Issue 5 FA L L 2 0 1 1 The health IT journal for the Integration Generation cover Putting Healthcare Back Together THE DEBATE OVER ACOsI N T H I S I SSU E HEALTH STANDARDS 5 QUESTIONS INSIGHTS Integrating a Healthcare Joe Moore, Radiology North Kansas Enterprise Consultants of Iowa City Hospital
Are ACOs Just 21st Century HMOs? by Chad Johnson, Corepoint Health If you are in or around health care, it’s impossible to avoid the ongoing debate over the changes that Accountable Care Organizations (ACOs) will bring to the industry. Much like the political rancor over Supporters argue that the introduction of ACOs will bring the Patient Protection and Affordable Care Act of 2010 that first long-overdue change to patient care, shifting the focus back mentioned ACOs, the new model of care has passionate support- to the quality of care the patient receives. Health care provid- ers and detractors within the health care industry. ers will be encouraged to coordinate care throughout the ACO An ACO is a network to the benef it of the of health care provid- It’s not unusual for a patient to visit patient’s health, other- ers and hospitals that different hospitals, doctors and other wise they won’t qualify sha re respon sibi l it y for certain rewards. for providing care to health care organizations for the same The many detractors patients. According to medical condition, with very little or no of ACOs believe they are the Centers for Medicare communication between the caregivers. a utopian big-govern- and Medicaid Services, ment dream destined to an ACO “agrees to be accountable for the quality, cost and over- fail. Many argue that ACOs are simply the 21st Century version all care of Medicare beneficiaries who are enrolled in the tradi- of HMOs – which were almost universally disliked by patients tional fee-for-service program who are assigned to it.” – that will produce lower-quality care with fewer choices and The rationale behind this new model of care is that the cur- higher prices. rent delivery of health care in the United States is fragmented. It’s In the 1990s, HMOs, or health maintenance organizations, not unusual for a patient to visit different hospitals, doctors and were common health insurance plans that restricted patientsealthcare Back Together the introduction other health care orga- to receive care from nizations for the sameSupporters argue that designated in-network medical condition, with physicians and refused of ACOs will bring long-overdue change toE DEBATE OVER ACOs care, shifting the focus back to the very little or no com- munication between the patient to pay for procedures they deemed unneces- caregivers. As a result, quality of care the patient receives. sary. HMOs still exist there often are too many today, but aren’t nearly expensive tests and diagnostic procedures performed, repeated as common; however, the near universal dislike of HMOs led to procedures and a lack of follow-up with the patient. insurance plans easing the restrictions they place on patients in The government is encouraging health organizations to regards to treatment and choice of physician. participate in the ACO model of care by financially rewarding There are, however, key differences between the proposed caregivers for meeting certain quality of care benchmarks that ACO model of care and the care patients received from HMOs in include fewer repeat visits or readmissions and patient adher- the 1990s. The main difference is in the accountability of care – ence to standard, preventative care visits, such as an annual in an ACO, health care providers, not an insurance company, are physical or a mammogram. responsible for quality of care. The ACO caregiver will have the
flexibility to contract with other affiliated ACO caregivers or Common IT Challenges of ACOsorganizations without the reliance on an insurance represen- • Interoperabilitytative who may make care decisions that are not in the patient’s • ACOs will dramatically increase interface demand to con-best interest. nect the patient data through the ACO workflow. Another key difference is that patients will not initially real- • Connectivityize they are receiving care in an ACO. HMOs are insurance plans, • ACO provider organizations will need to send data throughso patients were acutely aware of their existence, from the lim- a shared, secure network.ited choice of physicians they were given to the insurance cards • EHR Record Analysisthey were required to present for payment. Patients in an ACO • ACOs will need to leverage clinical IT for intensive carecan choose the physician of their choice, and that physician will management and data analysis. Creating disease regis-refer patients to other caregivers within the large network of tries will help caregivers and