REPOST: Health IT's Future: 9 Issues To Watch

Technology is playing a great role in stepping up the services offered by healthcare providers, including patient care. This InformationWeek.com article enumerates nine technologies that could bring significant changes in healthcare delivery in the next couple of years:

Expect the pace of innovation to pick up as healthcare providers increasingly leverage IT to improve patient care, make competitive gains, and save costs.

They've forged a strong foundation, but technologists and health professionals have more to do to fulfill the vision of a cost-effective, consumer-oriented, patient-engaged industry.

"Future systems will support clinicians and patients as they work together toward wellness," said Joe Frassica, chief medical informatics officer and chief technology officer/vice president for Philips Patient Care and Monitoring Solutions at Philips Healthcare. "These systems will provide increasingly personalized and real-time insights and advice for clinicians and patients and will come to be trusted partners in the care of patients."

Healthcare organizations cannot afford to wait, executives said. Laggards will suffer, unable to catch up to the ever-increasing pace of innovation.

"We are going to see the most significant changes in healthcare in the next five years that will be greater than what we've seen in the previous 50," Todd Pierce, senior vice president of healthcare and life sciences at Salesforce.com, told InformationWeek.

Let's take a look at some areas where health IT will undergo dramatic advances in the coming years.

1. Mobile health apps
Though Apple's Watch, slated for delivery in 2015, has the spotlight for now, experts expect a slew of other Internet of Things devices to attract interest from patients, clinicians, and insurers.

Image Source: informationweek.com

Apps will simplify how consumers and clinicians track diet, sleep, and exercise, as part of the initiative to promote wellness rather than responding to illness. "Consumers will play a larger role in understanding and managing their health, with the help of apps that will become easier and easier to use," said Markus Fromherz, chief innovation officer for healthcare at Xerox. "The key will be personalization based on real-time behavior observation, not just traditional population health analytics."

2. Data
Healthcare organizations will face mounting pressure to grant clinicians access to analytics tools and big data while being asked to protect patient data. Government or industry mandates could strictly rule whether and how nonhealth and health information are merged as privacy advocates become more vocal about the blurring privacy lines.

3. Security
Instead of focusing primarily on compliance, security will shift toward risk management as healthcare organizations' security infrastructures -- technological, personnel, and management -- mature.

4. Back office
Providers will turn CIOs loose on internal operations, seeking new productivity and cost gains via IoT, cloud, automation, and other technological tools. The goal will be standardization, said Brent Lang, president and CEO of Vocera. "The old saying 'When you have seen one hospital, you have seen one hospital' has to change, and we must move to a model of reliable, predictable, and repeatable results."

5. Telehealth
Expect many of the bureaucratic holdups to disappear as the entire healthcare ecosystem -- consumers, payers, and providers -- recognizes the many benefits telehealth delivers. Widespread access to low-cost cellular or high-speed Internet connections give most patients a way to connect with specialists and allow hospitals to save costs and improve patient outcomes, generating more rapid development of these programs around the nation.

6. Treatment
Technologies such as 3D printing, analytics, artificial intelligence, and machine-to-machine learning will propel advances in medicine, executives said. "Imagine a day when disease outbreaks can be thwarted before they have a chance to spread; when IT-enabled tools are available that assist clinicians in making more informed life-saving decisions; when healthcare becomes truly personal and predictive by harnessing the power of a person's genome," said Erik Giesa, senior vice president of marketing and business development at ExtraHop Networks. "IT will play a key role in all these exciting advances, and I, for one, am very excited to watch their development."

7. Interoperability
Today the interoperability conversation focuses on electronic health records. Future conversations will expand to incorporate the gamut of applications and devices used across healthcare systems to ensure they can capture and share all patients' data, no matter where consumers are treated. "I see interoperability across all kinds of technologies as a priority for 2015," said Terry Edwards, founder, president, and CEO of PerfectServe. "This is not something that will happen with the snap of a finger, but I predict more and more healthcare organizations and vendors will strive toward interoperability of solutions and data, helping move the industry toward more effective and efficient models of managing patient care across entire populations."

8. Value, not fees
In their continued shift to value-based pay, providers must add technologies that empower population health and patient engagement, and meet the evolving government mandates such as increasing levels of Meaningful Use, ICD-10, and HIPAA. They might, for example, invest in tools that reduce wait times, automate checkins, improve communications, and analyze high-risk populations. "To manage their revenue cycle, providers will need to manage patient outcomes, clinical quality, and cost/utilization -- and they'll need to manage them all together," Doug Fielding, vice president of product strategy at ZirMed, told InformationWeek. "Value-based care will be the new reality. The transition will be slower than some folks would like or that some experts are predicting."

