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.

President’s Budget Would Allocate $900B to HHS, Extend Higher Federal Medicaid Payments for Six Months

President Obama’s proposed $3.8 trillion budget for 2011, would allocate $900 billion for HHS, including a six-month extension of enhanced federal Medicaid payments to states.

In addition to $818 billion in mandatory spending, almost all for Medicare and Medicaid, the departments’ discretionary budget would increase by $1.7 billion, to $82.8 billion.

Here are some major features:

Six-month extension of enhanced Medicaid match. Allocates $2.5 billion for a six-month extension, through June 2011, of the stimulus bill’s temporary enhancement of the federal Medicaid match. The money would be part of $290 billion in federal funds allocated for Medicaid.

Medicare and Medicaid fraud and abuse. Adds a $2 million increase for the Office of the Inspector General to $52 million. However, the office is expected to recoup $722 million in waste, fraud and abuse. The budget “places a renewed emphasis on preventing, detecting and recouping fraudulent, abusive and wasteful payments,” the White House stated.

Comparative effectiveness research. Allocates $286 million for the Agency for Health Research and Quality “to compare the effectiveness of different options, building on the expansion of this research” under the stimulus bill, the White House stated. “The dissemination of this research is expected to led to higher quality evidence based medicine, arming patients and physicians with the best available information to allow them to choose the medical option that will work best for them,” the White House added.

Health IT adoption. Invests $110 million to build momentum on healthcare IT adoption.

Rural healthcare. Allocates $79 million for rural healthcare. The money would be used “to strengthen regional and local partnerships among rural healthcare providers,” the White House stated.

NIH research budget. Increases the National Institutes of Health’s health research budget by $1 billion. However, this proposed increase actually falls short of the $36 billion allocated to NIH in fiscal 2010, which was enriched by the stimulus bill.

Community health centers. Earmarks $290 million for community health centers.

Providers for underserved areas. Allocates $169 million for the National Health Service Corps to support 8,500 healthcare professionals in underserved areas.

ASCs were not specifically mentioned in the president’s proposed budget for fiscal year 2011, which begins on Oct. 1.

Read the White House’s release on its proposed federal budget.

President Obama’s proposed $3.8 trillion budget for 2011, released Monday, would allocate $900 billion for HHS, including a six-month extension of enhanced federal Medicaid payments to states.

In addition to $818 billion in mandatory spending, almost all for Medicare and Medicaid, the departments’ discretionary budget would increase by $1.7 billion, to $82.8 billion.

Here are some major features:

Six-month extension of enhanced Medicaid match. Allocates $2.5 billion for a six-month extension, through June 2011, of the stimulus bill’s temporary enhancement of the federal Medicaid match. The money would be part of $290 billion in federal funds allocated for Medicaid.

Medicare and Medicaid fraud and abuse. Adds a $2 million increase for the Office of the Inspector General to $52 million. However, the office is expected to recoup $722 million in waste, fraud and abuse. The budget “places a renewed emphasis on preventing, detecting and recouping fraudulent, abusive and wasteful payments,” the White House stated.

Comparative effectiveness research. Allocates $286 million for the Agency for Health Research and Quality “to compare the effectiveness of different options, building on the expansion of this research” under the stimulus bill, the White House stated. “The dissemination of this research is expected to led to higher quality evidence based medicine, arming patients and physicians with the best available information to allow them to choose the medical option that will work best for them,” the White House added.

Health IT adoption. Invests $110 million to build momentum on healthcare IT adoption.

Rural healthcare. Allocates $79 million for rural healthcare. The money would be used “to strengthen regional and local partnerships among rural healthcare providers,” the White House stated.

NIH research budget. Increases the National Institutes of Health’s health research budget by $1 billion. However, this proposed increase actually falls short of the $36 billion allocated to NIH in fiscal 2010, which was enriched by the stimulus bill.

Community health centers. Earmarks $290 million for community health centers.

Providers for underserved areas. Allocates $169 million for the National Health Service Corps to support 8,500 healthcare professionals in underserved areas.

ASCs were not specifically mentioned in the president’s proposed budget for fiscal year 2011, which begins on Oct. 1.

