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Are Client Server EHR Holding Back Healthcare?

Posted on December 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The number one topic of debate on this blog has definitely been Client Server EHR versus SaaS EHR. There are staunch parties on both sides of this aisle. No doubt both sides have a case to make and we’ll see both in healthcare for a long time to come. Although, I think that long term the SaaS EHR will win out.

As I was thinking about this recently, I realized that while client server EHR can do everything a SaaS EHR can do, it definitely makes a lot of things much harder to accomplish.

It’s much harder to create an API that connects to 2000 client server EHR installs.

It’s much harder to make 2000 client server EHR installs interoperable.

It’s much harder to evaluate data across 2000 client server EHR installs.

I’m sure I could keep going with this list, but you get the point. Even though something is possible, it doesn’t mean that they’re actually going to do it. In fact, if it’s hard to do, then it takes extreme pressure for them to do it.

All of this has me begging the question of whether client server installs are holding back the EHR industry. Up until now, many of the things I mention above haven’t been that important. Going forward I think that all three of the things I mention above are going to be very important.

The good thing is that I see many client server EHR moving to some kind of hosted EHR solution. That solves some of the problems mentioned above. At least if it’s a hosted EHR solution, they can control the environment and more easily implement things like API access and interoperability. That’s much harder in the client server world where if you have 2000 EHR installs, you have 2000 unique setups.

Of course, as soon as a large SaaS EHR has a massive breach, healthcare will go running after the client server EHR. The battle lines are drawn and each side knows each other very well. Although, I think the SaaS EHR have the high ground right now. We’ll see how that continues over time. Client server EHR have done an amazing job battling.

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking

Posted on December 17, 2014 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of  Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data.  One way to bridge this gap is through standardized role-based education.

Conclusion
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort.  Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT.  As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Top 10 Google Searches in 2014 – What Would Be Healthcare IT’s Top Searches?

Posted on December 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.

US Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
Flappy Bird
ALS Ice Bucket Challenge
ISIS
Ferguson
Frozen
Ukraine

Global Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
ALS Ice Bucket Challenge
Flappy Bird
Conchita Wurst
ISIS
Frozen
Sochi Olympics

Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:

ICD-10 Delay
EHR Penalties
Wearables
Meaningful Use Stage 2
Epic
Obamacare
FHIR
Cerner-Siemens
HIPAA Breaches
Patient Engagement

What do you think of the list? Would you order it differently? Are there terms you think should be on the list?

Last Day for Healthcare.gov Coverage by January 1st

Posted on December 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re like me and sometime gave your email to Healthcare.gov, then you’ve probably getting the daily reminders this past week about December 15th being the last day you can sign up on the Health Insurance Exchange if you want to get health insurance coverage starting January 1st. I wish they would have made the email system a little smarter and let us click a button that said “Already got my insurance this year.” Although, I appreciate that they’re just trying to make sure that everyone knows the timelines.

Based on the news coverage (or lack therof), it seems that Healthcare.gov has survived without any major issues this year. One thing that has annoyed me about the emails is they keep telling me how many people’s health insurance is getting subsidized on the exchanges. It seems that about 8 out of 10 people who get insurance from the exchange are getting a government subsidy.

I guess that means I’m in the 20%. Maybe their marketing is working great for those who can get the subsidy. However, it has the opposite impact on someone who does’t get the government subsidy. In fact, my insurance costs have nearly doubled since pre-Obamacare days.

Turns out, that because I wasn’t getting any government subsidies for my insurance, it was better for me to just go direct to the insurance company. That’s what I did and the process was super simple. In fact, I signed up for a plan that included ZDoggMD’s Turntable Health. I’m especially excited to do e-Visits and text message my doctor as needed. Plus, I’m going to have to see about tapping into the free yoga classes and demonstration kitchen. You can sure I’ll be writing more about this in the future.

I found this piece from HIStalk to be quite interesting:

A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.

Sorry if this post was a bit of a rambling rant. I just saw the deadline and needed to get it out of my system. I think the next 5 years we’re going to see a dramatic change in healthcare as we know it. As a blogger, that means I’ll have plenty to write about. As a patient, I have some cause for concern.

Firewall & Windows XP HIPAA Penalties

Posted on December 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Anchorage Community Mental Health Services, Inc, has just been assessed a $150,000 penalty for a HIPAA data breach. The title of the OCR bulletin for the HIPAA settlement is telling: “HIPAA Settlement Underscores the Vulnerability of Unpatched and Unsupported Software.” It seems that OCR wanted to communicate clearly that unpatched and unsupported software is a HIPAA violation.

If you’re a regular reader of EMR and HIPAA, then you might remember that we warned you that continued use of Windows XP would be a HIPAA violation since Windows stopped providing updates to it on April 8, 2014. Thankfully, it was one of our most read posts with ~35,000 people viewing it. However, I’m sure many others missed the post or didn’t listen. The above example is proof that using unsupported software will result in a HIPAA violation.

