It’s our data that’s hurting us! – Transparency in a consumer-oriented healthcare marketplace

The Internet is really enabling the healthcare consumer to shop and compare like never before.  Why would there be a need to shop for the better hospital, doctor or nursing home? The need to shop for quality care has never been more important and the competition between hospitals and other healthcare providers is heating up.  The consumer wants the best surgeon to do their procedure, in the safest hospital and they are turning to healthcare rating sites in record numbers.  The irony of rating sites is that they are dependent on data that is provided by the hospitals, doctors and other allied providers – it is their very own data that they are being judged by.

Today, it is easy for the consumer to Google “compare doctors” or “compare hospitals” and locate numerous websites with detailed information for comparisons.  Two notable examples are leapfroggroup.com and ucomparehealthcare.com.  Leapfrog does not just rely on publicly reported data from regulatory agencies but extends the information with detailed surveys of hospitals on the key issues: central line infections and infection control, for example.  One comparison website reports that the Top 5% of its reporting hospitals have a 29% lower mortality rate.

No individual or healthcare organization wants an unfair report card.  With medical mistakes as a leading cause of death each year surpassing car accidents, breast cancer and AIDS, the report card also serves healthcare organizations as guidance on critical areas of improvement.  The process to collect regulatory reporting information in many healthcare organizations is tedious, time-consuming and often manual.  In the classic sense of “we have the data somewhere but not in the format that we need it.”  There are several key problems with collecting core measures and other key metrics for reporting:

  • Key data elements for the calculations are paper-based or manually compiled
  • Manual process fatigue from paper form processing
  •  Automated reporting systems use sample patient populations that are too small resulting in a possible statistical errors
  • Errors in the data transfer process, especially in the hand-off of information from one area of the hospital to another skew results
  • Inability to track a diagnosis code early enough in the patient encounter to improve on the measure outcomes
  • Lack of staff training on collecting the right information at the right time in the right format

Consumers use the reported results to compare hospital performance and make decisions about where to receive care.  As a result, healthcare organizations need to focus on data governance to address treating data as an asset, ensuring data quality and tracking the right key metrics.  Addressing this challenge will not only improve the ratings report card for healthcare organizations but will demonstrate the commitment to quality data as well as patient safety.  Better data equals better results.  In the consumer-oriented healthcare marketplace, transparency of key metrics will yield competitive advantage.

From Free Text Clinical Documentation to Data-rich Actionable Information

Hey healthcare providers! Yeah you the “little guy”, the rural community hospital; or you the “average Joe”, the few-hundred bed hub hospital with outpatient clinics, an ED, and some sub-paper-pilespecialties; or you the “behemoth”, the one with the health plan, physician group, outpatient, inpatient, and multi-discipline, multi-care setting institution. Is your EMR really just an electronic filing cabinet? Do nursing and physician notes, standard lab and imaging orders, registration and other critical documents just get scanned into a central system that can’t be referenced later on to meet your analytic needs? Don’t worry, you’re not alone…

Recently, I blogged about some of the advantages of Microsoft’s new Amalga platform; I want to emphasize a capability of Amalga Life Sciences that I hope finds its way into the range of healthcare provider organizations mentioned above, and quick! That is, the ability to create adoctor microscope standard ontology for displaying and navigating the unstructured information collected by providers across care settings and patient visits (see my response to a comment about Amalga Life Science utilization of UMLS for a model of standardized terminology). I don’t have to make this case to the huge group of clinicians already too familiar with this process in hospitals across the country; but the argument (and likely ROI) clearly needs to be articulated for those individuals responsible for transitioning from paper to digital records at the organizations who are dragging their feet (>90%). The question I have for these individuals is, “why is this taking so long? Why haven’t you been able to identify the clear cut benefits from moving from paper-laden manual processes to automated, digital interfaces and streamlined workflows?” These folks should ask the Corporate Executives at hospitals in New Orleans after Hurricane Katrina whether they had hoped to have this debate long before their entire patient population medical records’ drowned; just one reason why “all paper” is a strategy of the past.   

