Industry Watch – September 2015

Memory advance is 1,000 times faster than flash

A new, longer-lasting memory architecture created by Intel and Micron Technology claims to be up to 1,000 times faster than flash and is 10 times denser than conventional memory. The developers are hailing the innovation as the first new memory category since the introduction of NAND flash in 1989.

The 3D XPoint (pronounced “cross point”) transistor-less technology can turn immense amounts of data into valuable information in nanoseconds. Its secret power is a 3D layered-wire structure that allows much more data to be stored close to the processor, providing access speeds previously impossible for non-volatile storage, which doesn’t “forget” information when a device is turned off. It is also not significantly impacted by the number of write cycles it can endure, which makes it more durable.

Intel says the architecture “creates a three-dimensional checkerboard where memory cells sit at the intersection of word lines and bit lines, allowing the cells to be addressed individually.” Perpendicular conductors connect 128 billion densely packed memory cells, with each memory cell storing a single bit of data. Using this method, data can be written and read in small sizes and not large blocks, which flash memory requires. This leads to faster and more efficient read/write processes that could turbocharge PCs, data centers, and more.

For healthcare, 3D XPoint technology could be used to identify fraud detection patterns in financial transactions more quickly, or researchers could process and analyze larger data sets in real time, which could accelerate complex tasks such as genetic analysis and disease tracking.

KLAS midterm report gives voice to provider opinions

Want to know what thousands of healthcare providers at physician offices, clinics, hospitals, and integrated delivery networks (IDNs) in North America think about the healthcare software they’ve been using? KLAS Research’s “2015 Midterm Performance Review: Software & Services” report has the answers. The report, released July 30, provides feedback on healthcare technology software vendors in 93 market segments.

The software products that have demonstrated the greatest score improvements for user performance since the “2014 Best in KLAS: Software and Services” report published in January of this year are:

• McKesson Practice Partner: +15 percent
• Recondo Technology Patient Access: +15 percent
• OnShift (Long-Term Care Only): +11 percent
• Allscripts Sunrise Emergency Care: +10 percent
• CureMD EMR: +10 percent

The executive summary available online also highlights the services section of the report, which provides a summary of the KLAS performance ratings gathered over the past 12 months (18 months for select services) for healthcare IT services firms in 21 market segments. Biggest gainers in this area are:

• Navin, Haffty & Associates Clinical Implementation Principal: +12 percent
• Allscripts Application Hosting (CIS/ERP/HIS): +11 percent
• Dell Services Clinical Implementation Principal: +10 percent
• Velocity Application Hosting (CIS/ERP/HIS): +9 percent

The full report also includes a listing of significant changes to the software market segment and a ranking of KLAS software and services reports that have the highest download rates, which KLAS considers to be an indicator of where provider and industry interest are most concentrated.

To access the “2015 Midterm Performance Review: Software & Services” report page, go to www.klasresearch.com/Research/Reports/?Productid=1079.

ICD-10

With the deadline here, what can providers do now?

Jayne Warwick, RN, HBScN, AWCN, Segment Marketing Manager, Skilled Nursing, PointClickCare, gives her top six recommendations to providers now that the Oct. 1 deadline for implementing the ICD-10 code set has arrived and no new delays are in sight.

1. Identify current processes where ICD-9 codes are required and determine how data in those processes will be converted.
2. Make sure there are no contractual changes required with payers related to the implementation of ICD-10.
3. Identify changes to existing workflows to ensure clinical documentation captures the required information to correctly determine the highest level of specificity.
4. Identify staff training needs. Who needs to be trained, for what purpose, and by when.
5. Determine how long it will take to convert. Studies suggest that it will take 15 percent longer on average to code. Some specialties, orthopedics, for example, may see even more time needed to code due to sheer volume of related codes.
6. Budget for training and implementation. Account for resources, such as additional coders, during the transition phase and coding books to support accurate coding.

Commentary

A ray of hope from Washington? Don’t rush Meaningful Use

By Alan Portela, CEO, AirStrip

What a relief to see that Washington is finally taking much-needed action on Meaningful Use with U.S. Senator Lamar Alexander (R-TN) recommending the delay for Stage 3, because forcing Stage 3 at this time would drive the entire system to its knees.

