beginners in health IT (one year: student), 30 percent of which were intermediate (one to five years: decision influencer, working level) and 50 percent of which where experts (five-plus years: decision maker, senior management).

According to the survey more than 10 percent of respondents believe that more than 200,000 new jobs will be created in health IT by the year 2015. Almost 30 percent think 50,000 to 100,000 new jobs will be created. And more than 40 percent believe there will be 50,000 new jobs created.

The survey found that most health professionals believe that health IT employers want both IT and healthcare experience and knowledge and that health IT certification is valuable in the hiring process.

According to a blog posted on InformationWeek, San Francisco EMR provider Practice Fusion is not worried about finding employees that have clinical experience when it comes to hiring new staff. As Ryan Howard, the company’s CEO, explained to InformationWeek, his firm “doesn’t want to hire people with preconceived mindsets about EMRs.”

According to the ASHIM survey half of survey respondents believe that IT professionals will be the more likely than healthcare industry professionals and new students to seek additional skills to work in the industry.

“While employers are ramping up to adopt electronic health records, IT workers are looking to augment their skills to meet those needs and to effectively communicate their qualifications,” said ASHIM Senior Vice President Stephanie L. Jones. “ASHIM believes it is important to understand and support the evolving needs of the healthcare community and will continue conducting this survey, adjusting questions, to inquire about them,” she said.

Respondents cited consultants and trainers as most likely to fill new positions (63 percent and 61 percent, respectively), with sales and IT positions following closely behind.

EMR 101: An Overview of Key Benefits

It’s no secret the Internet is everywhere, so it is a contradiction that millions of Americans feel secure enough to do their banking online, but the U.S. healthcare system is still wary of transitioning health and medical records into an electronic format.

As I sat with Ron Pelletier, vice president of market strategy, at a SourceMedical conference in Las Vegas, he stated, healthcare in general, grossly underutilizes the internet. We discussed one of the main reasons outpatient centers have been slow to change. “On the ASC side, things may not have been broken. Reimbursements were good, now that is changing. These centers are under pressure with reimbursements shrinking and costs going up. Many are saying, ‘In order to stay competitive and keep my business afloat, I need to find better ways of doing this.’ The necessity now is driving them.” states Pelletier.

This series of articles will cover some of the key points that need to be addressed when considering the implementation of an EMR in your ASC, including key benefits of EMRs, what to look for in a provider, how to get your staff ready for this impending transition.

To begin, we should consider the many definitions of an EMR. “There have been so many people out there that have said ‘I am selling an EMR’ and all it is is scanning in your paper and saving it to a computer,” says Craig Veach, senior vice president of operations for Amkai. “Then there are others who have a forms-based system. In the PIIM study, of the original 50 that were considered, none of those were even the forms-based systems because PIIM thought they were not commercially viable. You want something that is a true work-flow manager. Our EMR handles communications within the organization using an internal email and instant message (IM) that allows people to pass info and stay HIPAA compliant. It’s customizable on how it is set up to manage an individual organization’s workflow,” Veach adds. The Parsons Institute for Information Mapping (PIIM) study Veach refers to recently reviewed the top six EMR systems available on the market today.

This brings us to some of the key benefits a facility can gain through implementing an EMR. Michael Nolte, vice president and general manager of marketing for GE Healthcare IT, is aware that there are many questions and concerns from administrators and staff, but says that the long-term benefits will by far surpass the short-term apprehension. “In particular, for a smaller business, it’s a pretty big transition. There are three key benefits. First is the quality of care that you can deliver as a provider; when an EMR is used effectively it’s a really powerful tool. Both from a medical and a legal perspective, you have ensured that you have the right documentation in place that you are making good care decisions and that you have the ability to deliver the best quality of care for your patients. Second, is when our providers get really good at using a piece of software, and are transitioning from something that is usually more paper-based, it makes them more efficient. The ability to use their time more effectively, spending more time in the operating room and less time in the office is definitely enhanced by use of the software. And third is accuracy from a billing and reimbursement standpoint. In terms of getting a clear, well documented perspective on activity so that clinicians are getting paid for what they do everyday.”

On a more fundamental level, there are cost benefits in paper saving. “A lot of these centers are drowning in paper,” affirms Sean Benson, co-founder of ProVation Medical, part of Wolters Kluwer Health. “They are documenting everything on paper and with that come a lot of cost and inefficiencies. That includes the cost of paper, storage of charts, doing a chart pull, and assembling charts. All of those costs are really taken out of the system when you move to an electronic medical record. You are taking a lot of the redundancies out of the system.”

Oftentimes, hearing the benefits from peers can be most beneficial. Daren Smith, BSN, administrator at Fremont Surgical Center in Fremont, Neb., also shares his thoughts about the benefits. “It has so much capability to increase the level of quality of care that you are able to give to your patients. The EHR system capabilities to cross-check medications and make sure that the required information is there. Also, the ability for that information to be shared widely makes it very important. We have also found that it lends some credibility to your organization; that you are ahead of the game, ahead of the curve.”

What should an ASC look for in a provider? Administrators may want to consider what type of ASC in which they are working. If the ASC is a brand-new facility, it makes sense to start with an EMR. “For new ASCs, it’s almost a no brainer in terms of EMR and full-automation. We find that it is a straight forward conversation when you ask a new ASC, ‘why would you start by duplicating the old paper-based workflow when you have a chance to start fresh?’ The question is usually positively viewed since it just makes sense to go electronic from the outset. Existing ASCs are also interested, but have a little more adaptation to existing processes that they might see necessary. Actually, it’s an opportunity to look at current workflow and adapt it a little to realize the benefits from the software,” Don Fallati, senior vice president of marketing, Amkai states.

