How to do Business in Health IT

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  • Meaningful use is the granddaddy of all healthcare IT challenges. Passed in the 2009 economic stimulus package's HITECH Act, the program requires all providers to demonstrate the meaningful use of EHR by 2014 or face reduced Medicare reimbursements. (For Medicaid participants, the deadline for avoiding penalties is 2016.) Providers do receive financial incentives for using EHRs before those deadlines. Meaningful use is to be achieved in stages, with stage 1 underway and stage 2 beginning in 2014. Critics say the program is too costly and too ambitious. Given that large hospitals can spend several years and many millions on EHR and electronic prescription implementation, they may be right.Health Information ExchangeThe HITECH Act also funded the creation of state HIEs. These groups have the enviable task of helping healthcare organizations share data contained in largely proprietary EHR systems, of which there are literally thousands, though the Nationwide Health Information Network Exchange initiative to develop standards and policies for data exchange may help (provided varying laws about patient records crossing state lines can be reconciled). In addition, there are close to 300 HIE organizations (most of which predate the HITECH Act) that represent their own geographic areas, set their own policies and have matured more that the state groups. CIOs looking to get started with HIE will likely more questions than answers and find it a highly political processHealthcare ReformTwo parts of the controversial reform bill upheld by the U.S. Supreme Court concern technology. One is the mandate for each state to set up a health insurance exchange by 2014 so consumers can buy insurance on the open market. Even Massachusetts, the state at the forefront of healthcare reform, is struggling to implement the necessary combination of technology that includes content management, ecommerce, CRM and portals. The second is the accountable care organization, a voluntary partnership among providers who aim to give patients more coordinated, and less expensive, healthcare. Accomplishing this requires significant investment in EHR and HIE, as well as robust clinical data analytics and frequent patient engagement (both of which will be covered later).HIPAA ComplianceThe HITECH Act beefed up HIPAA, which predated the rise of information technology. It essentially turns business associates into covered entities, meaning they must take steps to secure personal health information, and it dramatically increases the fines for a data breach involving PHI. Tellingly, it notes that a loss of encrypted PHI does not constitute a data breach, implying that organizations should invest in encryption technology. The bigger issue, judging from the list of data breaches since new HIPAA rules went into effect, remains lost or stolen hardware—primarily laptops and mobile devices—containing PHI that's all too easy to obtain. On top of that, healthcare reform sets a 2014 deadline for electronic fund transfer compliance.Mobile Health and BYODMedical professionals love smartphones and tablets such as the iPad, which fits nicely in a doctor's white coat pocket, and the ubiquitous example of a doctor remotely accessing patient records from a child's soccer game points to the tremendous potential of mobile health, especially in the developing world. CIOs remain way. In addition to the usual security requirements of a successful BYOD policy, healthcare CIOs must contend with HIPAA privacy and security rules, which penalize providers even if users' personal devices go missing. This means taking an especially close look at which users can access which applications—or even particular data sets within applications—and, if field medics and trauma nurses share touchscreen monitors, robust, role-based identity and access management.Wireless NetworkingGiving healthcare workers access to mission- and life-critical applications and medical devices requires a strong, secure wireless network. In facilities filled with banks of elevators, radiology departments, stacks of bathrooms and box upon box of paper records—all of which interrupt wireless signals—building a strong hospital network can be a challenge. Linking an entire medical campus, especially one filled with buildings that predate the ENIAC, let alone the Internet, can be nearly impossible. Possible Food and Drug Administration regulation of hospital wireless networks doesn't help. The solution is often a combination of a wireless WAN and a plethora of access points, neither of which come cheap. Perhaps coincidentally, new hospital construction, when it happens, seems to focus more on wired networks.TelemedicineThe challenge of wireless networking in hospitals—not to mention bringing broadband to rural America—is one technological factor hindering the spread of telemedicine, which connects specialists (often in urban or university facilities) to