March 2007 — Volume 2, No. 3

Interactive Link

Interactive Link – Outsourcing in Healthcare

The “Interactive Link” survey is back with a new survey on outsourcing in healthcare.  The Digital Office is interested in readers’ opinions, so take a moment now to respond 

Tess Settergren, Director at SMDC Health System in Duluth, Minn. responded to the February survey will receive the Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid, edited by Steve Arnold, MD, MS, CPE.

Respondents to the March survey will be eligible to win another new book from HIMSS, Improving Quality and Reducing Cost with Electronic Health Records: Case Studies from the Nicholas E. Davies Awards, introduction by Patricia Wise, RN, MSN, MA, FHIMSS.

Now - read on to find out the results of the February survey on Pay for Performance.

1. Would incentives from a pay for performance/quality program change your time frame for adoption of health information technology? 

• Yes/62 percent
• No/38 percent

2. What is the appropriate incentive to encourage you to participate in a pay for performance, pay for quality program? 

• $1000/yr/MD – 0 percent
• $5000/yr/MD – 19 percent
• $10,000/yr/MD - 52 percent
• $20,000/yr/MD – 19 percent
• Other: per year/per MD – 10 percent

3. If you were rewarded, would you provide quality metrics as part of your participation?   

• Yes = 95 percent
• No = 5 percent

   
4. If "Yes" to question #3, which of the following entities would you be willing to share metrics with:   

• Centers for Medicare & Medicaid Services (CMS) = 28 percent
• Private payer = 15 percent
• Aggregate regional reporting = 15 percent
• All of the Above = 75 percent

^ back to top

A Look at Ambulatory Sessions and Events at HIMSS07

HIMSS07 welcomed 24,150 attendees and 885 exhibitors…with more than 300 education sessions from Feb. 25-March 1.  Recipients of the 2006 Davies Awards of Excellence spoke at several of those sessions, including the ambulatory care honorees that appear in the pictures that follow. 

For anyone wanting to learn more about implementing the electronic medical record, these events provided both information and an in-person opportunity to hear from some of those individuals who successfully traversed this transition.

Visit www.himss.org/davies for more information on the Davies Awards of Excellence.

Laura Jantos, chair of the Ambulatory Health Information Systems Committee, welcomes members to the Ambulatory Reception at HIMSS07

It’s a group shot of Ambulatory Care Davies Award recipients and Committee members who attended HIMSS07. This photo was taken at the Davies Reception on Monday evening, Feb. 25.  Back row (from left to right): Susan Beasley; Alice Loveys, MD; Nancy Babbitt, who is now the current chair of the Davies Ambulatory Award Committee.  Front row (from left to right): Michael Spain, MD; Nancy Nelson; William McClatchey, MD

Michael Spain, MD, who is with with 2006 Ambulatory Care Davies Award recipient Cardiology of Tulsa, spoke at one of the education sessions at HIMSS07. 

William McClatchey, MD, worked with Dr. Nicholas E. Davies, the namesake of the HIMSS Davies Awards of Excellence.  Dr. McClatchey is with Piedmont Physicians Group (PPG 775) in Atlanta, Ga. This practice received the 2006 Ambulatory Care Davies Award.

Listening to a question from one of the session attendees is David Griffin, MD, of Alpenglow Medical, PLLC, Fort Collins, Colo. The practice is a 2006 Ambulatory Care Davies Award recipient.

^ back to top

It’s Not About the Technology

Chuck Parker
VP, Chief Technology Officer / DOQ-IT
Masspro, Waltham, Mass.

In many cases, we have found that the barriers to success are related to lack of understanding of, or attention to, processes that should be completed before the ‘implementation’ of the EHR system…In other words, it’s not really about the technology.

There are many possible answers to this challenge, but we believe it has a lot to do with two factors:

• embracing change
• doing the hard work up front

In our experience, working with hundreds of practices that have implemented EHRs, those who are willing to change how they practice when incorporating an EHR into their world are the most successful. 

Additionally, these are the same practices that are:

• willing to do the hard work up front
• spending time defining goals for the project
• involving everyone in the process
• communicating early and often
• doing the necessary work ahead of the technology

First, let’s address change

I would ask you to consider this…successfully implementing an EHR and achieving your goals for this project is NOT about the software.

There are many excellent EHRs that you can choose from, and they often have the same features and functions.

CCHIT currently identifies 58 products that have met the requirements for 2006 certification.  Although their screens may look different, they accomplish generally the same things. 