The existing ASC wanting to convert to an EMR has various items to address. While a new staff in a new ASC can face the implementation of an EMR with ease, staff members in current less technology-based facilities may be quick to decline the idea of learning anything new. The biggest part of getting ready for an EMR system is to realize there will be change. “If the staff, especially the internal champions or the leaders of the organization are resistant to change then they are going to be real problems. If you can identify key leaders within the organization, who understand that change is an important part of the process, and the short term challenges are worth the longer term benefits moving to an electronic system then you are really on the right track.”, states Benson.

Joe Macies, CEO of Amkai adds, “These systems today are modular. You don’t have to swallow the entire package and it doesn’t have to change every single facet of workflow. My two words of advice would be: get started. The EMR benefits are so great over such a long term, and eventually so necessary, I think, in any healthcare provider organization that you can get started and have a fairly graceful migration of your people at a reasonable pace over time when you’ve got modular software that fits users needs. It’s helpful not to approach EMR as having to find the perfect solution.”

Stay tuned to the second part of this series, EMR 202: How to Get Ready for Implementation where SurgiStrategies speaks to some ASCs that are in the process of EMR implementation or have an EMR in place where they discuss concerns challenges and advice.

The height of health IT

Even health insurance giant WellPoint—with more than 35 million members and arguably enough reach to change the system with sheer volume alone—is taking few chances on the future of healthcare delivery. Like most plans, it’s testing new programs with cautious optimism, while aiming for large-scale implementation.

Charles Kennedy, MD, WellPoint’s vice president for health information technology, has a vital role in the plan’s innovation because few initiatives these days can be accomplished without the backbone of health IT.

Specifically, WellPoint’s emerging Individual Health Record—a simultaneously patient-facing and physician-facing electronic record—is “almost an air traffic control system to manage disease,” according to Dr. Kennedy. It’s probably one of the most promising efforts to control costs among members with chronic conditions. Pulling claims and clinical data through complex algorithms to arrive at a functional health summary differentiates the Individual Health Record from the typical EMR system.

“If you’re a hospital or institution, you have a variety of clinical data sources that have information on the patients that you see,” he says. “If you haven’t deployed an interface engine or some way of pulling those various clinical data sources together, you’re late to the party, and you need to do that ASAP.”

With more than 20 years of experience comprised of clinical practice and health IT implementation, Dr. Kennedy began his career in internal medicine. When he was a resident at Highland General Hospital in Oakland, Calif., he noticed how the patients’ needs far outstripped the hospital’s resources, and that experience solidified his vision of where medical care and information should meet.

“We tried to treat each patient regardless of who they were or their ability to pay,” he says. “It had the unfortunate side effect that we never thought about cost. We only thought about what was right for a patient. But that created a system where people are actually being hurt because they can’t afford care. I began to realize that the very laudable and applaudable approach of not caring about cost—only the patient—is right, but that doesn’t mean you can become cost unconscious. Cost unconsciousness has its own set of bad outcomes. That’s what’s led me into thinking we need to be more efficient. We need health IT.”

Earlier this year, Dr. Kennedy was named by the Government Accountability Office as a member of the new Health Information Policy Committee, which was established by the American Recovery and Reinvestment Act. Serving a three-year term, he and other committee members are creating policy framework for the development and adoption of a nationwide health IT infrastructure, including standards for the exchange of patient information. The committee will also make recommendations for handing out the $38 billion in health IT funding earmarked in the reinvestment act.

WHAT ARE SOME OF THE HEALTH INFORMATION POLICY COMMITTEE’S GOALS?

A:We’re trying to make sure the Obama health reform strategy becomes real. What people don’t realize is the number of things the industry and the government agree on. For instance, the government invested $1.1 billion in comparative effectiveness research.

The stimulus bill has $38 billion in it for health IT, and we’re trying to help the government develop policies to spend that money wisely. Our function is to say, ‘How do we take this incredible resource that Congress and the President have given us, and how do we turn it into an investment that creates healthcare value for the whole country?’ It’s a massive undertaking.

Our first objective was to ensure that the money from the stimulus package paid out over five years created value. We asked ourselves where we wanted to be five years from now, and then we worked backwards from there.

Deploying computers is not the goal. Having physicians and patients use computers to create better care at a lower cost is the goal. To do that, we have to set the bar high for the care system. Not only must you use the computer, you must use it in a meaningful way for better care. These are the ‘meaningful use’ criteria that we’ve published.

If we distribute a substantial number of computers, and physicians don’t use them, we won’t be successful. We didn’t want to focus on technical measures. We created the meaningful use criteria, and every single one is clinical.

We want physicians to achieve a clinical result, and we want information technology and the money in the stimulus package to be a contributor to that improved clinical result. For instance, one of the criteria is to avoid 1 million heart attacks and strokes by 2015. Another is to make cardiac disease no longer the leading cause of death in the United States. Those are stretch goals. That is not something simple and trivial.

It would have been much easier to say, ‘Our goal is to make sure 90% of physicians have computers.’ But we consciously didn’t do that because we recognize that health IT is a tool and that other changes need to happen.

HOW WILL THE INDUSTRY ACTUALLY ACHIEVE MEANINGFUL USE AND OTHER MILESTONES?

A:The law is actually quite specific in defining what a qualified system is, and we have a subcommittee that’s identifying the actual entity—such as the Certification Commission for Healthcare Information Technology (CCHIT)—that will assess systems as to whether they qualify or not. The bigger challenge is data integration.

Everyone recognizes that healthcare is horribly fragmented, that there are silos of care. We know that there’s massive inefficiencies, and there are significant quality concerns because information is not shared as people move across silos.

The challenge with data integration is that we really haven’t figured out how to do it correctly. If you’re an integrated delivery system and you buy one EMR, that’s fine, and that works. But 70% of physicians practice in a community setting, solo and small group practice. You have this tremendous problem that all of these systems are different. They call things by different names, and they even capture different sets of data.

