Forecast 2010: Hospitals

Jan. 8, 2010

The Future of Consulting

By Rob Merkel, IBM Global Business Services

Consulting services for the healthcare industry are in the midst of tremendous change. While cost and quality issues continue to drive the need for transformation across the industry, advances in technology and government stimulus will accelerate the rate at which it is implemented. In particular, three trends will shape the future of services.

First, technology advances are providing a foundation for capturing, sharing and analyzing information. As the industry becomes more interconnected and instrumented, a proliferation of both structured and unstructured data will be captured and shared to significantly improve care delivery and individual health.

Real-time instrumentation is pumping out new volumes of data from medical devices, chips, sensors and RFID tags. Innovations in data management, analytics and decision support will rapidly emerge across the industry to turn these mountains of data into intelligence.

Tomorrow's healthcare consulting leaders will require deep expertise in analytics, data privacy and security to provide meaningful insight into this wealth of information. Future leaders will need to leverage best practices across the industry, to provide these innovations rapidly and cost effectively.

Secondly, cost pressures will clearly remain a top priority of just about every healthcare organization. Traditional cost-improvement programs will not provide the necessary results. Fundamentally new business models will be required to streamline operations and eliminate waste.

Finally, collaboration will increase dramatically in healthcare. Team-based care will require better collaboration across all stakeholders, including care delivery, government and commercial payers, retail and individuals. Professional services to support this model will expand beyond traditional services to those that improve connectivity and insight across the healthcare ecosystem. Tomorrow's leaders will identify and capture value across traditional industry segments, as well as new entrants into the healthcare ecosystem.

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Era of the E-patient

by Peter Kuhn, CEO, MEDSEEK

Healthcare providers will spend most of 2010 aggressively selecting and implementing IT solutions that demonstrate meaningful use. While the economy continues to rebound, unemployment rates will turn around slowly, which means healthcare organizations will continue to compete for a smaller percentage of well-insured patients. Not only will they find themselves competing with the hospital down the street, but they will also have to contend with new cost-savings measures being deployed by payers.

Some payers have piloted presurgical intervention programs in which their representatives directly contact members prior to scheduled procedures. Early results indicate that up to 16 percent of members will change their minds when presented with alternative treatment modalities. In addition, the soaring costs of healthcare are leading some who can afford treatment to pursue it elsewhere. An increasing trend toward global medical tourism poses a growing threat to hospitals' bottom lines.

While early healthcare reform debates primarily concern payment, the long-term focus is likely to be centered on care delivery. The driving force behind this is a shift in the paradigm of patient thinking. Through the expansion of broadband Internet, the spread of wireless devices, the adoption of self-service technologies in other industries, the viral effect of social media, and simply through generational shifts, the era of the e-patient has been ushered in.

Demographic surveys show that those defined as e-patients are comfortable using technology, better educated, cost conscious and more demanding of quality. They are seeking an efficient and direct approach to healthcare services. In response, healthcare organizations will turn to tools such as customer-relationship management software, a computerized methodology that helps healthcare providers identify their prospective patients, differentiate them by needs, interact with them in a mutually beneficial manner and customize their relationship with them.

Because meaningful use requires that organizations engage patients and families, secure patient portals will be aggressively implemented and integrated tightly with back-end systems, particularly electronic health records and financial systems. Healthcare IT will begin to connect e-patients with their physicians to create a more collaborative relationship and provide access to health tools and support at home that are equivalent to those they utilize in other contexts of their lives.

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The Year of HIM

By Jim Klein, senior VP and CTO, QuadraMed

Until now, health information-management (HIM) solutions have been like quiet, competent, neighborhood music teachers, toiling anonymously in hospitals across the nation. In 2010, HIM solutions will begin a metamorphosis into rock stars, demanding equal billing with clinical and financial systems.

Senior management will realize that HIM solutions and professionals are more vital than ever to the success and financial viability of their organizations. The biggest catalysts will be the expansion of reforms tying reimbursement to the documentation of quality care and the federal government's emphasis on the electronic exchange of health information.

Other catalysts propelling HIM to center stage include the recovery auditor-contractor program and the ICD-10 code sets, scheduled to become effective on Jan. 1, 2010, and Oct. 1, 2013, respectively. Health reform, ARRA, HITECH and the federal push to create statewide health-information exchanges (HIEs) connected to the national health-information network (NHIN) will greatly expand the role of HIM departments.