There will be differences that fit your office…but…you need to understand what it is you want to change before you can effectively decide.

A successful implementation is about:

• embracing change
• saying, “I know I’m going to have to make some significant changes in my practice, and I know my staff has to be willing to do this too.”
• examining your current workflows to understand how paper and patients move through your practice, and then…
• considering how to accomplish this work differently using an EHR

These steps represent a crucial component of embracing change when transitioning to technology in a medical practice.  When practices are not willing to really change how they practice in the office, EHR implementations often fail. It’s not easy because the EHR is still fairly new to many physicians and because CHANGE IS HARD. 

This is the roadmap that we use with practices we are working with to implement EHRs. The roadmap starts on the left with the Assessment phase of the project.  The next phase is Planning, which incorporates Culture Change, Vendor Selection and Organizational Redesign as part of the process. 

If a practice does an effective job with this part of the roadmap, it is positioned well for a successful Implementation phase. In my experience, having been involved with EHR implementations for the last 6-8 years, I can honestly say that the overall success of these projects and the full benefits realized, are directly related to managing the elements before the implementation of any technology. 

^ back to top

What’s Next in Healthcare Business Process Outsourcing

Healthcare reform in the United States has reached a point of inflection. Affordable, high-quality healthcare is no longer simply a social goal. It has become an economic imperative, for businesses and governments alike. Today, 16 percent of US Gross Domestic Product (GDP) is spent on healthcare, but the World Health Organization still ranks America as 37th in the overall performance of its healthcare system.

Such expense can be attributed to:

• administrative costs
• maintenance of multiple legacy systems
• government regulations, such as HIPAA

Other statistics related to healthcare expense in the US include:

• Almost 40 percent of US hospitals lose money because for every dollar spent, 21 cents goes to administration and 11 cents to fraud due to overstating of expenses, according to estimates by the American Hospital Association.
• Average margins for medical insurance companies total about 2 percent.
• In 2002, state-owned Medicare had $20 million in liability expenses.

As a result of this financial environment in the US, healthcare BPO has grown in offshore locations - especially India. The opportunity: $4.5 billion by 2008 offering employment to about 200,000 people according to NASSCOM report. Currently, there are administrative functions worth $350 billion and billing/coding tasks worth $50 billion that can be sent to sites off shore.

Health insurance companies and providers have been able to achieve a competitive edge, operational excellence, and significant cost savings through offshore outsourcing.

The healthcare outsourcing market can be divided into four major blocks:

1. Providers (hospitals and physician groups) outsourcing tasks such as medical coding, billing, and account receivables follow-up. Technical tasks include software development and data conversion to HIPAA-compliant format, e.g., companies in Bangalore, Gurgaon, and Hyderabad providing software development and data conversion services.
   
   
2. Payers (health insurance companies and third-party administrators) outsourcing tasks such as claim form processing, membership application processing, claim re-pricing, and claim adjudication.
   
   
3. Drug manufacturers outsourcing clinical research processes.
   
   
4. Life sciences and medical equipment firms: Several Indian companies are providing, in addition to the above, maintenance of electronic medical record services to healthcare service providers, health insurance companies, life sciences and medical equipment firm.

Outsourcing bundles technology, transformation skills and operating skills to achieve the following benefits:

• Accelerate innovation and business change
• Transfer and share risks
• Yield higher savings
• Deliver higher, sustained business

Savings can reach 20-50 percent compared with the cost of doing business on shore.  But it is important to choose the "right shore" for sourcing business operations.

Healthcare sourcing services can be delivered on-shore, which is most familiar to healthcare providers and payers, in the US.  However, a higher ROI can be achieved with out sacrificing quality and security both with near-shore and off -shore services. The ROI is achieved in a short time and, with the savings, customers generate significant funds for growth and innovation.

With a global convergence in healthcare, these options should be considered as a strategy to manage administrative process and cost.

Amit Srivastava
Senior Manager of Healthcare
Keane Worldzen
Gurgaon, India

^ back to top

ACHO Welcomes Health IT Leaders at HIMSS07

The Ambulatory Community Health Organization (ACHO) Task Force held its inaugural reception at HIMSS07 with most of the membership, which totals just over 90 individuals, attending.  The reception included noted health IT leaders.

Dr. Mark Leavitt, chair of the Certification Commission for Health Information Technology (CCHIT), was the featured speaker.