Read the White House’s release on its proposed federal budget.

8 Top Hospital and Health System Trends of the Past Decade

1. Loosened cost controls. HMOs in the late 1990s had successfully slowed growth in healthcare spending, but by the end of that decade they had come to be regarded as heartless conservators of the bottom line. Managed care’s tight controls began to loosen and “the negotiating power slipped back into the hands of the providers,” says Dick Clarke, president of the Healthcare Financial Management Association. Healthcare costs again began increasing faster than the general rate of inflation. “It’s not clear yet how much of that will change if providers come under more pressure to contain prices,” he says. 

2. Healthcare IT. Healthcare information technology, still rough around the edges in 2000, became a major force in hospital operations by the end of the decade, says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. Innovations like computerized physician order entry and electronic medical records have been shown to improve safety as well as efficiency. Now, thanks to billions of dollars in incentives in the 2009 HITECH legislation, healthcare IT holds the promise of becoming virtually universal in the next few years. But Mr. Rowan reports that HITECH funds will pay for only about a quarter of the cost of the new technology. 

3. Patient safety movement. At the start of the decade, hospitals were just beginning to hear word of one of the most influential reports in the history of U.S. healthcare: “To Err Is Human: Building a Safer Health System,” published in Nov. 1999 by the Institute of Medicine. It concluded that from 44,000- 98,000 people die annually — the equivalent of 10 fully loaded 757 commercial airliners crashing each week, the report stated — due to errors in inpatient hospital treatment.

As a result, “hospitals started to get much more serious about quality and safety,” says Mr. Clarke at HFMA. The industry embraced continuous quality improvement, adds Thomas Dolan, president and CEO of the American College of Healthcare Executives. “Everybody realized that we have to constantly improve quality and it actually lowers costs because it reduces waste,” he says.

4. Physician entrepreneurialism. Many physicians became entrepreneurs, investing in ASCs, imaging centers and specialty hospitals as a way to supplement declining income due to lack of increases in reimbursements and become more efficient. The trend, however, put physicians into conflict with hospitals, who were concerned about losing market share to the leaner, physician-run organizations. By the end of the decade, it seemed that hospitals and regulators had blunted the trend.

“The ban on physician-owned hospitals in the health reform legislation signals the decline of the entrepreneurial physician,” says Nicholas Wolter, MD, a former MedPAC commissioner and CEO of the Billings (Mont.) Clinic. However, ASCs seem to have become a permanent fixture in U.S. healthcare, offering discounts too big for payors to pass up. 

5. Healthcare consumerism. “The future of market-oriented health policy and practice lies in ‘managed consumerism,’ a blend of the patient-centric focus of consumer-driven healthcare and the provider-centric focus of managed competition,” declared Jamie Robinson, a professor of health economics at the University of California, Berkeley, School of Public Health, in 2005 in the journal Health Affairs.

With the decline of HMOs, consumer-driven healthcare became a new way to contain costs. High deductible plans, with or without tax-free health savings accounts, would make patients cost-conscious consumers. Ratings of doctors and hospitals, from HealthGrades to CMS’ Hospital Compare site, would aid patients in choosing the best providers. Retail clinics opened to serve these new consumers. Hospitals developed a new fascination with patient satisfaction surveys. Brand-new hospitals lavished spending on patient-friendly design features, such as single rooms, sunlit atriums and concierge services, and these features seemed to shift market share. 

6. Shortages of healthcare personnel. In July 2007, the American Hospital Association reported 116,000 open positions for registered nurses in hospitals, and the existing RN workforce was aging. Mr. Rowan at Catholic Health Initiatives observes that the recession has erased the shortage for now, at least, as RNs were forced back into the workforce or into full-time work as family income fell.

Physician shortages also emerged. In a dramatic about-face at the beginning of the decade, the federal Council on Graduate Medical Education abandoned its long-held forecast of a physician surplus and predicted a shortage of 85,000 physicians by 2020. Since then, medical schools have been substantially increasing class sizes, but Congress has not removed a cap on the number of Medicare-funded graduate medical education positions for physicians that has been in place since 1997.

