Healthcare

Hospitals are run by smart people – very smart people. We instinctively know where there problems are and essentially know how to go about fixing them. But convincing our peers and our managers (or the accountants) is a wholly different experience. Modern administrators’ desire data, admire analysis, and crave consensus. But our attempts are routinely foiled by proprietary clinical systems, disparate data standards, acute data quality problems, and poor data management processes.  Data does exist, but either we can’t get at it or people don’t believe in it.  We agonize over the lack of data to help us improve fairly basic processes: reducing patient waiting times, reducing on-hand inventory, improving compliance, improving patient satisfaction, and providing assurances that people are doing their job. For these and many other process issues, there is a way to solve the data access and data quality problem. Create your own easily accessible, error-free Data!  Please read on.

Creating a New Layer of Error-Free data is available through the deployment of a number of technologies that might have been previously overlooked, misunderstood, or whose function or cost has improved greatly over the last 3-5 years. One of the most powerful of these technologies is the Real Time Locator Service or RTLS. This is an approach whereby a patient, a nurse, a bed, a pump, or anything that moves or has a power switch can have an “intelligent” tag attached that automatically transmits its exact location to a hidden network of readers (typically in the ceiling) so that we have a running record of the movement of that person or item. So what?  Think of this!  For very little money, a hospital can implement this kind of technology and achieve the following analysis, and the correspondingly available performance improvements, in about 90 days.

- ER Patients not waiting for more than 15 minutes without an interaction with a greeter, a nurse, or a physician

- ER patients waiting more than a certain threshold, based on triage level, get flagged receive special handling, and get proof that the special handling occurred

- Immediately return to central stores, or to a vendor, expensive inventory items that haven’t moved or been used in 30 days

- Prove to your inventory manager that you are running out of a certain item 3 times a week by showing an actual, to-the-minute usage pattern report

- Prevent infusion pumps from walking out the back door and onto e-Bay

- Prevent unauthorized access to the nuclear material cabinet by requiring an authorized user, and the authorized key, to present simultaneously to the authorized cabinet for access

- Definitively calculate the amount of time nurses and docs are on the floor, behind a nursing station, making rounds, in the breakroom, etc to alter work assignments and improve productivity

- Definitively identify throughput bottlenecks in real-time, and immediately take action to restore patient flows

All of this from an effective RTLS system coupled with analytics and data visualization tools.  Get error-free data. Without spending a lot of money. Without integrating with a closed, proprietary system. But getting tangible improvements in 90 days start-to-finish.

What's not to like about that?

Posted by Mark Brownlee at 01:28 PM | Permalink | Comments (0) | TrackBacks (0)

Every place I go these days and ask people the question if they are ready for 5010, the answer that I get is ‘Yes, absolutely’ and then invariably 20 minutes into the conversation it transpires that ‘No, not really’. Most everybody seems to have missed out one or two, and in some cases quite a lot more, crucial components of the overall transition. And it does not matter whether people are opting for tactical (downgrade to 4010 and proceed) or strategic (full remediation) approach.
That made me think; wouldn’t it be a good idea to create an illustrative checklist for things that one must take care of to ensure smooth transition? So, given the fact that once I start thinking on a particular line, I invariably become obsessed about it and must get it out of my system (mostly at the expense of readers), here is an attempt at a very high level checklist for the tactical approach. Will cover the mandatory requirements for the strategic approach in the next blog.

Tactical Approach

The approach entails downgrading the inbound 5010 into 4010, pushing the downgraded version through the downstream applications so that they can process them as they have been doing for last 10 years, upgrade the returning document to 5010 and then pushing it out through one’s EDI gateway. Things one must consider include but definitely are not limited to,
• First and foremost a bidirectional converter between 4010 and 5010 that is driven by dynamic rules, i.e., wherein the rules can be modified very easily by the end users without any involvement from IT. It is absolutely crucial to have the ability to be able to modify and configure these rules on the fly because the conversion logic is not going to be same for all payers/providers and they will change all the time.
• A solid store and forward mechanism wherein the downgraded information from 5010 is stored in a standalone repository so that it could be retrieved at any given point by any application throughout the infrastructure. It won’t be much fun to find out that once you downgrade the 5010 to 401, the information is lost for good.
• A clear strategy focused on performance aspects of the converter and store-and-forward mechanism because, trust me, having the best converter won’t hold you in good stead if it is slow because nobody, and I mean nobody, has any spare cycles for claims adjudication.
• A clear strategy to identify all the data attributes that are present in 5010 and not in 4010 and which can be required by the downstream applications in order to achieve basic compliance. In addition one needs to identify the methods and changes needed in the downstream applications to fetch the required data during production run and make use of it. For example, if the last name of a claimant happens to be 45 characters, the downgrade converter will chop of the last 10 characters when it converts inbound 5010 to 4010 as 4010 can support only 35 characters for last name, unlike 5010 which can handle 60 characters. So now, unless you want to address the claimant with partial last name, your downstream application that prints the Id cards better have some mechanism to access the store-and-forward repository being used by the downgrade converter.
• A large set of 5010s to test and a comprehensive test strategy along with associated test cases and test scenarios. There are 968 unique and more than 6500 combinational changes between 4010 and 5010 TR3s, not to mention the changes that are specific to companion guides. If you want to be at peace that you have tested every possible scenario, you better have a comprehensive list of the changes between 4010 and 5010, especially the ones that are specific (and hence configured) to your environment. The vendors may certify your 3rd party applications as 5010 compliant, but one can take them on their word only at one’s own peril. One must have a large number of 5010s to test those compliant applications and what better way to generate those 5010s but to create them from existing 4010s using, yes you guessed it, the same converter that was described in step 1.
• A clear set of rules to describe the re-morphing of the previously downgraded 4010 back into its outgoing version of 5010. These rules should not only leverage the standard transformation clauses (such as deletion of deprecated values) but also mechanism to get additional data from downstream applications and data received along with initial transaction. In addition there should be focus on a very robust unique identifier generation from within the data of the original transaction itself, which could be carried back to the up-converter logic.
So these are a few of my favorite things, when it comes to 4010 to 5010 transition using tactical approach, which by the way, is good only though the date when ICD10 hits the road. Next time, we talk about strategic approach. Stay tuned….