9. IT departments
IT is likely to partner with specialists such as cloud service providers and HIPAA compiance firms, allowing internal staff to focus on how to integrate technologies into each workflow and department, or how to monetize certain services such as app development or imaging. This environment "is making health IT workers learn more about the clinical side of healthcare operations, instead of just a provider of what I call raw technology services," said Bob Zemke, director of healthcare solutions at Extreme Networks.

Healthcare operations executives like David Wildebrandt welcome any technological advancements that will step up the delivery of medical services to patients and at the same time cut down expenses and boost savings. Follow this Twitter account for the latest in the healthcare industry.

REPOST: New challenge for HealthCare.gov: Tax forms

The Health and Human Services Department has introduced a new tax form, which aims to list all U.S. household members with health coverage and are receiving subsidies from the government on their insurance premiums. According to FOX News, this new project is challenging because any glitches could mean delayed tax refunds for many Americans.

Image Source: foxnews.com

The federal agency that had trouble launching a health insurance website last fall has a massive new project. Any glitches on this one could delay tax refunds for many Americans.

Because of complicated connections between the new health care law and income taxes, the Department of Health and Human Services must send out millions of new tax forms next year. They're like W-2s for people getting health insurance tax credits under President Barack Obama's law.

The forms are called 1095-As, and list who in each household has health coverage, and how much the government paid each month to subsidize those insurance premiums. Nearly 5 million people have gotten subsidies through HealthCare.gov.

If the forms are delayed past their Jan. 31 deadline, some people may have to wait to file tax returns -- and collect their refunds.

A delay of a week or two may not sound like much, but many people depend on their tax refunds to plug holes in family finances.

The uncertainty is unnerving to some tax preparation companies, which try to run their filing season operations like a military drill. The Obama administration says it's on task, but won't provide much detail.

States operating their own health insurance marketplaces will also have to send out the new forms, even if they had website problems. But the biggest job belongs to the federal exchange serving 36 states. HHS will have to manage that while in the midst of running the 2015 health insurance sign-up season, when millions more are expected to try to get coverage.

"It's very unrealistic to expect that they would be able to implement a process that distributed these forms in the middle of open enrollment, and on time," said George Brandes, vice president for health care programs at Jackson Hewitt Tax Service.

The average tax refund is about $2,690, and people who count on getting money back often file early.

Liberty Tax Service vice president Chuck Lovelace said his company is giving the feds the benefit of the doubt but the possibility of delays "is not something we can turn a blind eye to."

"It could have a dramatic impact on our customers," Lovelace said. "The tax refund is the largest check many consumers get."

Administration spokesman Aaron Albright said officials are "working to develop the technical processes to ensure the forms are generated accurately and timely." Part of the plan will include "robust outreach" to educate consumers about the importance of the forms, so 1095-As don't accidentally wind up in the recycling bin.

Some states running their own exchanges are providing more details about their plans.

California says it will include a cover letter with each form to help consumers understand what they need to do. The state is looking at using email blasts, public events and other educational efforts.

"We do not foresee any problems in meeting our responsibility," said James Scullary, a spokesman for the state marketplace.

The new health care law offers tax credits to help people without workplace coverage buy private health insurance. Next year is when the connections between the law's coverage expansion and the tax system will start to surface for consumers.

The nearly 7 million people who got insurance tax credits through federal and state exchanges will have to tally up accounts with the Internal Revenue Service to ensure that they got the amount they were legally entitled to.

Funneling subsidies through the income-tax system was once seen as a political plus for Obama and the law's supporters. It allowed the White House to claim that the Affordable Care Act is "the largest tax cut for health care in American history." But it also promises to make an already complicated tax system more difficult for many consumers.

Supporters of the law are also concerned about a related issue: People who got too big a subsidy for health care in 2014 will have to pay it back next year. And docking refunds will be the first way the IRS seeks repayment.

That can happen if someone's income for 2014 ends up being higher than they estimated when they first applied for health insurance. Unless they promptly reported the change to their health insurance marketplace, they will owe money.

"If someone wound up having more overtime than they projected, or they received a bonus for good work, these are the kind of changes that have an impact on subsidies," said Ron Pollack, executive director of the advocacy group Families USA. "My impression is that the overwhelming majority of people are unaware these kinds of changes require them to notify the exchange."