Mike Semel has a great post up about this ruling and he also points out that Microsoft Office 2003 and Microsft Exchange Server 2003 should also be on the list of unsupported software alongside Windows XP. He also noted that Windows Server 2003 will stop being supported on July 14, 2015.

Along with unsuppported and unpatched software, Mike Semel offers some great advice for Firewalls and HIPAA:

A firewall connects your network to the Internet and has features to prevent threats such as unauthorized network intrusions (hacking) and malware from breaching patient information. When you subscribe to an Internet service they often will provide a router to connect you to their service. These devices typically are not firewalls and do not have the security features and update subscriptions necessary to protect your network from sophisticated and ever-changing threats.

You won’t find the word ‘firewall’ anywhere in HIPAA, but the $ 150,000 Anchorage Community Mental Health Services HIPAA penalty and a $ 400,000 penalty at Idaho State University have referred to the lack of network firewall protection.

Anyone who has to protect health information should replace their routers with business-class firewalls that offer intrusion prevention and other security features. It is also wise to work with an IT vendor who can monitor your firewalls to ensure they continue to protect you against expensive and embarrassing data breaches.

Be sure to read Mike Semel’s full article for other great insights on this settlement and what it means.

As Mike aptly points out, many organizations don’t want to incur the cost of updating Windows XP or implementing a firewall. It turns out, it’s much cheaper to do these upgrades than to pay the HIPAA fines for non-compliance. Let alone the hit to your reputation.

“From the Heart” Documentary by Health Catalyst

Posted on December 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Health Catalyst recently showed a short healthcare documentary at their analytics conference. The documentary is called “From the Heart” and really does show some interesting work being done by a cardiologist in India and an organization in the Cayman Islands. The video is really well done and definitely provides some interesting perspectives on healthcare as we know it. You can watch the full video below.

Personally, I think it’s going to take some massive changes like some of the things they describe (ie. cheap, but high quality care) in order to change healthcare as we know it. I’m still chewing on the comment by the cardiologist about commoditizing healthcare. Many don’t even want to have that discussion. So, I’m really glad he’s raising it.

Finding the Ideal Practice Workflow

Posted on December 9, 2014 I Written By

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
We recently put together a whitepaper focused on what we consider the “Ideal Medical Practice Workflow.” After having worked with hundreds of medical practices we wanted a way to share our tried and true process for improving the efficiency and profitability of a medical practice. The whitepaper looks at 8 Key Steps to Maximize Reimbursement:

  1. The Effective Appointment Phone Call
  2. Thorough Eligibility Verification
  3. Patient Check-In/Out Process
  4. Pre-Physician Patient Engagement
  5. Do What You Do Best: See Patients!
  6. Consistent Claim Generation and Monthly Audit
  7. Monthly Cost Reduction Meeting
  8. Generate Clinical Reminders

The full whitepaper dives into each of these in detail, but as part of this series I wanted to take a deeper look at the final two: the Monthly Cost Reduction Meeting and Generating Clinical Reminders.

Monthly Cost Reduction Meeting
It’s amazing how many organizations don’t sit down regularly to assess the performance of their clinic. This simple monthly meeting should include your office manager and key physicians in your practice. Meeting together regularly to analyze your practice’s performance will help you reduce costs and improve revenue. It creates accountability and a scheduled time for this type of analysis.

At this monthly meeting, you should take a look at the key performance reports for your practice and how they trend over time. Next, you should analyze ways in which you can improve the performance of your practice. One solution might be utilizing technology to improve a process. Another solution might be outsourcing a process to a back office or external team member. Each month you can then evaluate the reports on how these process improvements have impacted your clinic and continue to adjust accordingly.

Generating Clinical Reminders
Creating a system of clinical reminders is one of the best ways to improve the performance of your practice. Your clinical reminders should start by focusing on these two key areas: identifying required patient visits and identifying patients for horizontal growth. Identifying these patients was a difficult task in the paper world that has been made so much easier in our new EHR world. Clinical reminders to these patients is a great way to increase visits to your clinic by previous patients, but this extra outreach is also a way to get your previous patients to refer new patients to your office.

Once these patients are identified, you can send them a clinical reminder using one of the following methods:

  • Patient Portal
  • Email
  • Automated Calls/Live Representative Calls
  • SMS

In our current healthcare system, these clinical reminders are about driving more patient visits to your practice. However, as healthcare continues to move into the new world of Accountable Care Organizations (ACOs) and value based reimbursement, these clinical reminders are going to become even more important. Instead of messaging your patients about a visit, your clinical reminder team will be responsible for medication adherence and outside testing and referral compliance. Developing the clinical reminder skill now will pay big dividends going forward.

Any clinic who embraces the 8 Steps outlined in this whitepaper and implements a mix of technology and outsourcing will see a dramatic change in the performance of their practice. Plus, you will be well on your way to the Ideal Medical Practice Workflow.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. You can download the Ideal Medical Practice Workflow whitepaper from ClinicSpectrum for FREE.