Let’s take one example most provider organizations can conceptualize: a pneumonia patient flow through the Emergency Department. There are numerous points throughout this process that could be considered “data collection points”. These, collectively and over time, paint a vivid picture of the patient experience from registration to triage to physical exam and diagnostic testing to possible admission or discharge. With this data you can do things like real or near-real time clinical alerting that would improve patient outcomes and compliance with regulations like CMS Core Measures; you can identify weak points or bottlenecks in the process to allocate additional resources; you can model best practices identified over time to improve clinical and operational efficiencies. Individually, though, with this data written on a piece of paper (and remember 1 piece of paper for registration, a separate piece for the “Core Measure Checklist”, another for the physician exam, another for the lab/X-ray report, etc.) and maybe scanned into a central system, this information tells you very little. You are also, then, at the mercy of the ability to actually read a physicians handwriting and analyze scanned documents of information vs. delineated data fields that can be trended over time, summarized, visualized, drilled down to, and so on.11-3 hc analytics

Vulnerabilities and Liabilities from Poor Documentation

Relying on poor documentation like illegible penmanship, incomplete charting and unapproved abbreviations burdens nurses and creates a huge liability. With all of the requirements and suggestions for the proper way to document, it’s no wonder why this area is so prone to errors. There are a variety of consequences from performing patient care based on “best guesses” when reading clinical documentation. Fortunately, improving documentation directly correlates with reduced medical errors. The value proposition for improved data collection and standardized terminology for that data makes sense operationally, financially, and clinically.   

So Let’s Get On With It, Shall We?

Advancing clinical care through the use of technology is seemingly one component of the larger healthcare debate in this country centered on “how do we improve the system?” Unfortunately, too many providers want to sprint before they can crawl. Moving off of paper helps you crawl first; it is a valuable, achievable goal across that the majority of organizations burdened with manual processes and their costs and if done properly, the ROI can be realized in a short amount of time with manageable effort. Having said this, the question quickly then becomes, “are we prepared to do what it takes to actually make the system improve?” Are you?

Web 2.0 for Healthcare Providers – Q and A Part 1

Thanks for all those who attended our webinar on implementing web 2.0 strategies last week. If you missed it, the recorded webinar is available on our site. Enjoy.

As I promised, here are some of the questions asked during the session that I have not had time to address:

Q1: Using Facebook and Twitter – how do I get started? How can we monitor it?

Getting started is ridiculously easy. Facebook has a good starter guide . Setting up Twitter is even simpler as there is not much to do other than selecting a name. You have only 15 characters so it is not always an easy task. Twitip has a good guide to best practices in twitting and a list of useful services to track and monitor twitter conversations.

Q2: Why would people want to follow a healthcare organization? How do I promote it without spending money? is it really worth the effort and Investment?

So setting up profiles and pages is easy. The hard part is getting people to follow you on a regular basis. The good news is that you just need to get users to act once and add you to their friends list or follow you on twitter. From that point forward you are just one in a stream of many others.
Spreading the word is done in every way possible, but not through direct advertising. Put it on your website, emails, blog and any other marketing communication form. The best promotion methods are viral. If you have something interesting to say, people will spread the word.

Social media communication tools are just one more way to reach an audience in a fragmented media world but health is something people really care about. If you are a regional hospital, publish daily information your community will want to know. Allergy report, flu alerts, flu vaccine reminders, etc. The cost is usually limited to a resource that will write and maintain all these social media properties. We’ll go into ROI in the next answer but first and foremost the benefit is relevancy. Hospitals that will engage and communicate will be relevant and top of mind. Others will be there when the appendix burst.

Q3: What type of investment is required? What is the ROI

We usually see 2 main areas of investment. The first is Strategy. With so many options, tools, opportunities and risks large organization usually do not just jump in but take some time to look at the landscape, their audience, their revenue centers and their media assets and capabilities to form a cohesive strategy. This is the main area we help clients in as they often lack internal expertise. We usually recommend forming a broader web strategy as these social activities are not isolated from the needs to have an attractive and interactive website than engages users and effective e-marketing programs. The strategy part also looks at the organizational ability to support these types of programs, the skills required and can help in building a cost and ROI structure. The cost of a comprehensive web strategy can range from five to low six figure depending on the size of the organization and scope.

The second area of investment is in the program operations. This usually translates to people who dedicate some of their time to writing content and managing user interactions. It can range from a few hours a week for a small program to a full time position.

The returns: like in any marketing program, these activities are judged by their ability to generate increase in profitable patients and donations. Since they provide a great way to reach an audience without a cost per unit (as you have in email, banners or paid search) the ROI increases as the size of your audience.

Mashable.com has a good overview for the qualitative and qualitative measurements for ROI. I think it goes back to relevancy and the need to be part of your audience daily life.