patients manage diseases toaffiliated ACO organizations. Patients may only become aware prevent emergency department visits.of the ACO after care is complete and the ACO asks the patient’s • Emphasis on ITpermission to allow Medicare to share their claims data with the • ACO IT measures will need to be included in organiza-ACO for shared savings determination. tional strategic plans. The goal of ACOs is to pay providers in a way that encouragesthem to work together, to pay providers in a way that does notencourage demand for unwarranted care, and to create an orga- For more HIE resources, visitnization that is rewarded for providing high quality care. corepointhealth.com/START. The proposed ACO model is still being refined and likelywill have its fair share of problems. However, that’s not stop-ping health care organizations who are taking huge steps, atsignificant financial cost, to qualify to become an ACO – such The many detractors of ACOsas implementing electronic health records and creating seam- believe they are a utopianless interoperability between affiliated organizations. Forward- big-government dreamthinking organizations are determined to remain profitable and destined to fail.at the forefront of patient care, regardless of the requirements. There are several obstacles to the success of the ACO model,including overcoming patients who may see ACOs as a newform of HMO. If patients believe ACOs are going to restrict theirchoices simply to save money, the model will be met with oppo-sition, which is detrimental since a large part of ACO’s successdepends on patients’ voluntary participation in preventativemedicine. There is little doubt that ACOs will alter the health care land-scape by changing the way health care providers measure suc-cess. Patient care will again become the main focus, placing thecurrent fee-for-service model in the past, alongside HMOs. Join the conversation on Twitter Tweet Chat for Health IT, every Monday, 8:00 PM CT. Use #HITsm and participate.
Health Standards:Integrating the Healthcare Enterprise (IHE) by Rob Brull, Corepoint Health IHE is a group of health care industry representatives that work to improve the way health care systems share information electronically. The group was formed in 1998 as a cooperative venture by the Healthcare Information and Management Systems Society (HIMSS) and the Radiologic Society of North America (RSNA) with the goal to promote interoperability among imaging and health care information systems. Today, IHE membership includes more than 200 global health care professional associations and health care vendors. IHE encourages the use of established interoperability standards such as HL7 and DICOM. Systems developed in accordance with IHE communicate with one another better, are easier to implement and help health care providers use information more effectively and, ultimately, provide better patient care. What can ihe do for health it professionals? Creating interfaces between systems is a key challenge faced by many health care IT departments. Understanding the differing implementation of standards in various vendor systems and creating a way to share information between those vendors is challenging. IHE offers a common framework for vendors and IT departments to understand and address clinical integration needs. IHE Profiles, described below, are not just data standards, they describe workflows, which makes them more practical for use by healthcare IT professionals and more applicable to their day-to-day activities. Because IHE’s membership includes a wide array of end users, it focuses on solving relevant integration issues. These solutions provide vendors with many benefits including: • shorter, less costly implementations. • Cross-system dataflow out of the box. • smoother, complete workflows. ihe profiles IHE strives to solve specific integration problems faced by its membership in the real world through Integration Profiles. These profiles define the systems involved (i.e., actors), the specific standards used, and the details needed to implement the solution. Each profile offers developers clear communication standards that have been reviewed and tested by industry partners. Commonly used health it ihe profiles for interoperability • XDm—CRoss-enteRpRise DoCument meDia inteRChange: WHat It’s usEd foR: according to IHE, xdM transfers documents and metadata using Cds, usB memory or email attachments. this profile supports environments with minimal capabilities in terms of using Web services and generating detailed metadata. this standard is utilized by the direct Project. ExaMPlE: using secure e-mail, a physician e-mails the patient’s CCd to the patient’s Microsoft Healthvault e-mail account for uploading to the patient’s online PHR.