Dr. Robert Kolodner, Interim National Coordinator of the Office of Health Information Technology, stopped by as well in a surprise visit to the event.

Cheryl Austein Casnoff, associate administrator for health information technology, Health Resources and Services Administration (HRSA), indicated her support for the task force’s efforts. 

Michelle Proser, director of policy research, National Association of Community Health Centers, was introduced by Lyman Dennis, chair of the task force.  He indicated that the task force hopes to soon have an agreement between HIMSS and NACHC for addressing IT in community health centers.  

^ back to top

Be Part of Brave New World…HIMSS Virtual Conference

HIMSS has something so new…and so exciting, it’s like nothing you’ve ever experienced. The Annual HIMSS Conference & Exhibition ranks as one of the most-respected educational events and tradeshows in the healthcare IT industry.  And now, the conference has expanded to cyberspace.

HIMSS introduces the HIMSS Virtual Conference & Expo, an online conference and expo taking place online May 16-17. Just imagine … all the networking…all the education…and all the exhibits…all at your desktop.

 Basic registration is free and gives you access to keynote speakers, the virtual exhibit hall, and live interaction with vendors and other attendees.

^ back to top

Help Shape the HIMSS08 Conference

Do you want to speak at the 2008 Annual HIMSS Conference & Exhibition on Feb. 24-28, 2008, in Orlando, Fla.?

The 2008 Call for Proposals for HIMSS08 is open until May 11…This is your opportunity to make a mark on the HIMSS08. Share your expertise. Teach attendees something new. Become part of the largest healthcare IT-related conference and exhibition in the world.

If you have questions on how to submit a proposal for the 2008 Annual HIMSS Conference & Exhibition, contact Adam Bazer via email or call at 312.915.9257.

^ back to top

Important Links – New Books from HIMSS

Take a moment to click on the links to these new books from HIMSS. These titles cover various aspects of technology implementation in healthcare from strategy to statistics.

2007 Annual Report of the U.S. Hospital IT Market, an industry developed by HIMSS Analytics LLC and HIMSS

Beyond Return on Investment: Expanding the Value of Healthcare Information Technology, by Pam Arlotto, MBA, FHIMSS, Patricia C. Birch, MBA, Marla H. Crockett, RN, MBA, and Susan P. Irby, MSHS

Guide to Establishing a Regional Health Information Organization, written by the HIMSS RHIO Guidebook Task Force and edited by Christina Beach Thielst, FACHE, and LeRoy E. Jones

Medical Informatics: An Executive Primer, edited by Kenneth R. Ong, MD, MPH, FACP, FIDSA

Improving Quality and Reducing Cost with Electronic Health Records: Case Studies from the Nicholas E. Davies Awards, introduction by Patricia Wise, RN, MSN, MA, FHIMSS

Electronic Prescribing for the Medical Practice: Everything You Wanted to Know But Were Afraid to Ask, edited by Patricia L. Hale, MD, PhD, FACP

^ back to top

CCHIT Update

CCHIT Approves New 2007 Ambulatory Testing Criteria
Teleconference scheduled for April 5

The Certification Commission for Healthcare Information Technology (CCHITSM) unanimously approved new 2007 criteria for ambulatory (office-based) electronic health records (EHRs). The final criteria, test scripts, and associated documents are posted on the Commission's Web site, www.cchit.org, and a revised handbook and contract agreement will be posted shortly thereafter. These criteria will take effect May 1.

Among a number of new requirements this year, systems must be able to send prescriptions and refills to pharmacies electronically. In addition, vendors must demonstrate their product’s ability to electronically receive standards-based lab result messages. Included with the criteria is a roadmap forecasting additional requirements for 2008 and 2009.

"These latest materials show not only the concrete progress made during the past year, but also the path forward toward more complete interoperability of EHRs and health information networks in the years ahead," said Mark Leavitt, MD, PhD, chair, CCHIT.

A Town Call teleconference is scheduled for April 5, at 11 a.m. EDT to discuss the 2007 ambulatory criteria, test scripts and certification process. Details on how to participate in the teleconference will be posted to www.cchit.org.

CCHIT Announces Expansion of Certification Program
Commissioners reviewed public comments and approved a roadmap for expansion of EHR certification to additional populations, settings, and specialties. The first population-based requirements will address capabilities needed for safe, quality healthcare for children; the first new care setting addressed will be the emergency department; and the first professional specialty area examined will be cardiovascular medicine.

