Picis Exchange Global Customer Conference – “It’s All About the Data”

The Picis Exchange Global Customer Conference went off without a hitch last week in Miami. The main information sessions were categorized by the four areas of a hospital Picis specializes in: Anesthesia and Critical Care, Emergency Department, Perioperative Services, and Revenue Management Solutions (via its acquisition of LYNX Medical Systems). I was able to attend a number of sessions, network with both the company and its customers, and hear what the top priorities for this diverse group are over the next few years. As I reviewed my notes this weekend, thinking back to all the conversations I had with OR Directors, Quality Compliance Managers, Clinical Analysts, Billing and Coding Auditors, Anesthesiologists, and IS/IT Directors, one theme emerged – it’s all about the data!

The most frequent discussions centered around a few major challenges the healthcare industry, not just Picis clients, must deal with in the coming months and years. These challenges vary in complexity and impact on the 5 P’s [Patients, Providers, Physicians, Payers, and Pharmaceutical Manufacturers]. Picis customers and users, who collect, analyze, present and distribute data most efficiently and effectively related to the following challenges, position themselves as stable players in an increasingly turbulent industry:

  • Meaningful Use – “What data must I show to demonstrate I’m a meaningful user of Healthcare IT to realize the greatest number of financial incentives available? How can I get away from free-text narrative documentation and start collecting discrete data in anticipation of the newly announced HIMSS Analytics expanded criteria?
  • Quality & Regulatory Compliance – “How can I improve my quality metrics such as Core Measures and keep them consistently high over time? How can I reduce the amount of time it takes for me to report my data? How can I improve my data collection, analysis, and presentation to enable decision makers with actionable data?”
  • ICD-9 to ICD-10 Conversion – “What data and processes must I have in place to demonstrate use of ICD-10 before the looming deadline? Is my technical landscape integrated and robust enough to handle the dramatic increase in ICD-10 codes? Does my user community understand the implications of the changes associated with this conversion?”
  • Resource Productivity – “How can I reduce the amount of time my staff spends chasing paper, manually abstracting charts, and analyzing free-text narrative documentation? What percentage of these processes can I automate so my staff is focused on value-added tasks?”
  • Revenue Cycle Improvement & Cost Transparency – “How can I integrate my clinical, operational, and financial data sets to understand where my opportunities are for enhanced revenue? How can I standardize these as best practices? Can I cut costs by reducing inventory on hand and redundant vendor/supply contracts or by improving resource utilization and provider productivity? How will this impact patient volume? Am I prepared for healthcare reforms’ “call for transparency?”

All of these challenges, although unique, have fundamental components in common that must be established before any progress is made. Each instance requires that processes are established to standardize the collection of data to ensure accuracy and consistency so users can “trust the data”. A “single version of the truth” is essential; without this your hospital will continue to be pockets of siloed expertise lying in Excel spreadsheets and Access databases (best case), or paper charts and scanned documents (worst case) that are laboriously re-validated at every step in the information lifecycle.

Picis did a wonderful job of reinforcing its commitment to its customer base. It promised improved product features, more intuitive user interfaces, an enhanced user community for collaboration and idea sharing, and more opportunities for training. Fundamentally, Picis is a strong player in a market that seems ripe for consolidation and its potential for growth is very high. Yet, Picis will always be just that, a product company. The healthcare industry no doubt needs strong products such as Picis to drive critical operations, and collect the data necessary for improved decision making and transition from paper to automation. But Picis acknowledged, through its evolving collaboration with partners such as Edgewater Technology that understand both the technical landscape and clinical domain, that the true spark for change will come when the people and processes align with these products more effectively. This combination will be the foundation for a heightened level of care from an integrated data strategy that propagates a formula of superior patient outcomes from every dollar spent.

Tackling the Tough One: Master Data Management for the Healthcare Enterprise

One of the big struggles in healthcare is the difficulty of Master Data Management.  A typical regional hospital organization can have upwards of 200+ healthcare applications, multiple versions of systems and, of course, many, many “hidden” departmental applications.  In that situation, Master Data Management for the enterprise as a whole can seem like a daunting task.  Experience dictates that those who are successful in this effort start with one important weapon: data and application governance.

Data and application governance can often be compared to building police stations, but it is much more than that.  Governance in healthcare must begin with an understanding of data as an asset to the enterprise.  For example, developing an Enterprise Master Patient Index (EMPI) is creating a key asset for healthcare providers to verify the identity of a patient independent of how they enter the healthcare delivery system.  Patients are more than a surgical case, an outpatient visit or pharmacy visit.  Master data management in healthcare is the cornerstone of moving to treating patients across the entire continuum of care, independent of applications and location of care.  Bringing the ambulatory, acute care and home care settings into one view will provide assurance to patients that a healthcare organization is managing the entire enterprise.

Tracking healthcare providers and their credentials across multiple hospitals, clinics and offices is another master data management challenge.  While there are specialized applications for managing doctor’s credentials, there are not enterprise-level views that encompass all types of healthcare professionals in a large healthcare organization and their respective certifications.  In addition, this provider provisioning should be closely aligned with security and access to protected healthcare information.  A well designed governance program can supervise the creation of this key master data and the integration across the organization.

An enterprise view of Master Data provides a core foundation for exploiting an organizations data to its full potential and offers dividends beyond the required investment.  Healthcare organizations are facing many upcoming challenges with reference data as a part of master data management, especially as the mandated change from ICD-9 to ICD-10 codes approaches.   Hierarchies are the magic behind business analytics – the ability to define roll-up and drill-downs of information.  Core business concepts should be implemented as master data – how does the organization view itself?  The benefits of a carefully defined and well governed master data management program are many: Consistent reporting of trusted information, a common enterprise understanding of information, cost efficiencies of reliable data, improved decision making from trusted authoritative sources, and most importantly in healthcare, improved quality of care.

Data and application governance is the key to success with master data management.  Just like an inventory, key data elements, tables and reference data must be cataloged and carefully managed.  Master data must be guarded by three types of key people: a data owner, a data steward and a data guardian.  The data owner must take responsibility for the creation and maintenance of the key asset.  The data steward will be the subject matter expert that determines the quality of the master data and its appropriate application and security.  Finally, the data guardian is the information technology professional that oversees the database, the proper back-up and recovery of the data assets and manages the delivery of the information.  In all three roles, accountability is important and overseen by an enterprise information management (EIM) group that is composed of key data owners and executive IT management.

In summary, master data management provides the thread that ties all other data in the enterprise together.  It is worth the challenge to create, maintain and govern properly.  For success, pick the right people, understand the process and use a reliable technology.

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.