Focused on the Bottom Line

Aug. 9, 2011
While the Health Information Technology for Economic and Clinical Health (HITECH) Act continues to drive interest in clinical systems - especially electronic medical records (EMRs) - both the HITECH Act and other developments are compelling a renewed interest in finding appropriate business-related solutions. Interest in patient accounting systems is growing as hospitals face the challenge of melding clinical and financial data, according to Mike Smith, general manager of financial and services research at Orem, Ut.-based KLAS. The top performing financial software venders can be found in the “2010 Top 20 Best in KLAS Awards: Software and Professional Services” report.
Mike Smith

While the Health Information Technology for Economic and Clinical Health (HITECH) Act continues to drive interest in clinical systems - especially electronic medical records (EMRs) - both the HITECH Act and other developments are compelling a renewed interest in finding appropriate business-related solutions. Interest in patient accounting systems is growing as hospitals face the challenge of melding clinical and financial data, according to Mike Smith, general manager of financial and services research at Orem, Ut.-based KLAS. The top performing financial software venders can be found in the “2010 Top 20 Best in KLAS Awards: Software and Professional Services” report.

Smith says many CIOs, who are implementing new EMR systems and want to have seamless integration between clinical and financial applications, are taking a close look at vendors such as MEDITECH, Epic Systems, or Cerner, who are providing integrated clinical and financial solutions. Other CIOs, who already have a modern EMR but need to replace their legacy patient accounting system while maintaining a best-of-breed environment, are considering next-generation revenue cycle solutions from vendors such as Siemens or McKesson.

Lorin Bird, KLAS's strategic research head, financial and services research, agrees, but adds that on the patient access side, the ability to integrate key operations such as eligibility and medical necessity verification, is a functionality now appearing in next-generation products by Siemens, Epic, and McKesson's new HERM product.

In its overall ranking of software vendors that have at least three separate products in three separate market categories, KLAS ranks Epic number one, while Siemens comes in at number 10.

Patient Accounting and Patient Management

As to overall software suite rankings, Epic is ranked number one, with Siemens Soarian in the third spot. Epic again scores well in the patient accounting and patient management category with its product, Epic Resolute Hospital Billing, getting the number one spot. MEDITECH C/S Patient Accounting/ADT has come in at number two after posting a 5 percent jump in its overall score from the previous year.

Lorin Bird

Bird says part of the reason behind this 5 percent jump was that MEDITECH has improved its relationship with clients, especially in the areas of contracting and customer service. Plus, he notes, the company has improved its “delivery of new technology.”

More Patient-Centric Environment

Paul Conocenti

In a way, the HITECH Act may also be helping to spark new interest in financial systems, says Bird. If, for example, a hospital is installing or upgrading its EMR, it might decide that now is the time to add a financial system from the same vendor.

But with changes in coding and Medicare reimbursements looming on the horizon, hospital CIOs are taking a hard look at their financial and accounting systems to see if they can meet the demands of a more patient-centric environment.

Paul Conocenti, senior vice president, vice dean and CIO of New York University Langone Medical Center, says that unless hospitals pursue an enterprise strategy, it will be difficult for them to assess the efficiency of their organization. “Revenue cycle systems and patient care are very closely related,” he notes. “And the ability to have good registration, scheduling, and billing ties all things together.”

But that's still not enough, he says. Another challenge is to be able to aggregate business-level data through a decision support system. As a result, “financial data becomes as important as clinical data,” he says.

KLAS ranks four decision-support products in its latest report. Allscripts Sunrise/EPSi Decision Support (Eclipsys) is ranked number one, while McKesson Horizon Performance Manager holds the second spot.

As for pure budgeting applications that can manage budgets and track variances, Allscripts Sunrise EPSi Budgeting (Eclipsys) comes in at number one, while Healthcare Insights takes the second spot.

For contract management software, which also can calculate expected reimbursement, KLAS ranks MedAssets Contract Manager as number one and McKesson Pathways Contract Manager as number two.

While the large, well-known vendors continue to dominate most categories, KLAS analysts admit they are surprised that a small, relatively unknown company has again topped the list in Business Intelligence/Reporting. Dimensional Insight Inc. has only about 40+ healthcare clients, but has created an inherently flexible product that can easily be interfaced with other systems, Bird says. He explains that The Diver Solution transforms all data into one virtual data warehouse-called a “sphere”-from which specific data can then be mined.

Practice Management (Over 100 Physicians)

The ability to mine data is becoming more and more important in the day-to-day operation of hospitals, says Sue Schade, vice president and CIO of Brigham and Women's Hospital in Boston, Mass.

Through data mining, CIOs can look at the drivers that affect the organization's bottom line, she says.

Dimensional Insight's product was ranked number one again this year. In last place was SAP Xi Data Analytics.

Enterprise Scheduling was a bit of a hot topic this year, since it allows patient information including that pertaining to insurance and Medicare coverage to be acquired at first contact. This category was one of two highest-performing market segments KLAS measured. In this category, Unibased Systems Architecture RMS captured first place. Coming in second was Epic Cadence. In last place was McKesson Pathways Healthcare Scheduling.