WELLPOINT HAS CREATED THE INDIVIDUAL HEALTH RECORD SYSTEM THAT USES ALGORITHMS. HOW WILL THAT MAKE A DIFFERENCE?

A:Algorithms, also known as decision support, are going to be the key to getting value out of these systems. Let’s say the federal government funds a comparative-effectiveness study that identifies a new drug is great for certain people. In today’s world, we know it can take up to 17 years for that to be commonly found in a physician’s paper record. With this approach, you can create an algorithm as soon as physicians or specialty societies have decided on certain best practices. Now you’ve created an infrastructure to get that message to every doctor, but only when there’s an appropriate situation for that rule to be applied. That will take that 17 years down to 17 days. That’s a huge advance.

Let’s say we have noticed that there’s a lot of inappropriate use of PET scans. In today’s world, a doctor would have to call us for preauthorization every single time he orders a PET scan. In the future, the algorithms will be running, and they will only alert the doctor if there’s an issue with a PET scan. Today, they call 100% of the time, and we generally approve the scan more than 90% of the time. Algorithms will take hassles, administrative costs and bureaucratic burdens out of the system.

The right kind of health IT allows us to use new knowledge from our outcomes research subsidiary [HealthCore] and any gaps in a member’s care identified by our informatics company [Resolution Health] in much more effective ways. The right kind of health IT allows these advances to be applied real time at the point of care while the doctor is treating the patient or helping the patient at home.

IS WELLPOINT’S INDIVIDUAL HEALTH RECORD WORKING? HOW IS IT ANY BETTER THAN OTHER EMRS OR PHRS?

A:We’ve run a pilot in Dayton, Ohio. The idea was not just to create interoperability—don’t just allow System A to talk to System B. When you connect systems together, what you create is just a data dumpster. It’s like putting a jigsaw puzzle on a physician’s desk.

That information has to be organized to just the summarized information that the doctor needs…You don’t take all of the information out of these various systems, you only take the information necessary for the ongoing management of the patient.

Many EMR implementations have failed to show value. About 30% of the time, physicians will actually turn them off because they are incredibly time-intensive and will reduce a physician’s productivity. That will hit them in the pocketbook. We’ve looked for solutions that wouldn’t be so intensive from a physician’s data-entry perspective and would do more sorting of information and presentation of information.

Physicians are not data generators. They’re data consumers. Their orders create significant amounts of data, but the physicians themselves usually just scribble a relatively brief note. The problem with many EMRs is they will require physicians to become data-entry clerks.

In Dayton, Ohio, we have a very significant market share. We’re Anthem Blue Cross Blue Shield of Ohio, and we also have a strong partnership with Kettering Hospital Network.

Kettering had already installed an application integration solution, so even though they had 120 different clinical sources, many of those clinical sources could be accessed through infrastructure they had already built. That made it easy for us to collect all of the clinical data out of their systems. We built feeds to the application from Anthem’s claims systems. We were able to get this application up and running in a little over three months, which is incredibly rapid. We made it available to the patient in the form of a PHR and to the doctor in the form of a CCHIT-certified EMR with e-prescribing.

When we looked at who was using the tool, we found that patients who had a higher illness burden actually made preferential use of the tool. For many of the tools we’ve deployed, the ‘worried well’ have been the type of people who used it, not the people with the chronic disease that we really need to reach.

We noticed the people who used the tool and had the higher illness burden, their cost increase year over year was actually less than the people who didn’t use the tool, even though those people who didn’t use the tool were healthier.

We built algorithms in the system that exactly correlated with various HEDIS measures and every time the doctor or the patient logged on, they could see their exact compliance. By giving the patients and the doctor the same information in a simple red light, yellow light, green light format with algorithms enabled us to see quality improvement scores of anywhere from 10% to almost 40%.

WHAT’S THE BUSINESS CASE FOR A HEALTH PLAN TO CREATE A SYSTEM LIKE THAT?

A: Our strategy is maximizing healthcare value, and healthcare information technology is really a tool to get you there. But it has to be the right kind of health information technology. It has to influence doctor’s decisions, and you have to present sufficient clinical data—not mountains of data but the key things the doctor needs to know so that you can influence his decision to do something that’s consistent with the evidence base, or to prescribe a drug that will cost the patient less but has the same likelihood of creating a good patient outcome.

If you look at why healthcare spending is out of control, it’s chronic disease, not health plan profits and not health plan administrative costs. We are seeing an explosion of chronic disease in this country, and chronic disease is managed largely by the patient at home. They’re managing their diabetes 99% of the time at their home, not in the physician’s office. If you don’t make your health IT solutions patient-centric and if they don’t address chronic disease, I don’t think that you’re going to get the kind of value that you want.

HOW ARE THE PHYSICIANS EMBRACING THE INDIVIDUAL HEALTH RECORD?

A:We have 300 physicians using the system now. We’re planning for a broader rollout to the greater Dayton area in 2010 to virtually all primary care physicians.

What we’re focusing on is chronic disease management, and there’s not huge debate about many of the things that need to be done to take care of these patients. That’s not the problem. The problem is actually getting it done. The physicians in general have been positive and are beginning to see how their lives could be easier.

We also added all of our pay-for-performance rules. We pay physicians more if they practice medicine consistent with the evidence base, and we took the existing measures and turned them into algorithms in the system. As long as the physician follows all the alerts, he can be sure that he’s going to maximize his pay for performance incentive. That’s convenient for the doctors because what they usually have to do is identify the patients who haven’t had certain interventions and then reach out and call them.

We’re just starting to incorporate our utilization management rules. If we can begin to move those algorithms to the point of care, then physicians might not have to call except for when there’s a real reason to discuss something, which might be 5% of the time.

DETERMINING THE EFFECTIVENESS OF TREATMENTS IN ORDER TO BUILD THE ALGORITHMS IS AN EXPENSIVE PROCESS. HOW CAN IT BE DONE?