patients in areas underserved by doctors. Another is equipping exam rooms with teleconference equipment, which can be expensive and hard to use. Then there's the thorny issue of telemedicine reimbursement; there's no national rule, and individual state policies vary, especially when it comes to providing services that cross state lines, so some doctors hesitate to participate in a program for which they won't get paid. Payers, including Medicare, have also been slow to catch on. Perhaps that's why robots are providing telemedicine services in some hospitals.Patient EngagementPerhaps the only thing harder than convincing healthcare professionals to use technology is convincing patients. Few use personal health record services, for example. PHRs offer electronic access to key information such as medical history, lab results and drug allergies, but many won't let patients edit info, are limited to certain providers or are just plain hard to use. The medical home model combines telemedicine and mobile health and offers promise for improving patient engagement and cutting care costs. So do emerging smartphone applications and gadgets that help patients track exercise and vital signs alike. Meanwhile, advocates including Regina Holliday and Dave de Bronkart remain outspoken in Washington about giving patients access to their data.Clinical Data AnalyticsBig data has big potential in healthcare. On a system-wide level, executives can see what medical conditions are most prevalent among patients and devote resources to treating or even preventing them. They can also determine if certain procedures lead to return hospital visits and share best practices for rehabilitation and recovery. On an individual level, abundant wireless mobile health devices and applications gives clinicians a chance to monitor and study patients' vital signs remotely, so, say a sudden spike in blood glucose is addressed without a expensive ER trip. The challenge, of course, is first implementing analytics systems and then bringing information together in a clinical data warehouse that's accessible yet secure. Often only the largest healthcare systems can afford thisStorage InfrastructureHundred-year-old hospital buildings frustrate storage administrators as much as they do network admins. The typical healthcare data center is bursting at the seams, inconveniently located and a low priority for executives focused instead on expanding clinical space. The electronic documentation needed to meet the HITECH Act's meaningful use requirements, not to mention state and federal data retention laws that may require healthcare organizations to keep patient records on file for as long as 25 years, will only make things worse. To combat this, organizations can deploy virtualized storage on a storage area network while rolling out thin provisioning, tiered storage and data replication technology on top of it. However, not all medical software vendors, and not all legacy applications, support SAN technology.The CloudIn theory, the cloud's a great place for healthcare organizations to store appointment summaries, medical images and other patient records, as well as a viable data backup option for disaster recovery planning. There's no need for additional infrastructure or personnel and, since data is essentially being archived, immediate access to data isn't necessary. In practice, questions about data ownership, HIPAA compliance, public cloud security "always-on" availability make many healthcare providers wary of cloud services—even though, as noted, hospital IT security itself tends to be weak. That said, some smaller healthcare providers are giving inexpensive, easy-to-use cloud-based EHR systems a shot, while a minority of larger providers are building private clouds as extensions of virtual server implementations.International Statistical Classification of Diseases and Related Health Problems, 10th RevisionWhile most of the world has been using the diagnostic code set known as ICD-10 for at least a decade, the U.S. still uses ICD-9, which was finalized in 1979 and is therefore quite dated. A federal mandate to move to ICD-10 by Oct. 1, 2014 is said to improve diagnoses recorded in EHRs and streamline onerous billing processes. However, organizations such as the American Medical Association oppose it, saying ICD-10 implementation places an unfair burden on physicians, nurses and coders. It's also a costly, time-consuming process that can't really be automated. Oh, and the World Health Organization expects to finish ICD-11 by 2015, so another upgrade is on the horizon.
  • JoelKurtzman (Booz and Company – Editor and Chief of Strategy & Business – credited with coining the term “Thought Leadership”

Transcript

  • 1. How to do business in Healthcare IT Christopher Kunney, CPHIT, MSMOT Emerging Healthcare Technology Strategist Infinite Options, LLC. 1
  • 2. I Need A HERO Not A ZERO! “80% of Success Is Just Showing Up!” Woody Allen
  • 3. Is This Healthcare IT Thing FOR REAL!!!