Whether institutions earn a bonus or are paid less will be determined by how well they comply with complex regulations, monitor the documentation of care and report core measures. The HIM department will become the gatekeeper for a provider's participation in regional HIEs and the NHIN.

To help HIM meet the increased compliance, documentation, abstracting and other medical records requirements, providers will implement computer-assisted coding (CAC) solutions powered by medical ontologies, natural-language processing (NLP) and expert-systems technology. These CAC solutions identify medical concepts in clinical documents and assign ICD and CPT codes to them. The initial coding, instead of being performed by coders, will be done by CAC solutions. Coders will review, edit and validate the output of CAC for accuracy and completeness. This will be a radical change for HIM professionals, who weathered a similar transformational storm caused by speech-recognition technology.

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Patient-centric Care Advances

By Sanjaya Kumar, MD, president and CEO, Quantros

The results of a recent study show health-insurance premiums have increased 131 percent in the past 10 years. Meanwhile, the Congressional Budget Office concludes that $700 billion of the nation's annual healthcare spending does nothing to improve health outcomes. New data-integration trends are poised to reverse this imbalance in 2010 and beyond.

By connecting patients and providers more quickly and accurately than ever before, new technology solutions will reduce costs while improving patient safety and quality of care. To empower real quality improvements, healthcare data solutions should integrate all relevant systems — including reporting, surveillance and pharmacy — to allow the free exchange of information and insight, both within the organization and with other providers.

By expanding the amount of associated data available for comparison, healthcare organizations will gain a better understanding of where their performance excels and falters.

True interoperability will also result in higher-quality technology solutions in the marketplace. By making easing implementation of best-of-breed solutions from multiple vendors, interoperability will help providers improve performance in every department.

Fully integrated systems will connect tools, such as wireless glucose monitors, with providers' data-management systems to create an on-demand, data-driven diagnostic environment that puts the patient in greater control of his healthcare.

As data input and retrieval opportunities increase, so does the need for robust data automation and aggregation capabilities. These tools can maximize the accuracy and value of data throughout an organization. Data technology solutions will provide executives and other key stakeholders with the transparency necessary to track these areas on a daily basis.

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Standardization Will Be Key

By Michelle Troseth, chief professional practice officer, Elsevier

In the coming year, healthcare organizations will become more serious about standardization of clinical documentation, practice and technology. Healthcare organizations, through trial and error, are realizing they do not have the time and resources necessary to develop and maintain the clinical tools that meet the latest evidence. These organizations face diverse challenges that arise from meeting the growing number of quality metrics and standards, while caring for an increasingly aging population and patients with chronic conditions. Standardization is essential to ensuring quality care and avoiding the duplication, delay, omissions, variances and medical errors that still plague the entire system.

Organizations will increasingly rely on partners, vendors and consultants whose core competency is creating point-of-care clinical tools that standardize care. Increasingly, vendors will be able to offer solutions that are easy to implement and learn, usable, customizable and able to meet the needs of patients across the continuum of care.

Technology will be more important than ever before in helping to control costs and improve efficiencies, and a growing number of providers will insist that evidence-based information be integrated into the clinical work flow to support an integrated approach to care. This technology will increase the access to data necessary for predictive analytics, outcomes reporting, regulatory reporting and comparative-effectiveness research.

This marriage between technology and practice will have a direct effect on addressing preventable conditions, which will ultimately lead to a reduction in costs, while improving care and outcomes.

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HIEs To Transform

By James K. Lassetter, M.D., CEO, Medicity

In 2010, expect to see shifts in the approach to health information-exchange (HIE) governance and innovative developments in the way health-information exchange is architected. As hospitals monitor the evolving meaningful-use definition, many are proactively moving beyond the basics of electronic health-record (EHR) selection and are exploring their options for HIEs.

For 2010, expect to see growth in self-governed, hospital-based HIEs — sometimes called regional cooperatives or organic HIEs — as providers strive to achieve greater care coordination and quality, while containing costs.

Under the organic HIE model, hospitals and health systems collaborate directly using common HIE technology to connect hospitals, affiliated physician practices and ancillary service providers. These health systems effectively take a bottom-up approach to HIE implementation, liquefying data at the foundation for easy exchange. Deploying technology in an incremental fashion, stakeholders achieve rapid time-to-value for the HIE-user community, while enabling deployment of higher-level services, such as patient-identity resolution, either in parallel or after initial efforts are begun.