A:This is the beauty of health information technology…if you bring it together in a repository that’s reflective of the patient’s clinical condition and how they’re being managed, you can begin to do database-driven studies rather than very expensive prospective clinical trials where you’re enrolling patients and following them over time. You can begin to do database driven studies that are a fraction of the cost. No, they’re not the gold standard, which will always be a randomized perspective-controlled clinical trial, but there’s a lot of information we’re going to be able to glean out of database-driven studies that are more observational and more retrospective.

BE A VISIONARY. WHAT DO YOU SEE AS THE POTENTIAL FOR HEALTH IT?

A: I hope that every time a patient needs information when they’re home or need to take care of their chronic disease or want to stay well, that they have that information at their fingertips, it’s actionable, and they don’t even have to think about it. If we can make it that easy—and there is a path to get there—we could actually fix the healthcare system.

Charles Kennedy, MD, has held strategic health IT positions with a variety of organizations. He also served as the medical director of a California health center in addition to other clinical service. He earned an MBA from Stanford University, an MD from the University of California at Los Angeles, and a bachelor’s degree in genetics from the University of California at Berkeley.
” Physicians are not data generators. They’re data consumers.”

Care models come together

When it comes to cost control, integrated care and improved communication among caregivers are among the most frequently cited needs.

Those needs are at the heart of a collaborative effort between the Little Rock, Ark.-based Case Management Society of America (CMSA) and the Washington, D.C.-based DMAA: The Care Continuum Alliance (DMAA). In October, the two industry groups announced the creation of a taskforce that will define the relationship between case management and population health management.

Working together, the organizations plan to develop a consensus statement detailing the interactions between case and population health management strategies and devise a roadmap for quality-based programs for the chronically ill.

“If we truly look at our patient populations and their needs, it’s pretty hard not to cross the line between the two,” says CMSA Executive Director Cheri Lattimer.

Despite the overlap, the two fields have historically acted independently, leading to duplication of services, unnecessary expenses and less than optimal care.

Case management focuses on meeting an individual’s comprehensive health needs through assessment, planning, facilitation and coordination of care, according to CMSA. DMAA’s definition of population health management emphasizes a central care delivery model led by the primary care physician, patient engagement and personal responsibility and the expansion of care through coordinated programs. While the interventions vary, the groups acknowledge there’s a lot of overlap between their functions.

“The two fields are so integrated,” says Lattimer. “If you continue to keep them siloed you continue to have a communication breakdown.”

By working together, the two organizations will be able to devise more collaborative, coordinated models that translate to better patient care and reduce duplication of services. Until the silos come down, legislation will have little impact, she says.

“Communication isn’t all about EMRs,” she says. “It’s about our processes, our basic communication strategy.”

Turning Data Into Insights: The Power of a Centralized Data Warehouse

Have you ever asked your information technology (IT) group for the answer to a question, only to receive an inadequate response (or no response at all)? It’s hard to fault the personnel. IT departments in the healthcare world are all too often over-tasked and understaffed. Typically, they are too busy with daily operations and systems maintenance to deal with requests that fall outside their normal duties. Items found on the chopping block often include marketing initiatives and/or requests for business intelligence.

To remain competitive in an increasingly competitive healthcare industry, organizations need high-level answers and in-depth insights — about patients, about the physicians they work with or the physicians that refer to them. How can you get the information you need to make key decisions on a day-to-day basis?

For many healthcare providers, the solution is a centralized data warehouse that stores a wide range of electronic information, from patient records to marketing data. As providers throughout the country look for ways to optimize American Recovery and Reinvestment Act (ARRA) funds earmarked for healthcare IT, this is the perfect time to take a close look at data warehousing and the benefits it provides.

The components of a data warehouse

If your organization is like most, you compile massive amounts of data but do very little with the information. By centralizing all of your data in a single place, you’re in a position to extract insights that can be valuable in many areas, including patient retention, reactivation and acquisition. Most data warehouses include the following:

» Patient records

» Inbound marketing data, including call centers and Web sites

» Donor and fundraising data

» Physician information

Every day, healthcare professionals use science as the basis for medical care and treatment, yet the vast majority of organizations are only beginning to infuse science into marketing efforts, market planning processes and in driving answers to key business questions. Just as data can drive better medical decisions, it can lead to greater effectiveness and efficiency in other organizational functions.

Who are your patients?

One of the biggest benefits of a centralized warehouse of data is the incredibly accurate picture it provides of your patient base. Many healthcare executives presume that they have a clear view of their patient population, only to be surprised by what the data reveals.

By linking your patient records with information from external databases, you can develop a precise picture of who your patients really are, including the demographic, financial and behavioral characteristics that set them apart from other patients in a market that you currently serve. You can also understand the differences between your “best, average and worst” patients and “best, average and worst” referral sources, whether it be system-wide, facility specific or within targeted service lines/specialties.

In addition, by having all of your patient records in one place, you can capture information at every touch point — from pre-op visits to surgeries, from phone calls to Web interactions.

Turning raw data into marketing insights

Once you have all of this information, what can you do with it? A data warehouse provides benefits in many areas:

Acquire new patients and new referrers. Once you know the profile of your best patients and best referral sources, you can examine your markets of service (or future interest) for people that “look” just like them. As a result, you’ll know exactly who should receive your marketing messages and who should not. The more targeted your prospect list, the greater your return on investment (ROI).

Retain your best patients. You’ll know who your best patients are, based on metrics and evaluation methods that are important to you. This will allow you to optimize your efforts to have them come back when next they may need your services.

Maximize marketing dollars. By truly knowing the target patient population and the target referral sources that you are after, your media plans will have less waste and higher return.