  • 4. Healthcare IT Forecast HIT Venture Capital Funding How Many Health IT Venture Capital Funding Deals Occurred Over the Past Five Quarters? • There were 104 health IT-related venture capital funding deals during the first quarter of 2013, compared with 30 health IT-related venture capital funding deals during Q1 2012, according to a recent report from Mercom Capital Group. • The report notes that there were 51 health IT- related venture capital funding deals during Q4 2012, 39 such deals during Q3 2012 and 44 such deals during Q2 2012. • The report is based on Mercom's analysis of quarter-over-quarter information on venture capital funding activity in the health IT sector. Source: Mercom Capital Group, "Healthcare IT Funding and M&A: 2013 First Quarter Report"
  • 5. EHR Adoption Rates Friday, May 10, 2013 — LATEST NEWS SurveySaysMore Than 90% of U.S. PhysiciansNowUse EHRs A survey conducted by Harris Interactive and released by Accenture finds that 93% of U.S. physicians report using electronic health record systems.According to the survey, 45% of U.S. doctors say they use health information exchange technology to access data from outside their organization, and 38% say that using EHRs and HIEs has helped lower their organization's costs. Healthcare IT News et al.
  • 6. Hospital Data Exchange Increased by 41% Over Four Years Health data exchanges between hospitals and other health care providers increased by 41% from 2008 to 2012, according to a results of a recent study lead by National Coordinator for Health IT Farzad Mostashari The study found that: • 58% of hospitals routinely exchanged electronic health information with providers and health systems outside of their organization in 2012, and data exchange efforts with outside hospitals more than doubled during the study period; • 84% of hospitals that adopted a basic electronic health record system and participated in a regional health information exchange shared information with providers outside of their organization during the study period; • The proportion of hospitals that adopted at least a basic EHR and participated in a health information exchange increased by more than 500% from 2008 to 2012; and • Hospitals with a basic EHR that participated in HIEs had the highest rates of hospital data exchange activity in 2012.
  • 7. More Employers Adopting Health Care Engagement Technology More employers are using mobile applications, social media and online games to boost employees' engagement in their health care, according to a report by Buck Consultants and WorldatWork The report also found that: • 50% of surveyed employers said they currently use social networking or other social media tools to boost employees' health care engagement and 37% said they likely will adopt such tools within the coming year; • 36% said they currently use at least one mobile tool to promote employee health engagement and 36% said they likely will adopt at least one mobile health tool within the coming year; and • 32% said they currently offer mobile tools to help employees manage their health care benefits and 52% said they likely will offer such tools within the next three years Challenges for adoption: • A lack of support from senior management • IT infrastructure challenges • Privacy concerns Source: Crain’s Business Insurance/Modern Healthcare
  • 8. Changes Effecting the Healthcare Ecosystem • Changing Payment Model • Physician Alignment • Patient & Employer Engagement • BI, Predictive Analytics and Big Data • Security & Compliance • mHealth and Telehealth • Interoperability & HIE • Limited Resources • Consolidation • Increased Investment in HIT
  • 9. Changes Effecting Healthcare IT According to CIO Magazine: Few industries faces as many IT Challenges as healthcare, where Government mandates, security requirement and a need to replace Outdated technology make a CIO’s job difficult: TOP ISSUES FACING HEALTHCARE CIOs: 1. Meaningful Use 2. Healthcare Information Exchanges 3. Healthcare Reform 4. HIPAA Compliance 5. Mobile Healthcare and BYOD 6. Wireless Networking 7. Telemedicine 8. Patient Engagement 9. Clinical Data Analytics 10. Storage Infrastructure 11. The Cloud 12. ICD10 Conversation Source: CIO Magazine August 21, 2012
  • 10. These are not your doctor’s techie toys anymore! Smart devices are now the new clinical tools for clinicians
  • 11. Today’s Healthcare CIO struggles to retain a place in the C-Suite “I’ve recently become very, very worried about the CIO position….” What I see that worries me is an erosion of the position in many healthcare systems… Shaffer also indicated that she sees “extreme variance” in the role of CIO and in the ability of healthcare organizations to get value out of the CIO position.” Source: Vi Shaffer - Gartner