Sue Schade

Bird says Unibased Systems' product achieved the top ranking because it is has a robust suite of scheduling capabilities that, when bi-directionally interfaced to the hospital's enterprise master patient index, allows the scheduler toperform almost all patient access functions without leaving the system. Interestingly, when asked if they would buy these products again, 100 percent of Epic users said yes, while 89 percent of Unibased users said they would. In explaining this apparent disparity, Bird said it again goes back to systems integration and whether customers would, in the future, look to a single-vendor solution. “If the hospital had to start from scratch, some indicated that they would start with a truly integrated system instead of purchasing different scheduling and registration/billing solutions,” he said. He also said the best enterprise scheduling systems can handle any visit type for any department. “In general, enterprise scheduling vendors are supplying products that support the client's needs,” he notes. “Once in place, they kind of run themselves.”

Trend Towards a Core Vendor Strategy

Although there had been a tendency in the past for hospitals and physician practices to purchase best-of-breed systems, today the trend is toward a single-vendor strategy, says Bird. By purchasing both clinical and financial systems from the same vendor, the odds are greater that a true systems integration can be achieved and that a single database can be created. But CIOs need to do due diligence before making this kind of major investment, warns Conocenti. “Over the last five years, people have thought, ‘I can piece them together.’ But you can't be as agile with a best-of-breed platform,” he says. “Even if companies bought other companies, the products may still be separate.”

From the time a patient registers, until he or she is discharged, a treasure trove of data is generated. And while much of the emphasis is placed on clinical data, a change to the ICD-10 coding system and possible changes in Medicare reimbursements based on “meaningful use” and the adoption of an EMR are generating a lot more interest in revenue cycle systems, says KLAS's Smith.

Conocenti offers some advice to CIOs who may be pondering the purchase of a new financial system in light of these changes: “If they're in the process of doing meaningful use, see if the vendor has a viable revenue cycle system. Look at KLAS rankings, but make sure it's on the same platform.”

Schade agrees, adding, “You want the front and back ends to be seamless.”

In watching their bottom lines, especially during difficult economic times, CIOs are relying more on enterprise resource planning (ERP) solutions. Historically, ERP systems have not gotten as much attention as clinical systems. But according to Conocenti, the products of these vendors are often more developed because they are key to other industries which these vendors serve. However, to be efficient, ERP systems need to be integrated with other hospital systems, he says. “If you have an ERP system with payables, supply chain, etc., in different systems, it's more difficult to integrate data. And because each system is separate, it creates silos and organizations around each system.”

In its rankings in this category, KLAS gives McKesson Pathways Financial/Materials/HR Manager the top spot. Coming in at number two is Oracle PeopleSoft Enterprise. Lawson Healthcare Solutions Suite was ranked third. Dropping out of the rankings this year was MEDITECH C/S General Financials.

Bird says that while Oracle has a very robust functionality, McKesson got high marks in customer support and executive involvement. On the downside, though, is the fact that this is not a fully integrated system, he added.

Another area that is showing growing interest is application hosting, notes Smith. He explains that since health systems have to be up and running 24/7, some have chosen to use either the vendor or a third party to host and maintain their applications, thus freeing up staff to concentrate on other hospital functions. In this category, KLAS ranked Cerner number one, followed by Siemens.

Revenue cycle transformation was ranked as the highest-performing professional services market segment. Smith says that there are a number of high performing consulting firms in this space-such as Deloitte and Huron Consulting-that generally exceed expectations and enable the hospital to see a higher return.

Deloitte Consulting again received a number one ranking in this market segment.

Physician Practices Face Tough Challenges

Although historically, hospitals and integrated health systems generally leapt into the maelstrom of intensive information systems development, with all its complexities, physician practices are now facing many of the same challenges. Being compelled by federal mandates to adopt an EMR, medical practices must be able to integrate both clinical and financial data through the interfacing between their core EMR and their practice management solution.

For practices with over 100 physicians, KLAS ranked Epic's Resolute/Prelude/Cadence as number one. NextGen Healthcare's EPM was ranked second. For practices with 26 to 100 physicians, McKesson's Horizon Practice Plus came in first, while Athenahealth's athenaCollector took the second spot. Practices with six to 25 doctors preferred Greenway Medical's PrimeSuite Practice. In second place was Athenahealth's athenaCollector. For practices with two to five physicians, KLAS ranked e-MD's Bill at number one. Greenway Medical's PrimeSuite Practice came in second. And for practices with only one physician, Athenahealth's athenaCollector took the top spot, followed by Ingenix CareTracker PM.

Decision Support-Business

With so much at stake, deciding which financial systems to invest in takes careful thought and planning. “Look very carefully at your organization,” advises Schade. “Look at the vendor. How important is product development? And be cautious as to what strategy is going to work for your organization.” Adds Conocenti: “Strive for the closest you can come to a single-platform solution. If you don't have a good systems integration team, get one. You have to take accountability for the system you put in - whether it's from a vendor or you built it yourself.” Healthcare Informatics 2011 March;28(3):S8

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