“Current evidence suggests that the United States is headed toward an aggregate shortage of physicians,” the Association of American Medical Colleges declared in 2009. “Given the extended time required to increase U.S. medical school capacity, and to educate and train physicians, the nation must begin now to increase medical school and GME capacity to meet the needs of the nation in 2015 and beyond.”

7. Accountable health organizations. While entrepreneurial physicians continued to spin off from hospitals throughout the decade, Dr. Wolter, the former MedPAC commissioner, says an opposing trend also emerged. Many young physicians were eagerly becoming employees. Accountable health organizations such as Mayo Clinic, the Cleveland Clinic and Geisinger Health System thrived by closely aligning hospitals and doctors to make care more efficient and effective.

Mr. Rowan at Catholic Health Initiatives says accountable health organizations seemed to be taking a lesson from the ASC playbook. Incentivizing physicians can make healthcare more efficient. But he adds that the trend is not easy for hospitals. “Many hospitals have no expertise in running practices,” Mr. Rowan says. “We’re hospital people, not group management people.” Hospitals used to hire doctors merely to generate business. Now, he says, “hospitals want doctors to take financial responsibility for outcomes.”

8. Recession. “The decade will be known for the financial turmoil that came at the end,” says Mr. Clarke of HFMA. In March 2009, Thomson Reuters reported that the median profit margin of U.S. hospitals has fallen to zero percent. Hospitals tightened their belts and many of them ended the decade solidly in the black. But the numbers of non-paying patients are still high and many leaders like Clarke believe we are entering an era of having to do more with less.

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.

GE Offers No-Interest Financing for Health-Care Technology

General Electric Co. said its GE Capital division will make 0% loans to hospitals and health-care providers that purchase GE’s health-care information-technology offerings.

GE said it expects to offer $100 million in interim financing to hospitals and health-care providers for projects that are expected to qualify for funds from the U.S. government’s economic-stimulus package. GE calls its program Stimulus Simplicity and connects it to the company’s Healthymagination marketing initiative.

One early borrower will be Hazard Clinic in eastern Kentucky, which plans to install an electronic medical-records system.

GE said the move offers doctors, community health clinics and hospitals a bridge to qualify for stimulus funds and faster access to electronic medical records. The company said the move also indicates GE will continue certifying its products to government standards.

The federal stimulus package allocates $19 billion to health-care information technology.

Vishal Wanchoo, president and chief executive of GE Healthcare IT, said many hospitals are cash-strapped and unclear on when stimulus funds will start flowing. The program will “take away a lot of the concerns hospitals have,” he said. “We think this will help us increase our market share.”

Healthcare IT makes up only 10% of GE Healthcare’s $17 billion in annual revenue. The company has said it would like to expand its presence in the fragmented health-care IT market.

Study Finds Many Healthcare IT Executives Increasingly Reliant on Mobility

A study by Motorola has found that more than 80 percent of global information technology decision makers within the healthcare industry reported that mobile technologies were more important to their organizations today than they were in 2008, according to a Motorola news release.

The Motorola Enterprise Mobility Healthcare Barometer, which surveyed more than 3,400 IT decision makers in 14 countries, cited increased order fulfillment accuracy, reduced manual errors and increased employee productivity as reasons for the increased reliance on mobile technologies.

Survey respondents also signified an increasing interest in voice over wireless local area networks, fixed mobile convergence and data capture offerings as part of their mobility investment strategies.

According to the study, the use of key mobility applications by survey respondents attributed to a 31 percent reduction in manual errors and helped these mobile workers recover approximately 39 minutes per day.

Read Motorola’s release on the healthcare IT mobility study.

This article originally published @ Beckers ASC Review

Recruit young IT professionals

As a generation of it workers prepares to retire, health plans are maneuvering to replace the vast amount of experience and knowledge that is leaving with them. The health information technology (IT) sector, while resilient, isn’t immune to what some experts call “brain drain.”

As chief information officer for the Regence Group with plans located in Idaho, Oregon, Utah and Washington, Cheron Vail has experienced the knowledge gaps left behind by retiring IT employees. She recruits the firm’s next generation of information technology staff and manages long-term retention strategies.