  • 12. Are HIT Investment Realizing The Results Expected? Financial woes at Maine Medical Center By Stephanie Bouchard, Managing Editor “In a memo to its employees last week, one of Maine’s largest health systems said it has suffered an operating loss of $13.4 million in the first half of its fiscal year…” “In the memo, Petersen said the operating loss is due to declines in inpatient and outpatient volumes because of the hospital’s efforts to reduce readmissions and infections; “unintended financial consequences” due to the roll out of the health system’s Epic electronic health record and problems associated with being unable to accurately charge for services provided; an increase in free care and bad debt cases; and continued declining reimbursement from Medicare and MaineCare, the state’s Medicaid program...” Source: Healthcare Finance News
  • 13. Nearly one in five healthcare CIOs have had a security breach within the past 12 months, according to statistics compiled by McKesson in Understanding Your CIO. Their top infrastructure IT focus is on systems that secure personal health information (22 percent), followed by servers/virtual servers (18 percent) and a focus on mobile devices (16 percent Security & Privacy Issues Continue Keep CIO’s Up At Night
  • 14. Security & Privacy Issues Continue Keep CIO’s Up At Night Vendor Scam Results in Data Breach for Clinic Raleigh Orthopedic Clinic in North Carolina is notifying approximately 17,300 Patients of a breach of their protected health information after the clinic apparently Was the victim of a scam Massachusetts provider settles HIPAA case for $1.5 Million Alaska Medicaid Settles HIPAA Security Case for $1,700,00 UCLA Health System Settles Potential HIPAA Privacy and Security Violation HHS Impose a $4.3M Civil Money Penalty for HIPAA Privacy Rule Violations
  • 15. Shift In HIT Leaders Behavior Is Needed Behaviors must change… Current: • Project lead by IT and Executives • IT approved everything doctors desired • Limited clinical juice in early EHR systems • IT accepts vendors limitations and standards Future: • Clinicians are more involved in technology projects • IT has to get better at scoping and communication its capabilities, not just approving everything doctors want. • IT doesn’t say “no”. The business has to say “no” • IT have to work closely with partners to innovative
  • 16. Do you know the HEALTHCARE Secret Hand Shake? Are you and your business part of the healthcare ecosystem? • What is my business focus? Revenue or mission? • Do you really understand what the term “Healthcare” in HIT really mean? • Can you effectively speak the language of healthcare? • Do you know who influences buying decision in healthcare? • Can you clearly articulate your “healthcare” value prop?
  • 17. Transitioning From Expert to Healthcare Thought Leader A Simple Formula For Success: • Share your perspective via social media and in public public forums • Get Certified in Healthcare IT • Involvement Industry Associations & Events • “Live the life” of a healthcare professional • Partner with other technology innovators • Turn your customer into your innovation partner
  • 18. Transitioning From Expert to Healthcare Thought Leader
  • 19. Innovation & Thought Leadership Goal: YOU = “Trusted Resource”
  • 20. Social Media - Strengthen My Brand Current Trends in Social Media Current trends to watch in social media in health care include: • Managing a conversation • Engaging e-patients • Convergence with personal health records • Social media for providers • Education communities for healthcare professional ARE YOU PLUGGED IN TO THESE SOCIAL MEDIA COMMUNITIES?
  • 21. Believe IT OR NOT… CIO’s Do Blog! John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 1 5 blogs ontaining almost 5000 articles with John having written over 2000 of the articles himself How do you deal with the challenge of a blog and Twitter account making you “too” accessible as a CIO? “People generally respect boundaries. Part of my life is to ignore cold callers (unless they are serendipitously offering something on my priority list), I would love to get back to every person that wants to meet me for lunch and talk about my organization’s prioirities but ,there isn’t enough time in the day to respond – let alone I have all those meetings. I have met a lot of great people on Twitter and I have hired a few, all of those have turned out great.” Will Wieder, CIO Ministry Health Care
  • 22. Get Certified! Why invest in industry certification? • The industry finds value in certified professionals • Helps to breakdown the “credibility wall” • Gives you greater insight into the culture of the industry • Strengthens your personal knowledge of workflow, technology, functionality of business and clinical systems used
  • 23. Join and get involved!
  • 24. When’s the last time you played Doctor? http://www.youtube.com/user/ClevelandClinic
  • 25. Dearly beloved, we are gathered here today to become partners…
  • 26. The Future Is Bright For Healthcare IT
  • 27. Now You Know… The Balls In Your Court Ask yourself… • Is this just a Job or a Calling? • Am I an active participant in the healthcare eco-system? • I’m prepared invest in myself and my community? • Am I dating my customers or am courting them for marriage?
  • 28. THANK YOU! Christopher Kunney, CPHIT, MSMOT Infinite Options, LLC. ckunney@comcast.net Emerging Healthcare Technology Strategist