Healthcare

Observations from our Booth at HIMSS

Wed, 17 Mar 2010 10:18:40 +0000

Many of you will find it surprising that I am not putting together a status report but rather blogging about my observations from the Infosys booth at HIMSS. Well for starters the blogs are easier to write and are just my own opinions. This time the HIMSS was all about complex ideas about making healthcare simpler, cheaper and better. But looking at the X-ray machines which some of our co exhibitors were presenting and the cost of the same for so little additional benefit was kind of counter intuitive – in the name of connectivity and at the cost of adding a chip to the machine we are probably going to end up making the diagnostic process so complex that it would be hard to counter argue about the cost reduction and at the end of the day can even end blaming the machine or the user for a wrong decision. This I believe the providers are learning well from the Payers and the politicians!

Patient Centered Medical Homes: RHIO déjà vu

Thu, 25 Feb 2010 10:48:00 +0000

Regional Health Information Organizations (RHIOs) gained limelight in 2004 when President Bush called for Electronic Health Records for every American by 2014. The primary objective of RHIOs was to create an interoperability and information sharing infrastructure so that 360 degree view or complete medical history of patient’s health records can be made available for healthcare decision making. The desired outcomes were improved quality of care, prevention of clinical errors, elimination of redundant tests or care, prevention of adverse reactions, better care coordination and reduction in healthcare costs. The concept of Patient Centered Medical Homes (PCMHs), also called Medical Homes, goes back to its introduction by the American Academy of Pediatrics in 1967. However this primary care model has gained popularity over last one year as President Obama rolled out healthcare reforms. Patient Centered Medical Home is a care model where primary care physician is responsible for complete care coordination of the patient. Primary care physician collaborates with other physicians and care organizations based on the care needs of the patient and also educate the patient on self-health management. PCMHs share the same goals as RHIOs in terms of improved quality of care, better care coordination, better clinical outcomes and reduced healthcare costs.

Healthcare Reform and its impact on individual market

Thu, 25 Feb 2010 10:19:39 +0000

The debate on Healthcare reform is going on at full throttle in Washington DC as well as the rest of the country. No one knows where this is headed to or can confirm what the outcome will be. It looks more likely that we will see Healthcare exchanges will get setup. Most probably not at the national level, but instead at the state level.

Ever heard of getting caught between a rock and a hard place…

Wed, 24 Feb 2010 07:42:23 +0000

Well, that’s where the provider community finds itself right now. I have been talking to quite a few providers (large and small, specialized and generic) and eventually I have formulated an opinion (You will never find me short of opinions). The hypothesis goes such…

ICD 10 – Crosswalk Strategies

Tue, 16 Feb 2010 04:14:57 +0000

ICD-10 codes are ten times as granular as their predecessors. This opens up whole new opportunities to improve patient safety, care delivery and streamline provider reimbursements – but all that is possible, if and only if I-10 codes are captured at the point of service (or the provider’s billing department). If the provider continues to capture I-9 codes and that’s what is going to be sent to the payer, then there’s a subtle chance that the benefits will be fully realized. But nonetheless that’s going to be the situation. Based on the market feedback, most providers will continue to capture, store and send I-9 codes for a long period post the compliance date. The transition period will be long, may be very long.

ICD 10 – uncertainty around provider reimbursement

Fri, 29 Jan 2010 04:51:40 +0000

CMS has used the opportunity brought in by the increased specificity of ICD-10 codes to increase the granularity of DRG codes. This will help CMS streamline Medicare payments. Since significant number of Medicare and commercial claims is paid based on DRG codes, the added granularity is bound to cause uncertainty around provider reimbursements. This uncertainty combined with the payment reductions under SGR (Sustainable Growth Rate) has the potential to significantly impact providers’ bottom-line. Payers are not immune to the impact either. It’s crucial that payers and providers simulate claim payments, compare the payouts between I9 and I10, and be better prepared for the change.