"After being asked to expand the scope of certification to address more specialized needs, we invited input from any and all stakeholders. The Commission reviewed this data and created a roadmap to prioritize the expansion by examining the potential benefits, readiness, and effort involved in each area," said Dr. Mark Leavitt. "The first of these efforts could begin as early as April of this year."

A roadmap of the expansion program appears on CCHIT’s Web site with more details on the expansion released following the April 16 Commission meeting.

CCHIT Seeks Inpatient EHR Products for Certification Pilot
CCHIT will be accepting applications for its inpatient electronic health records certification pilot through March 30. Preparation for pilot testing will begin in early April with testing to follow in late April and early May.

Participation in the CCHIT Inpatient EHR Certification pilot is open to any company that has an inpatient EHR product offering clinician electronic order writing (CPOE) and electronic medication administration (eMAR) functions. Companies that only offer eMAR are also invited to apply.

Interested parties may apply for participation in the pilot by downloading the Inpatient Pilot Application and returning the completed form via email by March 30.

Inpatient Public Comment Period Open
CCHIT has released the proposed final 2007 inpatient criteria, test scripts, and revised test strategy, opening a 3-week public comment period on the materials. Feedback gathered from these comments will be reviewed and considered before the pilot test, and will also be used for any needed refinement of the criteria and test scripts before final publication.
Please register to participate in the public comment period.

^ back to top

News Briefs

Using Information Technology to Improve Health Quality and Safety in Community Health Centers
Review a research agenda on implementation of health IT in community health centers in a paper by Neil Calman, MD, Kwame Kitson, MD, and Diane Hauser, MPA, all from the Institute for Urban Family Health in New York, NY.  In the link above, scroll down through the index of the sample copy of the new journal, Progress in Community Health Partnerships, to access their article.

Is Dr. Blogger telling too much? Read this recent article on medical bloggers and online medical diaries in the Detroit Free Press (online).

Apply Now For HIMSS Davies Awards of Excellence
View the Davies Award Application Process guidelines.

• Ambulatory Care Davies Award
  initiated in 2003
  13 practices recognized to date
  Applications due April 30

Contact David Collins for more information.

^ back to top

Terms and Definitions

Teleconsult/Telemedicine - Part of telehealth that is defined as a health professional in one location using electronic technologies for the diagnosis and/or treatment of a paitent in another location.

Telehealth - Using communication networks to provide health services including, but not limited to, direct care, health prevention, consulting, and home visits to patients in a geographical location different than the provider of these services.  Any delivery of health services to a client in a geographical location different than that of the provider.

Source:  HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 2006

^ back to top

Vendor Update

Improving Productivity and Quality with an EMR

Dr. Michael Hennigan

Decatur Internal Medicine Associates
Decatur, Ala.
Practice Partner Patient Records®

Decatur Internal Medicine Associates is a four-provider internal medicine group that serves the community’s high-risk cardiac and diabetic patients. When the decision was made to find a tool to better manage patient care and increase productivity, they selected Practice Partner Patient Records®.

To maximize productivity and ensure complete documentation, the templates embedded within the electronic medical record were standardized for past medical, family and social history during a patient’s initial work-up, which the physician could then review and expand as needed.

To avoid under coding services, the practice uses templates with built-in E&M coding guidance. These are flexible enough to handle patients presenting multiple problems and ensure that, when properly completed, the documentation supports the appropriate level of service. The practice also utilizes the system’s laboratory interface to incorporate lab information directly into the electronic record, providing easy access for patient discussions and allowing for trending of results.

During routine follow-up visits with diabetic patients, physicians use the EMR’s disease management features to automatically see such critical information as the last HgA1c, date and results of the last urine microalbumin test, last eye and foot exam, overdue preventative procedures, and the current medical history.

ROI
Since implementing the EMR, Decatur Internal Medicine Associates has realized:

• a per physician gain in productivity of 50 percent 
• annual revenues per physician increase from $550,000 to $800,000

Quality improvements included better disease management for patients with diabetes with:

• 90 percent of the practice’s diabetic patients with an HgA1c value below 7

A HgA1c mean for the practice is 6.4 for a diabetic population of 1,000 patients, while the state average is 9.

“I am convinced that the Practice Partner system has allowed us to maintain and improve quality, while increasing productivity,” said Dr. Michael Hennigan, internist and founder of Decatur Internal Medicine Associates.