• XDR—CRoss-enteRpRise DoCument Reliable inteRChange: WHat It’s usEd foR: the exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs and other systems without the need for a document repository. ExaMPlE: a nurse at Hospital a enters a patient’s information in the local EHR, and then sends the CCd directly to Hospital B’s system. • XDs.b—CRoss-enteRpRise DoCument shaRing: WHat It’s usEd foR: the sharing of documents between any health care enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility, through a common registry. Medical documents can be stored, registered, found and accessed. ExaMPlE: 1. Hospital a has a document to store. Hospital a creates a description and metadata for the document and submits it to the HIE Repository. 2. the HIE Repository accepts the document with metadata. It stores the document and forwards the metadata to the HIE Registry. 3. the HIE Registry receives a query from Hospital B and identifies the document as a match based on the metadata. 4. Hospital B retrieves the document from the HIE Repository. • XDs-i.b—CRoss-enteRpRise DoCument shaRing foR imaging: WHat It’s usEd foR: the sharing of images, diagnostic reports and related information through a common registry. ExaMPlE: a radiologist accesses the local HIE, in a similar manner as for xds.b, to find a MR report conducted and uploaded to the HIE at Hospital a. • pDQ – patient DemogRaphiCs QueRy: WHat It’s usEd foR: Requesting patient Id’s from a central patient information server based on patient demographic information. used when a system has only demographic data for patient identification. ExaMPlE: Hospital a admits Patient Y, who has not been at the hospital before. Hospital a submits a request to the local HIE, based on demographic information such as name, birthdate, sex, etc., to obtain the appropriate HIE patient Id for Patient Y • piX – patient iDentifieR CRoss RefeRenCing: WHat It’s usEd foR: Cross-referencing multiple local patient Id’s between hospitals, sites, health information exchange networks, etc. used when local patient Id’s have been registered with a PIx manager. ExaMPlE: Hospital a transmits Patient d’s Id information to the HIE for cross referencing. Hospital a receives Patient d’s local Id for Hospital B which they can use to request information from Hospital B, based on need.IHE Integration Profiles provide standards that address specific needs, eliminating ambiguities and ensuring a higher level ofpractical interoperability. Because it encourages use of established healthcare standards such as HL7 and DICOM, IHE is in a uniqueposition to accelerate the process for implementing standards-based interoperability among electronic health records systems. For more information visit: www.himss.org/ASP/topics_ihe.asp. Your Resource Center. Go to HL7standards.com to read practical insights and viewpoints.
Questions Joe Moore Chief Information Officer Radiology Consultants of Iowa What changes do you see in radiology as ACOs unfold? Joe Moore: More confusion, turmoil and disruption. Imaging has a target on its back due to the increased utilization and skyrocketing costs. In the government’s usual fashion, they avoid dealing directly with the cause and instead have chosen the route of making imaging less profitable. This will have little impact on those responsible since they will just order more tests, and imaging is not their core line of business. Radiologists on the other hand get all their revenue from imaging and will be affected significantly. What do you believe the radiology IT priorities are for 2012? Moore: Position for survival. Radiology needs to be more flexible and embrace a service model that will make them more vital. The industry of radiology is partly to blame for current trends toward outsourcing imag- ing to large, national groups. Radiology is now a 24x7x365 service and hospital administrators are increasingly demanding more from their radiologists. IT can prepare the practice for the transition to a more complete service model by ensuring their systems can support multiple orga- nizations, run on networks designed to distribute the workload across the enterprise, interoperate and integrate with many systems, and adapt to the changing landscape. What technologies are exciting for radiology right now? Moore: The most exciting technology today, for my money, is cloud services and virtualization. These technologies support the pri- orities I mentioned above and are critical to our operation. We’ve made a fair amount of progress in my organization virtualizing the data center and many of our desktops. We have what I con- sider an internal cloud. I look forward to the day when we can virtualize our PACS workstations, which will provide flexibility, cus- tomization, fault tolerance and efficiency. External cloud services can best be utilized to offload common IT tasks such as spam, virus and web filtering, backup, disaster recovery and web hosting, thus allowing the internal IT to