Vail expects that between 60 and 90 people—about 10% to 15% of her existing IT staff—will retire over the next five years.

“It is definitely challenging for us to replace IT members who have many years of experience on our systems,” she says.

Vail explains that the company is constantly recruiting in certain key competencies, including systems engineering, data architecture, data management and system analysis. Besides the area universities, the Regence Group is looking beyond the Northwest for future IT employees.

“We have found over the last couple of years that as we backfill existing competencies and bring new competencies in house, we have to cast a wider net,” she says. “For example, we will recruit a lead Java developer from some other part of the country if that person has the right skills, whereas two or three years ago, we would not have looked outside our own geography for candidates.”

Publicly-traded Computer Sciences Corp., an IT staffing firm headquartered in Falls Church, Va., last year collaborated with Madison, Wis.-based firm, Next Generation Consulting Inc. to examine brain drain in health IT departments. That shortage has been magnified by the difficulty of recruiting and retaining younger staff fast enough to fill both vacant and newly created positions.

“The Multi-Generational Healthcare IT Workforce” report, published in September 2008, includes data from CIOs and other senior IT managers from 10 healthcare organizations located around the United States, including two large group practices and seven integrated health delivery networks.

According to the paper, an exodus of retiring traditionalists and boomers is a serious threat to IT departments because the older workers often selected, implemented and managed the systems that are in place. Their experience is difficult to replace.

The report identified four segments of workers that might be found in a health IT department at any given time: traditionalists born before 1946; baby boomers, born between 1946 and 1964; Gen X born between 1965 and 1980; and Gen Y born between 1980 and 2000.

The older generations make up a large proportion—as much as 50% at some sites—of the health IT work force. Unless their departure is transitioned or otherwise controlled, their retirement threatens to leave critical gaps in staffs that are responsible for existing IT systems.

YOUNG ALLIES

As more of Vail’s experienced IT employees retire, the need to attract and retain talented replacements has increased. More candidates looking to design and manage IT systems are arriving from the college ranks. The Regence Group has expected its younger workers to press for more work benefits such as telecommuting and flexible work hours as part of signing on. Vail says that the organization is looking at accommodating future generations as well.

“We are pushing ourselves to adopt a more collaborative work environment along with the necessary tools to allow for it,” Vail continues. “The younger generation is our ally for keeping this effort moving.”

According to a recent report by the U.S. Department of Labor and Statistics, the demand for jobs in medical records and health IT is projected to increase by 18% through 2016. According to the Healthcare Information Management Systems Society (HIMSS), there are about 108,000 health IT professionals in the United States now.

Bonnie Siegel is a vice president who focuses on health IT at Cejka Search Inc., a healthcare executive and physician search firm in St. Louis.

She says with more traditionalists and boomers reaching retirement age, keeping workforce rolls filled with IT replacements is fundamental to an organization’s success.

She notes that new-generation workers not only grew up during a technological revolution, they helped to cause it. Managers should recognize that those workers may value a sense of balance between work and personal life even more than their experienced counterparts.

For example, Gen Y employees, who are 20-to 29-years-old, instead of better pay, might expect a flexible work schedule or company-provided BlackBerrys and cell phones.

“They’re not going to be the same as the boomers that value money or just a work ethic,” Siegel says.

For most healthcare plans, evolving health IT technology requires a savvy work force. When MVP Health Care merged in January 2006 with Preferred Care, its sister company in Rochester, N.Y., the strategy included fending off larger health plans that had been encroaching on their membership market share.

Jack VanGraafeiland, chief information officer, says upgrades of the company’s products in past two years has enabled healthcare providers to better determine and share with patients the exact cost of a procedure prior to the delivery of care. Those upgrades have required a heavy dose of IT support.

VanGraafeiland has a staff of 200—a mix of veterans and the less experienced. Relying on senior employees as mentors has been good formula for MVP Health Care, especially since some are postponing retirement because of the recent downturn in the economy, he says.

“They hold the keys to the kingdom, and we do want to keep them around because of their history and experience,” VanGraafeiland says.