Social Networks In Healthcare: Breaking Down Barriers To Change

Posted on December 4, 2014 I Written By

The following is a guest blog post by Ivo Nelson, Chairman of the Board of Next Wave Connect.
Ivo Nelson
As U.S. hospitals, professionals, and patients from coast to coast grapple with a daunting maize of healthcare challenges that’s growing more complex each day, it’s easy to forget that the solutions we need might just be sitting in someone else’s back yard.  And no matter who might own those great ideas, harvesting their value depends upon finding the best ways to share and make the most of them.

Both of these themes were at the heart of an exceptional two-day event I attended in Copenhagen recently, hosted by Healthcare DENMARK.  Called “The Ambassadors’ Summit,” each participant was invited to attend based upon his or her lifetime healthcare-industry contributions.  The Summit provided our group the opportunity to compare ideas and benchmark best practices with peers from around the world.  And while every national representative had something valuable to offer, some of the best thinking came directly from our hosts themselves.

Denmark has long stood out among nations for its health system, which is differentiated by its fundamental focus on the patient.  The Danish system functions by placing the patient in the center of its care-delivery circle.  Patients’ involvement in their own care is essential for the system to work.  And while few argue that patients should have a greater say in their own care, in Denmark they really do.

Because the Danes have made healthcare a true national – not political — priority, there’s a team mentality country-wide to support it – to improve it continuously over time.  It was this commitment that led Healthcare DENMARK to hold the Summit in the first place: they recognized that every country around the world has its own best practices to offer for consideration.  For example, Summit Ambassadors from Germany brought participants their expertise in international healthcare systems, managed care, integrated care, secure data transfer, and theoretic medicine, among others.  Colleagues from the United Kingdom shared insights from their roles in organizations like the World Health Care Congress and in subject areas such as healthcare analytics and health system financing, to name a few.

At the end of the Summit, we all agreed to return a year from now having advanced our own care systems by harnessing and developing the rich ideas we’d shared in just 48 hours.  Easily said, but what will prove the best means of connecting all the ideas in all those back yards?  The answer is social media used smartly – in a way that establishes closely defined social networks that engage communities interested in solving very specific problems.

As I left the Summit, I could already envision a new group of social communities that could invite the participation of the leaders who contributed so much to the Ambassadors Summit – effectively creating real-time conversations around the key issues that concerned each one of us.  For example, we could launch a new community with a “Danish voice” to advance our nation’s work to increase patient centricity.  Another smart social network could consider the construction of new hospitals and the consolidation of existing ones.  Other smart social healthcare communities could focus on medical homes, the roles of primary-care physicians, and the true connectivity of personal health records.

The possibilities are energizing because they are so clearly within our reach.  With the smart use of social platforms, global boundaries lose relevance, great meetings like the Ambassadors Summit never have to adjourn, and our power to drive a world of better care increases exponentially.

The Healthcare “Business” and Interoperability

Posted on December 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last month I started what I think is a really important conversation about interoperability. I asked the question, “Do Hospitals Want Interoperability?” Go ahead and read the article. We’ll be here when you get back.

In response to that article and that question, Thomas Lukasik offered the following commentary on a LinkedIn thread:

Imagine one car dealer asking another car dealer to send them all of the information that they have on a customer of theirs so that they can do a better job of selling them a car. Healthcare is a business just like a car dealership, and patients are their customers, so expecting healthcare providers to support a level of health information exchange (a/k/a Interoperability) that would enable another healthcare provider to take business away from them is naive to say the least. Competition is a reality for modern hospitals.. you’ve seen the billboards. They’re more comfortable with the old school business model. Interoperabilty is a double edged sword for them.

I think that most hospitals would agree with this view, but they’ll likely only share it behind closed doors. The hospitals understand the benefits to healthcare of sharing their data with each other, but as a business it doesn’t make sense. As I mention in the article, I’m hopeful that things like value based reimbursement and ACOs can help shift that model where it does make business sense for a hospital to share their data. In fact, I think we’re heading to a day where if you don’t share data you’ll be at a disadvantage.

While we’re heading in that direction, it’s hard to face the stark reality of what Thomas says. Healthcare is still a business and healthcare leaders salaries and bonuses are based on successfully running the business. If we want to have interoperability, we have to change the incentives so that they match that goal.

Five Commonly Overlooked ICD-10 IT Transition Strategies

Posted on December 1, 2014 I Written By

The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
Daniel M. Flanagan, Executive Consultant, Beacon Partners
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared.  About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.

ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today.  However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.

Below are five often overlooked transition planning steps:

  1. Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing.  We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
  1. Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces.  Extensive remediation is needed after the readiness assessment is completed in such cases.  Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
  1. Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions.  End-users can also be valuable in identifying potential solutions.  Involving end-users as early as possible in transition planning can avert wasted time.  For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
  1. Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin.  In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness.   A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
  1. Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR.  The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe.  The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly.  Define clear objectives and create a detailed plan to monitor progress for achieving each goal.  For example:
    • Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
    • IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
    • Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.

Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.

About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.