Minimize patient churn. Analysis of data can be useful in predicting those patients that are likely to churn. This proactive information allows you to have strategies in place to communicate with these patients before you lose them.

Develop long-lasting patient relationships. Once you attract new patients into your network of care, it is critical to convert them to life-long patients. Data warehousing allows you to drill down and filter information to yield valuable “business intelligence.” For example, you’ll know how much you’re spending on patient acquisition, and how long it will take to break even on new patients. You’ll also know how much annual revenue comes from top-tier patients and the average patient value at different stages of the patient relationship.

Ease the burden on your IT department. In most healthcare organizations, the IT department is simply not equipped to perform the level of analytics needed to solve for marketing, market planning and business intelligence questions. By outsourcing this work to experts, you can enable your staff focus on what they do best while gaining the insights that you need.

For healthcare systems, the time is now.

As networks of all shapes and sizes continue their EMR conversions, the benefits of housing all pertinent information in a singular location will become increasingly evident. Those proactive providers that factor a data warehouse into their current and long-term processes will remain on the leading edge of the industry – and far ahead of the competition.

Ken Rabinoff-Goldman, DC, is vice president of Buxton – HealthCareID and is responsible for business planning, market development and sales focusing on superior site selection, targeted marketing and other strategic planning tools for the healthcare industry. Having served patients at his private practice in Albany, N.Y., for 22 years, Rabinoff-Goldman contributes greatly to Buxton’s executive medical experience by helping understand the needs of clients in the healthcare field.

Leverage health data gathered from electronic records

IT MAKES COMPLETE SENSE TO MOVE patient records from paper to a digital filing system where information can be stored, shared and accessed. On the surface, Electronic Medical Records (EMRs) appear to be one of the most obvious ways of maximizing efficiency and delivering managed care’s goal of high-quality care.

Over the next three to five years, financial incentives from the federal government through the HITECH Act are expected to accelerate EMR use. The biggest return on investment won’t come from electronic medical records alone, however. While electronic records can improve safety, prevent errors and reduce duplication, the real value for health IT does not lie in the collection of health data.

The greater payoff for the health system will be found in the secondary use of the data and how it is shared among payers, providers, pharmaceutical and life sciences companies and others throughout the system.

In a recent survey of nearly 500 providers, PricewaterhouseCoopers found that fewer than half have implemented anything but the most basic functions of EMRs, and only 23% are actually using EMRs for patient clinical documentation. The findings mirror HIMSS’ analysis, which found that only 0.5% of hospitals have implemented advanced clinical applications that improve patient safety and care delivery outcomes.

TRUE VALUE OF EMRS

Despite an intuitive appreciation, many providers are still struggling with the EMR value proposition. PricewaterhouseCoopers estimates that the average three-physician practice can expect to invest between $173,750 and $296,000 over two years to purchase and maintain an EMR system. The costs run into the tens of millions of dollars for large hospital systems.

Estimates say the conversion to digital records will save $12 billion over 10 years. But many providers see the dividends accruing to private and public payers. Clearly, this conundrum underscores the fact that realignment of financial incentives is some of the hardest work that still needs to be done.

Furthermore, the collection of patient health data is expected to explode over the next five years as the HITECH Act expands EMR adoption. But it is the secondary use of data that will bring the biggest payoff.

The “secondary use” of data is defined as clinical, financial, administrative and self-reported data, which is collected from electronic medical records, personal health records, insurance claims, clinical-trial information, billing information and other sources. The information is then de-identified, aggregated, analyzed and presented in a concise, actionable format for the purpose of improving health outcomes, reducing medical errors, predicting health trends and demonstrating the comparative value of drugs and treatments, among other benefits.

Imagine a time when a physician can prevent a chronic condition from becoming a catastrophic event because he has access to an analysis showing the efficacy of different treatment options across large populations. Imagine the use of predictive modeling to intervene before a claim is ever filed. Imagine a time when payers can easily track questionable filing patterns and identify fraudulent claims quickly.

In the future, the vast amount of data residing in the health system can be put to use to identify evidence-based best practices; monitor patient compliance; identify candidates for clinical trials or personalized medicine; better monitor after-market drug or device safety; and detect fraud. Equally important, secondary data can be used to manage finances and demonstrate value and quality in an era of pay for performance.

USING SECONDARY DATA

PricewaterhouseCoopers also studied secondary health information use, and surveyed more than 700 executives from payer, provider and pharmaceutical and life sciences organizations. Secondary use of health data is being used in limited form, primarily by providers and pharmaceutical companies. Specifically, 65% of providers and 66% of pharmaceutical companies are currently using secondary data while only 54% of health plans are, despite access to vast repositories of claim information.

The number one reason given by survey respondents for not using secondary data is lack of access to EMRs. Only 39% of payers offer personal health records, and few members use them. Pharmaceutical companies have almost no access to health information contained in EMRs. Thus, they have become heavy purchasers of EMR-based data from third-parties that de-identify and license their data for research.

Three-quarters of healthcare executives surveyed agreed that the secondary use of health information will be their organization’s greatest asset over the next five years, and nine in 10 believe that the secondary use of health information will significantly improve the quality of patient care with the promise of even greater benefits in the future.

Of those surveyed, nearly half of payers and providers who are using secondary data say they have achieved cost savings and seen significant increases in quality improvement.

In one pilot, a large managed care organization integrated clinical and financial data to create a comprehensive, shared record for the patient and the physicians. Over a two-year period, the pilot resulted in more than a 7% trend reduction in cost per-member per-month.

Clearly, the opportunity for secondary use of health data exists. To drive greater benefits in the future, payers should consider investing in health IT and prioritizing these investments around ensuring data accuracy and data mapping. A healthier membership will result in higher satisfaction rates among members, which will drive loyalty, market competitiveness and differentiation.