He points out that it’s good policy that when a senior employee takes on a mentor role, which gives that person a break from his or her normal routine, that the time taken doesn’t harm the mentor’s chances at promotions or involvement in special projects.

VanGraafeiland says other ways to keep veteran IT workers from retiring can include: sabbaticals; a switch to consulting status; financial incentives; retirement based around a system conversion or sunset.

Vail says planning for an able IT work force is as important as the technology that plans use to stay ahead of the competition.

“We are adopting tools looking down the road three to five years to determine the kind of skill sets we need and factoring in how long it takes to recruit or train,” she says.

David Bennett is a senior editor in Advanstar Communication’s Centralized Content Group

How to Prepare for the 5 Most Common IT Disasters

If your healthcare IT system crashed or was damaged, say in a natural disaster, what would you do? Your business data, clinical data, e-mail, and other documents and correspondence – all gone (at least temporarily). Are you prepared?

I wish I had good news for you, but it’s only a matter of time before your healthcare IT systems suffer some type of breakdown. It is not feasible to completely prevent this from happening. The best you can do is to identify and mitigate the biggest risks to prepare for an IT disaster, and know how you will handle it when (not if) it happens.

Here is guidance for preparing your ASC for the five most common IT disasters.

1. Hardware failures/power outages. This category makes up 49 percent of IT malfunctions and potential data loss. Preparation here comprises designing and implementing the right infrastructure:

• redundant, hot‐swappable components (power supplies, network interfaces, disk drives);
• RAID hard drives (at least RAID 1 or 5, never RAID 0);
• uninterrupible power systems (UPS) are not truly uninterruptible, they are batteries, so plan for only 20 to 30 minutes of up‐time (and remember: They don’t work if your systems are not plugged into them); and
• functioning data backups.

2. User error. Users – you and your staff – are responsible for 36 percent of IT disasters. Work to mitigate these risks by having the system set up right by experts, limiting users’ access (with user‐level security policies), providing user training, implementing corporate computer-use policies and maintaining offline backups (this keeps your production data out of harm’s way).

3. Viruses. Don’t let the fact that viruses make up just 8 percent of problems lull you into a false sense of security when it comes to protecting yourself against them. Use server-based anti-virus software that’s kept current and up-to-date (and budget for this, as it costs money to update annually). Also be sure to use a hardware firewall and anti-spam software to buttress the anti-virus program. Install only safe software, and train users to practice safe surfing (most viruses are enabled/activated by users).

4. Software issues. Four percent of the time, software is to blame. Because of this, be careful of automatic updates for OS software. Do a full backup of all data before doing any major application software updates/patches, and make sure you are aware of any customizations you have made to your software before you do any updates. Finally, keep in mind that HL7 (and other standards like CCHIT) do not mean interoperability between software apps (and if it sounds too technical for you, have an expert install software to help prevent these issues).

5. Natural disaster. Events such as fire, flood and theft cause only about 3 percent of IT nightmares. Consider investing in a fire safe for key paper and electronic files. Keep a set of (rotated) backup tapes off‐site (this creates its own set of issues to deal with, which is another article entirely), and maintain an archive of all software media, license keys and system logins and passwords.

– Dr. Jenkins (Marion.Jenkins@qsetech.com) is the CEO of QSE Technologies, a premiere IT systems integrator serving the ambulatory healthcare industry for more than five years. Read more about QSE.

Industry Experts Sound Off

A proposed rule from the U.S. Department of Health & Human Services requires all physician practices and other providers to adopt a new ICD-10 code set by 2011, and use it for coding diagnoses on all HIPAA standard transactions. So we asked information technology experts from the ASC industry to respond to this question:

How can facility owners/operators mitigate the challenges and costs associated with potential practice management and billing system software upgrades?

Prepare now! Establishing cross-functional transition teams and plans now will help ASCs identify the impact of ICD-10 on key business processes. Begin speaking and negotiating with both payors and vendors to gauge their preparedness and determine what cost they plan to pass along to clients. If you haven’t yet automated procedure documentation and coding, do so now, as it will cut down on the time and cost of comprehensive staff education. Every vendor will likely have a different plan, timeline and cost structure. Finally, designate a monitor. By designating one individual to monitor changes to the mandate, an ASC can ensure the most appropriate use of resources to achieve compliance in a timely manner.