Illustration: Monica Parra / Newsweek

ICD-10: Apocalypse or Advantage?

mayan-calendarWith humanity coming up fast on 2012, the media is counting down to this mysterious — some even call it apocalyptic — date that ancient Mayan societies were anticipating thousands of years ago.  However, the really interesting date in healthcare will happen one year earlier. In 2011, per the mandate of Senate Bill 628, the United States will move from the ICD-9 coding system to ICD-10, a much more complex scheme of classifying diseases that reflects recent advances in disease detection and treatment via biomedical informatics, genetic research and international data-sharing. For healthcare payers and providers that have used the ICD-9 coding system for submitting and paying healthcare claims for the last 30 years, it could be apocalyptic without proper planning and execution.  Conservative estimates of the cost of switching to ICD-10 are 1.5 to 3 billion dollars to the healthcare industry as a whole and nearly $70,000 for each doctor’s practice.

Since 1900, regulators of the U.S. health care system have endeavored to give care providers a systematic way to classify diseases so that care processes could be standardized and appropriate payments made. Like many of the world’s developed health care systems, the United States follows the World Health Organization’s (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD) code standard that is typically used internationally to classify morbidity and mortality data for vital health statistics tracking and in the U.S. for health insurance claim reimbursement. In 2011, technically, healthcare providers and payers will be moving from ICD-9-CM to ICD-10-CM and ICD-10-PCS.  To meet this federal mandate, it will be essential that information systems used by U.S. health plans, physicians and hospitals, ambulatory providers and allied health professionals also become ICD-10 compliant. The scale of this effort for healthcare IT professionals could rival the Y2K problem and needs immediate planning.

The challenge is that the U.S. adoption of ICD-10 will undoubtedly require a major overhaul of the nation’s medical coding system because the current ICD-9 codes are deeply imbedded as part of the coding, reporting and reimbursement analysis performed today. In everyday terms, the ICD-9 codes were placed in the middle of a room and healthcare IT systems were built around them. It will require a massive wave of system reviews, new medical coding or extensive updates to existing software, and changes to many system interfaces. Because of the complex structure of ICD-10 codes, implementing and testing the changes in Electronic Medical Records (EMRs), billing systems, reporting packages, decision and analytical systems will require more effort than simply testing data fields – it will involve installing new code sets, training coders, re-mapping interfaces and recreating reports/extracts used by all constituents who access diagnosis codes. In short, ICD-10 implementation has the potential to be so invasive that it could touch nearly all operational systems and procedures of the core payer administration process and the provider revenue cycle.

A small percentage of healthcare organizations, maybe 10 to 15 percent, will use ICD-10 compliance as a way to gain competitive advantage – to further their market agendas, business models and clinical capabilities. By making use of the new code set, these innovators will seek to derive strategic value from the remediation effort instead of procrastinating or trying to avoid the costs. An example will be healthcare plans that seek to manage costs at a more granular level and implement pay for performance programs for their healthcare providers. In addition, ICD-10 offers an opportunity to develop new business partnerships, create new care procedures, and change their business models to grow overall revenue streams. Healthcare organizations looking for these new business opportunities will employ ICD-10 as a marketing differentiator to create a more competitive market position.

There are three key areas for healthcare organizations wanting to convert regulatory compliance into strategic advantage with ICD-10 remediation:

  1. Information and Data Opportunities – Healthcare entities that are early adopters of ICD-10 will be in a position to partner with their peers and constituents to improve data capture, cleansing and analytics. This could lead to the development of advanced analytical capabilities such as physician score cards, insightful drug and pharmaceutical research, and improved disease and medical management support programs, all of which create competitive advantage.
  2. Personal Health Records Opportunities – Using ICD-10 codes, innovative healthcare entities will have access to information at a level of detail never before available, making regional and personal health records (PHRs) more achievable for the provider and member communities. Organizations that align themselves appropriately can provide a service that will differentiate them in the marketplace.
  3. Clinical Documentation Excellence Program – Developing and implementing a Clinical Documentation Excellence (CDE) program is a critical component of organizational preparedness to respond to future regulatory changes because there could be an ICD-11 on the horizon.

Healthcare organizations need to understand the financial impact that ICD-10 will have on their bottom line and begin the operational readiness assessments, gap analyses and process improvement plans to facilitate accurate and appropriate reimbursement. Without action, a healthcare organization can expect to endure “data fog” as the industry moves through the transition from one code set to another. Now is the time to choose to gain the advantage or procrastinate on the coming code apocalypse.