We all agree that the industry must change. I am not criticizing the goals of Meaningful Use (Stage 1 – Data Aggregation and Access; Stage 2 – Healthcare Information Exchange and Care Coordination; Stage 3 – Outcomes Improvement). This bi-partisan initiative started when President George W. Bush appointed David Brailer as the National Health Information Technology Coordinator in 2004 and has continued under the Office of the National Coordinator for Health Information Technology (ONC).

Rather, I am extremely disappointed that we did not implement clear and aggressive guidelines on interoperability requirements, an essential step toward outcomes improvement, as part of Stage 1. Instead, the effort was directed to EHR implementation for data entry, which created silos around a few vendors. Provider consolidation that resulted from the Affordable Care Act (ACA) has exposed these interoperability failures.

If true interoperability is not established early, then the healthcare system cannot easily migrate to Stage 2. The only data available is now centered on the very limited standards of C-CDA, HL-7, and the Fast Healthcare Interoperability Resources (FHIR) – which should be called “SHIR” for “Slow Healthcare Interoperability Resources.” FHIR is promising, but decidedly limited.

With the movement to value-based reimbursement, many top vendors have developed tools for their customers to query the data without opening up any further. We first need to create a temporary layer that enables everyone to collaborate. Ultimately, vendors should provide an EHR application programming interface (API) with sufficient functionality to be considered “open.” While there are no established standards, the result should make all EHR data available to external systems, while also allowing external systems to input data back into the EHR.

True interoperability would grant access to all clinically relevant data supporting multiple clinical workflows throughout the care continuum to complete the care coordination loop, rather than limiting available data and write-back capabilities to parameters only supported under C-CDA, HL-7, and FHIR.

EHRs are often a large investment. Interoperability should strengthen the role of the EHR as the source of truth while granting health systems the ability to innovate around initiatives they choose (such as mobile technology and analytics) rather than being limited to EHR vendor-driven initiatives.

Rather than immediately addressing data access, the ONC issued a 10-year road map that brings the industry to where it needs to be toward the end. The push to Stage 3 (Outcomes Improvement) would force the ongoing move to a value-based reimbursement model without giving caregivers access to clinically relevant data to make informed decisions, again exposing the limited success of Stage 1.

Developments are now moving at “Washington speed,” driven by elections rather than the original Meaningful Use mission. Listening to providers and patients instead of vendors could be a win/win: By acting as champions for the providers and patients who know what works best, politicians will get the votes they need.

More than half of physician practices not ready

The Workgroup for Electronic Data Interchange (WEDI) published the latest results from its recurring series of ICD-10 preparedness surveys on Aug. 3, 2015. The key takeaway from the latest survey is that less than half of physician practices are ready or would be ready come the Oct. 1 deadline. Hospital and health systems are in much better shape, with almost 90 percent of this group saying they are ready for the deadline, and almost three-quarters saying they have started or completed testing. Comparatively, only about 20 percent of physician practices have started or completed external testing.

WEDI polled 621 respondents, consisting of 453 providers, 72 vendors, and 96 health plans. Other findings from the survey (the eleventh ICD-10 readiness survey the organization has conducted since 2009) include:

• Health plan testing and readiness: Nearly 75 percent of health plans have begun or completed external testing. Forty percent responded that they were already prepared, and the remaining 60 percent said they would be ready by Oct. 1.
• Vendor product development and availability: Seventy-five percent of vendor respondents have fully completed product development, and no one responded that their products would not be ready by the compliance date.

WEDI shared its results and recommendations in a letter to the Health and Human Services (HHS) Secretary. The suggestions included:

• HHS should expeditiously provide full transparency regarding the readiness of individual Medicaid agencies by state.
• The recently announced Ombudsman position should be appointed as soon as possible, and WEDI strongly urges CMS to not wait until the compliance deadline to complete this appointment.
• The go-live ICD-10 support plan should include leveraging WEDI’s and the Centers for Medicare & Medicaid Services’ (CMS) implementation support program, which already serves as the central source for collecting ICD-10 industry issues and solutions.
• Additional outreach is needed in order to help providers with complying with the most recent local coverage determination codes (LCDs).