Patient enablement via technology

Mon, 25 Jan 2010 08:09:05 +0000

Physicians, nurses and case managers spend time with patients to educate them on self-health management; however, technology is increasingly playing an important role in enabling patients lead a better quality of life. Two key dimensions of patient enablement are:
• Access to care at the right level and the right time
• Access to information that helps them manage their health
Technology is addressing both the dimensions of patient enablement. E-Consultation is enabled via internet, IP TV, kiosks and mobile devices which gives patients anytime, anywhere access to care for certain conditions that do not require physician office visit. E-Consultation can happen in synchronous mode over video/web chat or in an asynchronous mode over email. Some payors are reimbursing for eConsultation making this form of care a viable option for their members.

Interoperability Trends within the Healthcare Provider Sector

Thu, 21 Jan 2010 08:45:36 +0000

To begin diving deeper into interoperability within healthcare, let’s talk about interoperability within the healthcare provider sector. The healthcare provider industry is suffering from, what a colleague has very eloquently described as, ‘extreme heterogeneity’ of IT systems even within a single provider.

“The Complete Electronic Medical Record” - What will “Complete Integration” require from a Service Provider?

Mon, 04 Jan 2010 06:51:19 +0000

Observation

As we enter the next decade, it is interesting to reflect on where the leading healthcare provider and payer organizations were in 2000 and what has been accomplished to solve the evasive dilemma of creating a truly integrated Electronic Medical Record (EMR) that can provide a complete picture of an individual’s health available on demand.

Can informed and enabled patients contribute to better outcomes?

Tue, 29 Dec 2009 09:48:31 +0000

Yes, I believe so. Earlier patients were not well informed about their conditions, disease progression, medications, their side effects and the onus was entirely on the physicians to extract necessary information from patient and care-givers for treatment related decision-making. Extracting clinically significant information was a challenge in with language/cultural barriers coming into play or a patient who is inarticulate or unobservant about relevant signs and symptoms. With information explosion in the wake of internet wave, now a large number of patients visit physicians with prior research on their signs and symptoms as well as treatment options.

Interoperability requirements will underpin key health industry and health consumer trends

Tue, 29 Dec 2009 09:19:52 +0000

As the global healthcare industry grapples with tremendous challenges on both cost and quality fronts; the healthcare consumer is simultaneously undergoing an equally dramatic change in behavior, attitude and awareness. This new-age healthcare consumer will soon demand a significantly more active role in managing his/her own health needs as well as filtering and monitoring the relevant services that would be provided by the health industry.

ICD 10 – processing adjusted claims

Mon, 28 Dec 2009 12:08:42 +0000

The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims.

5010 – Are you really ready? – Part 2

Tue, 22 Dec 2009 07:52:05 +0000

Few weeks ago, in one of my blogs, I had attempted to set some basic tenets for the tactical option (downgrade-store-and-forward) for complying with the 5010 mandate. They primarily covered,
• A dynamic rules based bidirectional converter
• A comprehensive store-and-forward mechanism for storing and retrieving reduced data
• A clear performance management strategy to manage data reduction (for down conversion) and data addition (for up conversion)
• A robust API to provide access to reduced data for the downstream applications, and
• A comprehensive test bed and associated test strategy
I promised in that blog that I would not ignore the strategic approach (remediating downstream applications to make full use of the mandate) and would tackle that in a future blog. So here we are. Lets see what are the basic tenets for the strategic approach.

The Law of Supply and Demand - "Healthcare Rationing for our Future”

Mon, 14 Dec 2009 12:37:30 +0000

Supply and demand is perhaps one of the most fundamental concepts of economics and it is the backbone of a market economy. Demand refers to how much (quantity) of a product or service is desired by buyers. The quantity demanded is the amount of a product people are willing to buy at a certain price; the relationship between price and quantity demanded is known as the demand relationship. Supply represents how much the market can offer. The quantity supplied refers to the amount of a certain good producers are willing to supply when receiving a certain price. The correlation between price and how much of a good or service is supplied to the market is known as the supply relationship. Price, therefore, is a reflection of supply and demand, according to Investopedia.com, a Forbes company.

HIPAA 5010 transition – building a case for automation

Fri, 20 Nov 2009 07:25:06 +0000

Bad news first… HIPAA 5010 has nearly 1,000 unique changes. Some of these changes (like expansion of patient last name alone) could have thousands of impact points across your applications and databases. Overall, the number of impact points could easily run into a couple hundred thousand for an organization of average size. The direct and indirect impact of these 1,000 changes on the IT systems needs to be analyzed as the first step in the 5010 transition journey.