It’s important to recognize the value of the information that exists within the organization. Some managed care companies are evolving into health IT organizations, in the business of ensuring health and wellness for their members and deploying health IT to that end. This may require hiring a workforce with different skills.

Furthermore, public and private sectors need to work together to overcome barriers to the use of secondary data and to foster greater collaboration.

As a first action, the industry should focus on establishing guidelines about how health information can be gathered, used and shared. Ninety percent of executives surveyed agree this is a priority, and believe the healthcare market should be responsible for defining standards.

Some are suggesting the formation of an industry consortium to develop standards for secondary data use. A consortium of this kind could determine industry needs; develop common goals; and innovate a new data architecture that will enable interoperability.

Early adopters agree that the industry can’t go it alone; government has an important role to play in advancing secondary data use through incentives to motivate the industry to collect, report and use the data in a meaningful way.

The expectation is that these actions will drive growth of secondary use of data as an industry-accepted practice. As that occurs, stakeholders will discover numerous opportunities to collaborate with one another to create new revenue streams and new business opportunities.

Paul Veronneau is a Principal in Pricewaterhouse Coopers’ Health Industries Advisory practice and leads the firm’s U.S. payer practice.

Online management comes of age for chronic conditions

ONLINE PATIENT SELF-MANAGEMENT provides a dynamic and economically feasible means for physicians to interact with patients. It can extend the practice of medicine to reach more patients, more frequently to improve their health outcomes.

Those with obesity, for example, are at increased risk for cardiometabolic disorders: type 2 diabetes, high blood pressure, high cholesterol, cardiovascular disease as well as premature death. The complications of type 2 diabetes alone add about $23 billion a year to the nation’s healthcare costs, with obesity-related illnesses resulting in more than $117 billion in annual healthcare expenditures.

Yet, the ability of the medical community to create significant and sustainable changes in patient lifestyle choices has been limited for a variety of reasons. Healthcare providers have been restricted by the availability of clinical personnel, the cost of providing the needed services in an exclusively one-on-one environment, and by the difficulties patients have in accessing information and support.

Managing large numbers of patients with varying levels of risk is the biggest challenge for managed care. There is a delicate balance of providing the right mix of services to improve outcomes based on each person’s needs and risks.

Today, chronic care is being dramatically altered by the confluence of several trends, such as patients wanting an active role in managing their own health and a collaborative relationship with their healthcare providers and their health plan; widespread, low-cost internet access; advanced Web 2.0 technologies; wireless health monitoring devices, such as accelerometers, blood glucose meters, scales, and blood pressure sensors; and plans’ integrating population-based risk assessments with disease management and wellness services.

Patient self-management supported by information technology is becoming an important factor in the way providers deliver healthcare. Clinicians can support patient behavior change in an economical, practical, and profitable manner. Health plans can offer a new paradigm of care delivery with improved services to its members that are an extension of the onsite clinical setting.

Creating and maintaining such multidimensional education and support systems requires a wide range of technologies. Using modern software development methodologies ensures requirements and solutions that will evolve through collaboration between these cross-functional teams. Additionally, healthcare organizations can contract for services, rather than buying programs and the computer hardware on which to run them, in what is usually referred to as a software-as-a-service (SaaS) model.

For example, the Virtual Lifestyle Management service (VLM) is an online program based on the Diabetes Prevention Program (DPP), a weight management approach developed by the University of Pittsburgh faculty under a federal research grant from the National Institutes of Health. Through Web-based technology, the VLM delivers the DPP research-proven lifestyle interventions aiming to enhance the efficiency and success of healthcare provider weight management programs.

The DPP was a multi-year study with 3,234 adults with pre-diabetes in 27 U.S.-based centers, in which an intensive behavior change intervention was used to increase patients’ physical activity, improve nutrition and decrease weight by 5% to 7%.

The DPP decreased the progression to diabetes by 58% (5% vs. 11% for the control) and by 71% for those individuals over 60 years of age. It was more effective than the diabetes drug tested (metformin). The intervention consisted of face-to-face, individual counseling sessions with a skilled coach at a per patient cost of about $3,540 over three years.

A recent 50 person year-long pilot study of the DPP, delivered online as the VLM service, demonstrated 38% of the participants lost at least 7% of their body weight.

To be successful, these programs must be:

• Grounded in behavior change theory and clinical expertise;
• Evidence based;
• Flexible in design and implementation;
• Able to allow choice of media and alternative learning pathways while providing continuous feedback and engagement; and
• Integrated with clinical practice, and technology including EMRs and biometric devices.

The industry is moving to a medical model in which patients are given the tools they want and need for self-management with the process remaining under medical guidance and oversight. A new means of interaction is necessary if the industry is to have a functionally useful role in patient self-management and behavior change. The one-on-one paradigm typically cannot deliver, in a cost-effective way, what is needed.

—Neal Kaufman, MD

Neal Kaufman, MD, MPH, founded DPS Health, and is co-founder of the UCLA Center for Healthier Children, Families and Communities. He is a professor of pediatrics and public health at the UCLA Schools of Medicine and Public Health.

Claims data still a secret weapon in care, cost containment

THE MOST POTENT WEAPON in the campaign to control costs—until EMRs reach critical mass—might be claims data. All the pertinent information is found there, including the provider, type of treatment or procedure, prescriptions, as well as the cost of service for the plan, sponsor and member.

While that information is useful, it only scratches the surface of what claims data can tell health plans and payers about their members. By accessing electronic claims data, health plans can mine, analyze and download information about members individually or collectively. This data can be used to determine which members are at risk for specific health issues and inform disease management program design to help them before the event occurs.

“So much of the information that would tell a plan what is driving the cost of healthcare is either unavailable or late,” says Keith Lemer, president of WellNet Healthcare in Bethesda, Md. “What winds up happening is you don’t get to the root cause of the problem—what is driving costs and what type of action can be implemented on the appropriate segment of the population to keep those costs down.”