^ back to top

Thinking About Implementing Health IT

EMRs Are Effective but Not Always Easy

Dr.  Lisa McTavish

    Dr. McTavish would advise anyone thinking about an EMR to:

• be process-oriented first in a paper world
• see how those processes can be incrementally improved using the EMR
• start with a clinical data repository
• get familiar viewing clinical information during the encounter. 
• consider all methods of documenting such as voice recognition, direct dictation to the EMR, and templates
• be prepared to using multiple methods for documenting

With two months of experience using the EMR, Dr. McTavish said that she would change her mind on wanting to be first in the rollout. Her feeling is that waiting for the systems to be even more intuitive, like a “Google” search, would also be an appealing option. From this physician’s perspective, an EMR is effective, but getting there can be tough.

Mark Zirkelbach
Chief Information Officer
Arnett HealthSystem
Digital Office Task Force member

^ back to top

Already Implemented Health IT

The Winnipeg Clinic in Winnipeg, Manitoba, owned and operated by 55 physicians, is one of the largest multi-specialty clinics in Canada and offers a wide range of diagnostic facilities and health related services to its patients. The physicians and staff at the Winnipeg Clinic were becoming increasingly frustrated and stressed by the clinic’s antiquated and inefficient paper medical records system, said Winnipeg family physician Dr. Felix Sikora.  “The return on investment from the transition to electronic charts will not only be monetary, but will include improved quality of care for patients and quality of life for physicians and staff,” added Dr. Sikora. The clinic has used a digital billing and scheduling system for more than 20 years and is now transitioning to the electronic medical record, using CHARTCARE for all systems.

^ back to top

National Health IT Week - Support for Technology Adoption

National Health IT Week - May 14-18, Washington, DC.

The week is a broad-based partnership effort enabling private industry and the public sector to strengthen health IT relations among associations, payers, provider groups, vendors, consumer organizations and research foundations. Working together, these groups will help foster widespread health information technology adoption and accelerate change in national healthcare.

The cornerstone event of National Health IT Week, HIMSS Advocacy Day, will be held Tuesday, May 15, at the Washington Court Hotel. The purpose of the day is to advance the best use of healthcare IT to improve the quality and affordability of healthcare.

Advocacy Day participants connect with federal and congressional healthcare policymakers in a half-day discussion on current issues before traveling to Capitol Hill to engage with members of Congress and their staff on the HIMSS Advocacy Agenda. The events are capped off with a Solutions Showcase and a joint National Health IT Week and HIMSS Advocacy Day Networking Reception on Capitol Hill where the Advocacy Award winner is announced.

Monday, May 14

• Advocacy & Public Policy Steering Committee
• HIMSS Chapter Advocacy Liaison Roundtable HIMSS Government Relations Roundtable

Tuesday, May 15-6th Annual ADVOCACY DAY

• Advocacy Day Kick-Off, Washington Court Hotel, Washington, D.C.
• Capitol Hill visits
• National Health IT Week Reception, Capital Hill Club, Washington, D.C.

Wednesday, May 16

• Virtual HIMSS Conference & Exhibition
• Press Conference:  Including the Women’s Caucus, Black Caucus and Hispanic Caucus

Thursday, May 17

• Virtual HIMSS Conference & Exhibition

Friday, May 18

• Friday Collaborative Group/SHIRE/HIMSS Educational Meeting for congressional staff on Capitol Hill

Visit the National Health IT Week 2007 Web site at www.healthitweek.org to register and for agenda features and updates

^ back to top

Connecting Communities – May 3 and May 10

^ back to top

^ back to top

^ back to top

The Digital Office is a monthly online newsletter published by the Healthcare Information and Management Systems Society (HIMSS).
Copyright© 2006 by the Healthcare Information and Management Systems Society.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission. Contact HIMSS Publications at 230 E. Ohio St., Suite 500, Chicago, IL 60611; 312-915-9237; jlofstrom@himss.org
HIMSS Healthcare Information Systems Initiative
Patricia Wise, RN, MSN, MA
Colonel, USA Ret'd
Vice President, Healthcare Information Systems, HIMSS
For information on the HIMSS Davies Awards or the Ambulatory Care Initiative
David Collins, MHA, CPHIMS, SHIMSS, CPHQ, CMOM
Manager, Davies Award Program, HIMSS
dcollins@himss.org/703.837.9817
For information on The Digital Office
Joyce Lofstrom, MS, APR
Manager, Corporate Communications, HIMSS
jlofstrom@himss.org/312.915.9237