Posted by Rajiv Sabharwal at 01:15 PM | Permalink | Comments (0) | TrackBacks (0)

Healthcare reform is all about money. Most of the discussion happening is around the reform to Healthcare Insurance. The various provisions that are discussed today like universal coverage, removal of restrictions on pre-existing conditions, electronic health records, Health Information exchanges etc are going to increase the cost that is currently borne by the members and the employers. Even without these changes, we are seeing the healthcare costs going up on an annual basis and it has increased consistently and alarmingly in the past 15 years. We have seen employers reduce their share of the expenses as the total price keeps going up. This trend is going to continue. When you talk about removing pre-existing conditions restriction that currently exists or allowing even chronically ill patients to be able to buy affordable (?) health insurance, it sounds great. But what does this mean to the health care costs? This definitely is going to increase the cost burden on the Insurers. So who gets to pay for this additional expense? Of course the member! Or let us consider the scenario where there is a competing government health plan option. Where does the government get the money from to pay for covering everyone? Again the members, who are the tax payers will get to pay for it. So is having Universal coverage not a good thing? Definitely not! So what do we need to focus on? Definitely the most efficient and cost effective way to provide the coverage to everyone. And that means the focus should be on efficiency and eliminating wastage and reduction in errors.

Also another important concept that everyone should focus on is prevention and wellness. It is always better not to get sick at all instead of trying to fix once you get sick. We have seen a lot of focus on wellness recently compared to disease management. Well, that is easier said than done. This requires a major change management in the way we live our lives. A lot has to do with how we eat and exercise. When I visited China, I saw a lot of people during dawn and dusk on the roads and public parks doing various physical exercises from Tai chi to Karate and even ball room dancing! They were in groups of 20 or more and they do this on a regular basis. I think it is a cultural thing. In China I don’t seeing too many people who are obese. Maybe this daily exercise helps in keeping them healthy.

In Singapore, elementary school kids get to run a few extra laps around the school playground because they are a couple of pounds overweight with respect to the WHO guidelines. I felt really angry when I first heard about the thought of a six year old I would consider to be of normal weight being subjected to this kind of treatment in school. But on second thoughts, I think it is a good idea to instill the value of good healthy living in kids when they are really young. If you get used to such good practices as a young kid, you will tend to stick to it later in life too. That is wellness management in action!

Posted by Shinju Damodaran at 05:35 AM | Permalink | Comments (0) | TrackBacks (0)

Business transformation by definition is an initiative to align People, Process and Technology initiatives to the company’s strategy, vision and long term objectives, with defined outcomes such as 30% reduction in operational costs or 70% increase in customer satisfaction.

A major business transformation has become necessary in the healthcare industry to control costs and put a check on the steep rise of health insurance premiums. And ICD-10 is just the right opportunity.

ICD-10 is not just another new code-set. ICD codes are the basic building blocks of clinical diagnosis and procedures. ICD codes are also used to negotiate provider rates and to pay claims. Combine these with the fact that the level of granularity is increasing tenfold in ICD-10 and you have a legislation that has its impact running across systems, processes and human resources.

ICD-10 implementation across the organization is going to be a business transformation in itself. Organizations can go beyond and embark upon strategic initiatives as well. For example, ICD-10 is a good opportunity to phase out aging and inflexible claims systems or to modernize legacy claims systems into service oriented architecture. The cost of implementing such strategic initiatives may be well justified in view of the cost to implement ICD-10 in inflexible systems.

While major policy changes, that are currently underway, may control the cost of healthcare in the United States, there is going to be a multi-year wait period before any concrete results are seen. Status-quo should not be acceptable with more and more people joining the uninsured or underinsured population.  ICD-10 is one great opportunity to make a difference both in the short and long terms - to make health insurance affordable again to millions of Americans.