Electronic claims can keep high-risk members from slipping through the cracks of the healthcare system before an event occurs, says Jo Anne Hunt, director of clinical solutions for Casenet, a Bedford, Mass., provider of healthcare case management software.

“They [patients] are not high dollar yet, so no one is paying attention,” she says. “By the time they are in the hospital, it’s too late to do anything about preventive care. You’ve already incurred big dollars.”

TOWNSHIP’S STRATEGY BASED ON PREVENTION

Upper Merion Township in suburban Philadelphia launched a multi-year assessment of its healthcare strategy in order to control costs. The community, with a population of 27,000, is self-insured through a PPO arrangement for its 200-plus employees and 30-plus retirees. Healthcare costs were draining the general fund budget, according to Fred Santoro, director of human resources for the township.

“The increasingly negative budget impact [of healthcare costs] was threatening to affect the level of services we provide to our residents,” he says.

Instead of opting for a short-term fix or shrinking benefits for its employees, Upper Merion used claims data to take a long view of utilization. First, the township negotiated a cost-sharing plan with its workforce. Employees, for the first time, contributed to the cost of healthcare at a flat rate of $656 annually, no matter the level of coverage. Costs were paid 100% by the township previously.

“Part of our strategy is to get our employees more involved in cost containment,” Santoro says. “One of the ways to do that is to give them a stake in the process.”

Since the township was asking its workforce to share in the cost, officials wanted to reciprocate by building preventive care measures into its healthcare solution. Upper Merion and WellNet Healthcare, its DM provider, implemented a software solution that uses electronic claims data from the prescription benefit program to provide a summary of members who are at the biggest health risk so that they could receive care management and the proper attention and education before an adverse event occurs, Santoro says. At the same time, the technology allows Upper Merion to gain a view of past, present, and future healthcare-cost scenarios for the township.

The technology platform electronically deposits pharmacy claims data daily into an interface that resides on the human resource and finance departments’ desktop computers. The real-time, consolidated data is available in a centralized, online dashboard, and the snapshot of information delivers an actionable overview of patterns and warning signs associated with the township’s plan expenses.

“This helps to determine cost-saving plan decisions,” Santoro points out.

From the employees’ perspective, the technology’s member engagement tool is a patient portal that allows users to coordinate all aspects of their healthcare in a HIPAA-compliant manner, Santoro says. Members can communicate with care managers, claims specialists and providers, and they have the ability to research conditions, compile a PHR, review medications and claims, track spending and manage incentives.

The program has been in place for less than a year, so there is no hard evidence of cost savings yet, but Santoro says township officials are convinced that in three to five years, the township will achieve a 4-to-1 return on its investment in prevention.

“That’s the benchmark we’re shooting for,” he says. “It will be a positive if we get anything more than a 1-to-1 ratio.”

THE ENTIRE PICTURE

Prevention is just one area where electronic claims data can be leveraged for cost-containment purposes. Jeffrey Allison, engagement manager for the Michigan Public Health Institute, which studies the state’s Medicaid program, says electronic claims data, in conjunction with other quality measures, can be used to improve patient care and outcomes.

“We can use the data to determine the cost of care [for patients] when preventive care is used versus those who did not have preventive care, and wound up in acute care for the same disease states,” he says. “That allows us to try to make more preventive care available.”

That is one clear reason why the federal government, employers, plans and others who seek to control costs tout the need to enhance electronic data.

“Within claims data, you see what the actual results are for the various disease states,” says Matthew Haddad, president and CEO of Medversant Technologies, a Los Angeles software company. “You can see some definite patterns over time. The data can tie treatments and procedures with outcomes.”

And with the drive to push providers to adopt EHRs and members to adopt personal health records, electronic claims data can become the hub of information.

“It helps bring pieces of information together, so providers can more clearly understand what is going on with the patients they are working with,” Casenet’s Hunt says. “You need the entire picture to have a real impact. Claims data is a key piece because it identifies opportunities and figures out where there are areas of underutilization and overutilization. Plans can look for people with the greatest opportunity for intervention.”

Santoro says the preventive care strategy in Upper Merion has gotten some of its older employees to think proactively about their health.

Without electronic claims data, the strategy would have been useless, he says. “The statistical information about high-risk populations and potential costs down the road could not be done without technology,” he says. “You might eventually be able to gather the data. But not in a timely way, which means it would be of little use in preventive care.”

Ken Krizner is a senior editor in Advanstar Communications’ Centralized Content Group.

Predicted progress of EMR adoption through 2013

The adoption of EMR systems will increase during the next three years, says Dennis Schmuland, MD, Microsoft’s national director of health and life sciences, U.S. health plan industry.

Dr. Schmuland, however, sees the current focus on the adoption of EMRs and health information exchanges as only one step toward true health reform.

“We have to keep in mind that technology is a powerful tool, but should never be the end-goal,” he says. “Rather, we need to focus on innovative solutions designed to meet goals such as improving population health, quality of care and reducing chronic disease, while rewarding physicians and hospitals for improving health and outcomes. If we limit our focus to one type of technology solution, we may end up doing little more than automating the current set up rather than [creating] a healthier and more productive nation.”

Dr. Schmuland stresses that the cause of cost growth isn’t paper records, informational disorganization or a lack of interoperability among systems. More precisely, the root cause is the growing prevalence of chronic disease, which accounts for two-thirds of medical cost growth because of the high-cost services needed for that population. How the industry innovates to reduce root causes will determine not only the future of healthcare but also the industry’s economic success.

“Rather than asking the question, ‘How can we stimulate adoption of EMRs and health information exchanges?’ payers, providers and government leaders should be asking what are the technology tools we need to actually improve health and outcomes at a lower cost per capita,” he says.

While they certainly have a place in the industry, EMR systems cannot solve the healthcare crisis alone, Dr. Schmuland says.