focus on technology that is unique to radiology. I don’t see us going fully to external cloud services any time soon, but certainly a hybrid model of both internal and external cloud services is the way to go. Healthcare integration and interoperability have always been a strategic initiative for RCI. What new initiatives are you undertaking? Any HIe involvement? Moore: RCI is involved in a couple of HIE initiatives at the state and local level. We feel that to continue to add more value to our ser- vice, it is critical that we make our information available to all who need it, when they need it, in an appropriately secure fashion. I think we’ll have to support numerous avenues of integration and interoperability whether it be with PHRs, EHRs, HIEs or whatever else comes down the pike. This really leads back to our priority of being flexible and prepared for the known and unknown changes coming at us. There are many new professionals joining the health IT profession. What advice would you give them? Moore: I would say the number one thing to focus on is the core business or core service you are supporting. Make sure you under- stand the point of view of the clinician. This transformation isn’t similar to other industries. You have to remember that clinicians work impacts people’s lives. When you put a new application or process in their hands, it’s important to understand that many of them are horrified at the thought. IT should be there to get clinicians over their anxiety and provide the training needed to use the new system to its fullest extent. Don’t take criticism personal and never assume you know what a clinician wants; most of the time the opposite is true. Your success relies on clinicians’ successful use of applications and services. If the end users are miserable, you’re going to be mis- erable. Take pride in being a service provider. Too many in HIT see themselves at some higher level of intelligence because they work in a field that is a mystery to many. Don’t think of the technology as the most important thing. Think about the end result, take pride in being a service provider and have some patience and respect for your end users.
“Insights”North Kansas City HospitalNorth Kansas City Hospital, a 451-bed acute-care facility in the Kansas City BLOGmetro area, chose Corepoint Integration Engine TM to replace their legacy solu-tion because the innovative platform requires minimal programming knowledgeto use and maintain and supports continuous data delivery with little down-timefor upgrades. The hospital also chose Corepoint Integration Engine because it is aflexible solution to their unique needs, offering improved auditing, database inter- For insights on health IT,action and the ability to accommodate a broader set of health care standards (e.g., innovation, debates, andall versions of HL7, X12, and others). HITECH. Since implementing the new system, North Kansas City Hospital successfully corepointhealth.com/GENimaintains interfaces to applications such as Cerner, McKesson, Dictaphone, andSoftmed, as well as addresses new requirementswith medical devices. Along with the solid inte- “ Because it will alwaysgration platform, the hospital welcomes thesupport and assistance of Corepoint Health’s be necessary to movecustomer relations team, available 24/7. health information “There are a lot of changes that will be comingour way with Meaningful Use, and I expect a lot from system to system,of interface needs in the future. Corepoint Health inside and outside thewill be in the center of these changes, deliveringat each step of the way,” said Kelley McFarland, hospital, North Kansasinterface analyst at North Kansas City Hospital. City Hospital plans to“We have called customer support as neededsince purchasing Corepoint Integration Engine incorporate Corepointand our experience has always been positive, Integration Engine intowith fast and thorough resolution.” Because it will always be necessary to move future IT plans.”health information from system to system,inside and outside the hospital, North Kansas City Hospital plans to incorporateCorepoint Integration Engine into future IT plans. “One thing I really like, that makes it so easy to develop interfaces, is the abil-ity to test messages while building interfaces before saving anything. That is oneof the most valuable shortcuts I have experienced with the interface engine,” saidMcFarland. “Corepoint Integration Engine is easy to use and it is intuitive. Evenwhen you don’t know how to do something, you can find information in the helpfiles or online user community.” North Kansas City Hospital is one of the largest employers in the Kansas Citymetro area with over 3,000 employees. In January 2011, the Northland CardiacCenter opened to further enhance the Hospital’s cardiac services in a projecttotaling $13 million, followed in February by a $17 million project to renovate twomaternity floors. Read the complete case study at corepointhealth.com/START.