Sean Benson

Director of Marketing

ProVation Medical/ Wolters Kluwer Health

ICD-10 coding should not be a surprise to anyone in the healthcare management industry since it has been around since 1999 and its predecessors go back as far as 1900, when ICD-1 was implemented. The major challenges facing facility owners and operators will be in educating their clinical and coding staff to the new coding standards, dealing with the phased in adoption by different insurance carriers as with any new standard, and the readiness of their software vendor. The benefits projected by HHS are: more accurate payments for new procedures; fewer rejected claims; fewer improper claims; better understanding of new procedures; improved disease management; better understanding of health conditions and healthcare outcomes (no monetary estimate made); and harmonization of disease monitoring and reporting world-wide.

Ron Cousino

Director of Client Relations

Experior Healthcare Systems

I believe there are three actions that an organization can begin that will reduce the impact on converting to the ICD-10 code set. First, begin dialogue with your IT vendor now. Make sure they have a well-defined plan on how they will meet the requirements for filing claims and contingencies for the inevitable problems that will arise. Secondly, identify your primary payors and begin dialogue with them as soon as possible. Make sure your IT vendor is party to those conversations, too. There are going to be some payors that switch on schedule, others that may migrate earlier or later-you and your billing system have to be ready for those challenges. Finally, staff education will be critical. Understanding the terminology and the requirements will help spot problems before they can affect your operations and cash flow.

Craig Veach

Senior Vice President of Operations

Amkai

Now is the time to ask your practice management and billing providers about ICD-10 conversion. Ask if ICD code fields are “hard coded.” If they are: a warning sign. Also, ask about NPI conversion history. Vendors with properly structured systems finished the conversion early: in either 2006 or early 2007. If that isn’t the case: a second warning sign. Another major challenge will be education of coding staff. If your ASC uses a billing vendor, ask about training plans. If coders are on your staff, plan now for a major investment in education and training, and a substantial productivity hit during the transition.

Bill Gilbert

Vice President of Marketing

Advantedge Healthcare Solutions

The new ICD-10-CM codes incorporate better detail but will also greatly increase the complexity of coding with over 68,000 ICD-10-CM codes versus roughly 13,000 ICD-9-CM codes. This increased difficulty will invariably lead an increase in denied/rejected claims as all parties learn to use the new system. We believe that having digital charts will be extremely important during this transition by allowing facilities to better manage their revenue cycle. We have an application that allows facilities to cost-effectively digitize paper charts and significantly reduce time and effort necessary to resubmit rejected/denied claims. This faster turnaround results in quicker reimbursement and greater working cash flow to the center. The new coding system is necessary and we are working to make the transition as smooth as possible for our partners.

Jeff Blankinship

President and Chief Executive Officer

Surgical Notes

According to the World Health Organization (WHO), “It is not possible to convert ICD-9 data sets into ICD-10 data sets or vice versa. ICD-9 has 6,969 codes while there are 12,420 codes in ICD-10 (14,199 with the fourth-character place of occurrence codes in Chapter XX (External Causes of Morbidity and Mortality).” In our software system, we already accommodate the use of the fourth character in the ICD-10 code set. HST already has one strategy in place to mitigate the transition to ICD-10. One important point that may be missed in this discussion is that the payors and Electronic Claims Clearinghouses must also update their systems to properly handle the ICD-10 code set.  During this transition period, ASCs be on heightened alert to process any rejections and their associated causes. The best mitigation is for ASCs to be well-informed, educated and have processes in place that the entire business office staff can follow.

Tom P. Hui

President and Chief Executive Officer

Healthcare Systems and Technologies

Facility owners and operators need to confirm with their billing and practice management software vendor if their existing system will support both ICD-9 and ICD-10 and replace it with one that will have the capability prior to 2011. As with the NPI transition, many carriers may not be able to convert to the ICD-10 diagnosis system by the deadline and may still only support ICD-9. Software systems will need to support both versions and provide the capability to select either one, so that claims can be submitted to the carriers in the right format to ensure that they will be processed and paid.