“There is clearly value in EMRs in relation to reducing duplicate tests and medical errors, as well as measuring and analyzing clinical effectiveness,” he says. “But they can only do so much given the current state of our healthcare system.”

It’s estimated that only 2% to 4% of hospitals have true digital systems with another 15% operating with some digital environments. Physician practices are still largely paper-based.

EMR update

IN THE RUSH TO PARTICIPATE IN the federal incentives program to install electronic medical records (EMR), healthcare providers are faced with a glut of vendors—some household names and some emerging companies, some certified and some not.

Choosing the right vendor and EMR system is a high-risk gamble for healthcare providers with profitability, efficiency, staff morale and even patient safety at stake. With 139 vendors certified and more to come, providers are considering the merits of choosing established legacy sellers, whose certification guarantees that a hospital or health system will see some reimbursement for its investment, or perhaps dealing with a smaller company that hasn’t been certified, but offers innovation and, maybe, a smaller price tag.

The market for EMR data transfer equipment and applications could reach $1.6 billion in 2013, according to market research firm Kalorama Information. A growing number of small vendors, as well as technology giants such as Intel, General Electric, Microsoft and Qualcomm, are vying for the business.

The Certification Commission for Healthcare Information Technology (CCHIT) is contracted through HHS to certify health IT vendors. By law, the Centers for Medicare and Medicaid Services provides grants only to those doctors and hospitals that buy certified systems.

CCHIT has come under criticism by some experts who question its ties to its parent, Healthcare Information and Management Systems Society (HIMSS), which represents 350 technology vendors. Specifically, they argue that the certification mandate that EMR be supplied by a single vendor limits a provider’s options. Also, they contend that CCHIT certification prohibits many simpler EMR applications with fewer features. It also prevents end-users from assembling software from separate vendors and submitting this for certification.

Sharona Hoffman, professor of law and bioethics at Case Western Reserve University and co-director of its Law Medicine Center, believes rigorous certification and approval processes make it simpler for providers to find the right EMR.

“It is true that demanding certification or approval requirements may keep small entrepreneurs out of the market,” Hoffman says. “However, it is extremely important that only vendors who can produce safe EMR systems that will not compromise patient welfare be allowed to sell their products.”

The federal Health IT Policy Committee is considering a proposal from one of its workgroups for three tiers of meaningful use, with corresponding deadlines in 2011, 2013, and 2015. The term “meaningful use,” which indicates a significant number of the right results-oriented measures of success, is part of the language used in the legislation that will help determine whether providers qualify for part of $17 billion in Medicare and Medicaid incentive payments.

To be a meaningful user of EMR in 2011, providers must electronically capture, report and exchange key clinical health information.

SMALL, NIMBLE COMPANIES

While larger companies may scoop a big share of stimulus dollars, their success is not guaranteed, says Brian Klepper, PhD, a healthcare market analyst and founding principal of Health 2.0 Advisors Inc. He predicts the market will support smaller, more nimble companies that offer Web-based technology that turns out faster, cheaper and better EMR products.

CCHIT spokeswoman Sue Reber says the majority of CCHIT vendors of certified products are considered small, with annual revenues of $10 million or less. One-third have revenues of $1 million or less. CCHIT is looking toward offering more than just single-vendor options.

The certifying body in June unveiled three new certification approaches, including one for electronic prescribing, personal health records, registries and other technologies. CCHIT says the plans “appeal to providers who prefer to combine technologies from multiple certified sources”—some of which would likely come from smaller vendors.

Recently, KLAS Enterprises LLC, an independent, Utah-based market watchdog firm that reviews healthcare vendor performance, found few offering creative solutions for health IT requirements, including EMR. The KLAS report is based on feedback from dozens of CIOs and other healthcare executives.

According to the report, 28% of providers have accelerated or changed the direction of their IT plans since the announcement of stimulus package, with 43% ready to move forward. But buyers are aware of the dangers in purchasing the wrong system.

The Joint Commission last year called on providers to be “mindful of the safety risks and preventable adverse events” of new technology.

Problems can happen if a system fails to meet provider expectations, says Jeffery Daigrepont, senior vice president of business development for the Coker Group, Atlanta, which helps 3,000 clients a year identify and install EMR systems.

Part of its job is bailing out providers who have installed ill-fitting systems.

“Thirty percent of our projects are de-installing or removing failed EMR systems,” Daigrepont says. “I refer to these as career-defining decisions.”

According to Daigrepont, the top reasons for buyer’s remorse are:

• Vendor overpromised and underdelivered;
• Vendor’s product was defective, not usable at the point of care;
• Poorly designed system configuration and/or policies;
• Unsustainable infrastructure; and
• No integration of important information such as labs, results and pharmacy.

Klepper says the low adoption rate nationwide can be blamed on the high cost and limited performance of many EMR products.

Case Western’s Hoffman has two recommendations for avoiding EMR problems. The first is a “premarket” approval process, including testing the product at several facilities for at least six months. She also recommends healthcare providers form committees to field test and monitor the product.

Buyers should insist vendors provide quality support, project management, and a demonstrated return on investment, Daigrepont adds. They should avoid unnecessary features and functions and get promises in writing.

A provider must be diligent in identifying the right vendor, says John Jenkins, chief information officer of nonprofit Moses Cone Health System in Greensboro, N.C.. Moses Cone has spent three years planning a nearly $2.5 million investment in EMRs for its five hospitals and several outpatient clinics, and is about halfway to its goal of implementing EMRs across all of its 29 hospital clinics by the end of the year, Jenkins says.

He recommends that hospital CIOs contact various vendors and make numerous visits to providers where their products are operating. Also, administrators should compare notes and make no decision without extensive input from the physicians.

David Bennett is a senior editor in Advanstar Communications’ Centralized Content Group.

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