Also expect to see the cloud-computing architecture that underlies much HIE functionality progress to a next-generation model: client-cloud computing. This technology makes services running in the cloud available to client applications running locally, and vice versa. Client applications are installed in user locations — integrating to local systems, such as EHRs, in a physician practice — and meet customized work-flow needs, while ensuring that functionality persists, should access to cloud services become unavailable.

Clients leverage cloud services to perform broader HIE functions, such as posting data into a registry or evoking a vocabulary-standardization service to transform data from a local proprietary format to a standardized format. The client-cloud architecture thus complements local work-flow requirements, while effectively connecting providers to regional and national HIEs through cloud services.

This synergistic approach to information exchange that penetrates the point-of-care in such a customizable manner will promote HIE adoption and will also stimulate growth of dynamic-care teams that will realize a continuum of collaborative care for patients.

Lastly, client-cloud computing will stimulate the production of a new generation of composite healthcare IT applications that run on the client platform to perform specific work-flow or care functions that leverage both the data exchanged across the HIE and services in the cloud — and that can be selected, downloaded and deployed in minutes through an application store.

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More Data To Monitor

By David Mavashev, CEO, Nastel Technologies

One area that will continue to grow in 2010 for healthcare IT professionals is transactional monitoring. The inherent complexities of capturing, warehousing and transmitting data in a healthcare setting are many; grasping the full picture of a business can be undertaken with a business-transaction performance (BTP) strategy that leverages a complex event-processing engine.

Such a strategy can provide enough visibility and automated response options to ensure IT infrastructures are running smoothly at all times. If not, crucial patient data transmitted to pharmacies, doctors, insurance providers and others can be compromised, lost, delayed or reported incorrectly.

BTP methodology determines in real time the behavior of transactions it is observing, including activities that were not intended by its developers and lack of sufficient resources due to operational constraints. This means it is instantly able to compare what it has discovered, correlated and analyzed to the user description of business as normal; from this it is able to predict business problems before users are affected — enabling its practitioners to prevent problems rather than repair them.

BTP can be best enabled by including a complex event-processing engine that is able to process millions of rules per second in order to handle the loads of the largest, most-dynamic environments and find the patterns that correspond to business-normal or business-abnormal conditions.

For 2010, as electronic-records and revenue-cycle management software platforms ramp up, the need for an efficient transaction-monitoring strategy will correlate to the increasing volume of patient information available electronically. Without the right middleware, organizations will not have the visibility necessary to control processes in a way that accounts for glitches, error queues, broken applications and other normal accidents.

Another driving factor behind the growing need for better transaction management is the variety of uses for patient data. Some healthcare organizations are using more than one software platform to leverage electronic-data communication for insurance claims, pharmaceutical treatments, doctor-patient and doctor-doctor interaction.

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Video Use To Widen

By George H. Fleming, president and CEO, TeleHealth Services

Patients often do not retain verbal instructions and lose or do not understand written instructions. Busy nurses and physicians have only small windows of time to brief patients, with additional questions and demands cutting into time spent with other patients. In 2010, hospitals and providers will focus on ensuring that patients have the best information available, reducing patient angst and facility re-admission expenses.

The potential is great for increased access to hospital-approved educational videos this year. Patients will be able to access a hospital's network of educational videos before being admitted, during treatment at the facility and after discharge. Patients would no longer need to rely on materials from searching the Web — they could instead access the hospital's clinician-approved videos. Nurses also will use interactive education systems to facilitate discharge, assigning a patient to a discharge video while working with another patient simultaneously.

Facilities will also use videos to educate staff on important hospital procedures. Many interactive education systems allow users to designate channels for specific departments of a hospital, allowing each to run relevant patient information, such as welcome messages, gift shop and visiting hours. Some systems allow patients to order food and access the Internet through the systems. This can provide savings to a facility — allowing it to offer conditions-based menu items.

Hospitals will continue to recognize the importance of using technologies on the front lines of patient care and across the care continuum. Automating education benefits patients and practitioners alike — for patients, taking the guesswork out of searching for reliable information; and for providers, alleviating the stress sometimes associated with providing information or constantly answering calls for questions, resulting in more clinical time for actual patient care.

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