Mel A. Gunawardena

Chief Executive Officer

Medigain

The impact to healthcare IT is vast, touching virtually all functions including registration, clinical, quality, billing and reporting. Vendors must aggressively plan to ensure their products support ICD-10 end-to-end, as well as maintain legacy ICD-9 data. “Getting there” requires far more than modifying fields and reports; applications must also reflect many new provider and payer business rules and processes. Perhaps the largest technology consideration is the pre-requisite move to the X12 5010 transaction set. The transition will require significant application modifications plus extensive inter-system testing to ensure processes and workflow are not interrupted. The broad scope of this change will be greater than the HIPAA changes of 2003, since the focus on interoperability and the prevalence of interfaces has increased substantially in recent years.

Lindsay McQueeney

Director of Product Management

SourceMedical Solutions

Containing costs key to care delivery improvement

When it comes to improving our care delivery system, focusing on quality is the key to containing costs and improving access, according to a report issued by the Partnership for Quality Care (PQC).

According to Kate Navarro-McKay, executive director, PQC, the average family insurance policy exceeds $12,000 in premiums, and national healthcare costs are at $2.3 trillion and counting.

“Yet the more we spend, the more the number of those without insurance continues to grow, reaching 46 million last year,” Navarro-McKay says. “Likewise, healthcare was one of the top issues in the recent election-in a CNN exit poll, 10% of voters named it as their top issue, and two-thirds of voters said they were worried about how they would afford healthcare.”

As Congress and President-elect Obama begin to reform the healthcare system, they will need a way to evaluate competing proposals for reform, according to Navarro-McKay. “The PQC report demonstrates that we cannot look at expanding access to care or decreasing costs in a vacuum-improving the quality of our healthcare delivery system is the real key. That is how you create sustainable long-term savings, and it is how you create a healthy, productive populace.”

To help that discussion, the report, “Quality, Cost Control, Universal Healthcare,” includes nonpartisan recommendations for reform to hardwire effectiveness through healthcare IT; change delivery systems to address healthcare disparities; and to empower patients. There are proven strategies to combat the chronic disease that accounts for seven out of 10 deaths in America and 75 cents of every healthcare dollar the U.S. spends.

Kaiser Permanente’s chronic disease treatment program raised rates of controlled hypertension from 36%, which is the national average, to 75%. “Part of that program’s success was the use of Kaiser’s electronic health record, and a surprising part of that story was the ability of organized labor and healthcare employers to work together to design and implement the nation’s largest civilian medical record at Kaiser Permanente,” Navarro-McKay tells Managed Healthcare Executive.Montefiore Medical Center’s clinical data warehouse aggregates all patient records in conjunction with a complex statistical program that enables physicians, caregivers, and researchers to quickly perform complex longitudinal studies.

“It allows physicians to track their own patients, seeing which are meeting target treatment goals and which are slipping through the cracks,” Navarro-McKay says. “More surprisingly, it also gives every caregiver the potential to become a robust clinical researcher, pushing the frontier of medicine as he or she delivers care.”

At Group Health Cooperative, its patient-friendly electronic medical record helped patients improve their own health by integrating educational materials into the patient’s own record, and enabling them to have questions answered electronically. Forty-seven percent of patients now access their records on-line, moving them from passive recipients of health information into active, engaged participants in improving their own health.

Navarro-McKay believe executives should advocate for health reform along the following principles, to ensure a quality, affordable healthcare system:

• Ensure universal healthcare coverage for all Americans.
• Improve the quality and efficiency of healthcare services by adopting clinical best practices and promoting organized systems of care.
• Establish a stable, equitable, broad-based, and predictable healthcare financing system.
• Promote affordability and address rising healthcare costs by advancing opportunities to achieve the greatest value for our healthcare dollars.
• Provide meaningful individual choice of providers and plans while promoting preventive care, protecting consumers from the costs of major illnesses, and improving the management of chronic conditions.
• Achieve greater reliability in healthcare coverage, including improved portability of coverage and continuity of care.

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