Posted by Vijay Kumar B at 07:47 AM | Permalink | Comments (0) | TrackBacks (0)

“Imagine this situation: you go to a supermarket and before you pick up anything from the shelf, the manager needs to call your bank to find out if you are eligible to buy it. Then when you reach the checkout counter, your bank has to confirm if they will allow the charge on the credit card or if you need to pay cash for a particular item and ask the supermarket to raise a invoice to them against your purchase! Imagine the number of people who would be involved in calling up the bank, responding to the questions at the bank and working on preparing the paperwork for the invoice and then adjusting it against their system. Now that you have visualized it, try to also imagine the costs involved around the same and how much you are paying for that box cereals actually went into making that box and bringing it to you at the store.

But to all of us who go to a doctor’s office or to any other provider in the US, this is a reality. If we are able to convert a much higher volume retail operation to a near real time scenario, what prevents us from doing the same to a much smaller volume medical transactions? The answer lies in the following:
- Lack of interoperability across the various stakeholders and missing/disparate standards
- Complex, legacy systems that cannot realistically support real time transactions
- Poor adaption of electronic records with providers
- No incentives for the providers and the payers to make this happen

If we are able to address this issue it will help us to address 3 key problems that we all complain about
1. A higher percentage of the dollars the member use for HC can actually go to care rather than support administrative work. This will undoubtedly improve the efficiency
2. A significant reduction in “siloed” information will help create better care for members
3. Real time comparison on cost of care would ensure fair charge and also help people with newer plans like CDHP etc

So how do we go about doing this? A centralized information repository with patient information, seems to be the most logical starting point. There are key performance, access and HIPAA related concerns that we need to address, but those are technical nuts and bolts that can be build in once we have an agreement to go forward at the industry level. The second aspect would to create and support a B2B exchange where providers, payers and clearinghouses can seamlessly connect to one another. The third component of this solution would involve the member – a B2C and a C2C peer exchange with robust analytics should ensure that the information captured is put to good and probably to meaningful use – and not just as another input to underwriting. The web 2.0 technical components and tools can help create these platforms.”

Posted by Anirban Majumder at 12:58 PM | Permalink | Comments (0) | TrackBacks (0)

Mobile banking, Mobile payment and Mobile commerce are the phenomenon roaring across the world. Banking industry has been constantly ahead of others in terms of ICT (Information and Communication Technology) investment to drive its businesses. On analyzing the typical characteristics of the banking and financial industry, it will be clear why this industry has been so progressive as far as ICT adoption goes.

It’s humongous scale cannot be effectively managed without usage of Information technologies. The industry’s highly transaction oriented nature and need to be highly competitive in market place is accelerating the adoption of technology. Banking enterprise needs to differentiate in all respect like speed of innovation, faster time to market, quality of service, customer relation management, secured transactions, regulatory compliance, transparency in process etc. all of which can be well addressed by adoption of ICT. 

All of the above mentioned points led this industry to heavily invest in ICT in core business processes over the years and now it’s ready for leveraging advances in wireless communication technologies despite various challenges. Prior investments in Information systems are helping this industry to quickly enable wireless channels for customers as well as their own employees.

Looking at the healthcare industry one cannot say it’s not adopting ICT, in fact quality of ICT Innovation in healthcare enterprise is at much more advanced level than banking. If one looks at areas such as Wireless sensors based BAN, Home monitoring and whole technology area around telemedicine etc. it will be evident that this industry is thriving with innovations. But when it comes to adoption in real life environment, apart from regulation and information security concerns, change management from provider’s & payer’s perspective becomes real inhibitors to adopt various advances in technology. Due to more personalized and consultative nature of this industry, conventional ways of doing things get more favor than newer technology and tools. Also innovation is happening in more fragmented way which is failing to deliver comprehensive value to customers.

Wait a minute! Things are not so gloomier either, there are pockets of areas wherein Healthcare industry is quickly adopting IT, like Electronic health records, Pay for Performance, Hospital Performance and Capacity management etc. Recent stimulus is also helping these institutions to accelerate IT adoption. This will improve communication and information flow, but to get the most out of the ICT, there is also need of adopting pervasive wireless technologies to make the above system more effective via enabling them anytime anywhere.

In a recent study conducted, physicians often neglected electronic messages alerting them of abnormal diagnostic imaging test results. Of the 1,196 alerts examined, 18 percent went unopened for two weeks, and nearly 8 percent were ignored for at least four weeks. Some of the patients that didn't get proper follow-up, eventually were diagnosed with cancer. In above scenario, by appropriate usage of anytime anywhere wireless technologies and automated workflows, the things could have improved drastically. We are already witnessing strong wireless adoption trends, wherein younger generation is quickly adopting newer technologies. Recent report project that by 2012, four in five physicians will carry a smart phone- a business critical tool. With this trend, technology will become integral part of physician workflow and Physician will able to carry out most of his/her professional activities via smart phones.

Indeed, wireless has arrived in healthcare and it’s just matter of time to become vital part of healthcare business processes. So healthcare organization need to put comprehensive wireless technology adoption plan as part of their strategic business road map.

Posted by Anant Kulkarni at 12:18 PM | Permalink | Comments (0) | TrackBacks (0)