Since the whole system is brand new, experts are predicting that millions will end up having to repay money.

David Wildebrant is the director at Berkeley Research Group, a leading global consulting firm that provides strategic advice and data analytics to government agencies. Follow this Twitter account for the latest healthcare news.

REPOST: Poor planning and oversight led to HealthCare.gov flaws, GAO finds

Americans could have trouble buying coverage in the federal health insurance marketplace this fall because of poor planning and lax oversight of outside contractors by federal health officials. The Washington Post has the full report below.

A consumer waits by a laptop as she tries to sign her father-in-law up for health insurance. (Jeff Roberson/AP) | Image Source: washingtonpost.com

Federal health officials were responsible for the problem-pocked start of HealthCare.gov last year because of poor planning and lax oversight of outside contractors, according to government investigators who warned that “significant risks remain” that some Americans could again have trouble buying coverage in the federal health insurance marketplace this fall.

Such management failures are the central conclusion of the first report issued by the Government Accountability Office as part of a wide-ranging appraisal of the reasons the computer system was not ready when the marketplace opened in October.

The initial slice of the GAO’s work focuses on the main contractors the government hired to build HealthCare.gov, the Web site for the federal insurance exchange created under the Affordable Care Act. In particular, the report examines the shepherding of the contractors by the Centers for Medicare and Medicaid Services (CMS), the branch of the Department of Health and Human Services responsible for developing the marketplace.

Building “a first-of-its-kind marketplace” was certain to be a complex undertaking, the investigators conclude in the report, made public on Wednesday. But agency officials aggravated the situation by allowing too little time for the work; changing the directions it gave the main contractor, CGI Federal; and not scrutinizing the contractor’s progress, the investigators found.

The results, the GAO says, were “significant cost increases, schedule slips” and delays. Between September 2011 and February of this year, the cost for building the marketplace ballooned from $56 million to $209 million. Building HealthCare.gov, the report said, had cost $840 million as of earlier this year, the GAO found.

David Wildebrandt is a healthcare operations expert who guides healthcare organizations through today’s financial landscape. Follow this blog for more discussions on the healthcare industry.

REPOST: The Strategy That Will Fix Health Care

How can the healthcare sector achieve the best outcomes at the lowest cost? Find out in the article below.

Image Source: disabilityscoop.com

In health care, the days of business as usual are over. Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. Health care leaders and policy makers have tried countless incremental fixes—attacking fraud, reducing errors, enforcing practice guidelines, making patients better “consumers,” implementing electronic medical records—but none have had much impact.


It’s time for a fundamentally new strategy.


At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. And we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care.


Making this transformation is not a single step but an overarching strategy. We call it the “value agenda.” It will require restructuring how health care delivery is organized, measured, and reimbursed. In 2006, Michael Porter and Elizabeth Teisberg introduced the value agenda in their book Redefining Health Care. Since then, through our research and the work of thousands of health care leaders and academic researchers around the world, the tools to implement the agenda have been developed, and their deployment by providers and other organizations is rapidly spreading.

Image Source: telegraph.co.uk

The transformation to value-based health care is well under way. Some organizations are still at the stage of pilots and initiatives in individual practice areas. Other organizations, such as the Cleveland Clinic and Germany’s Schön Klinik, have undertaken large-scale changes involving multiple components of the value agenda. The result has been striking improvements in outcomes and efficiency, and growth in market share.


There is no longer any doubt about how to increase the value of care. The question is, which organizations will lead the way and how quickly can others follow? The challenge of becoming a value-based organization should not be underestimated, given the entrenched interests and practices of many decades. This transformation must come from within. Only physicians and provider organizations can put in place the set of interdependent steps needed to improve value, because ultimately value is determined by how medicine is practiced. Yet every other stakeholder in the health care system has a role to play. Patients, health plans, employers, and suppliers can hasten the transformation—and all will benefit greatly from doing so.

Image Source: azbilingual.com

Defining the Goal


The first step in solving any problem is to define the proper goal. Efforts to reform health care have been hobbled by lack of clarity about the goal, or even by the pursuit of the wrong goal. Narrow goals such as improving access to care, containing costs, and boosting profits have been a distraction. Access to poor care is not the objective, nor is reducing cost at the expense of quality. Increasing profits is today misaligned with the interests of patients, because profits depend on increasing the volume of services, not delivering good results.


In health care, the overarching goal for providers, as well as for every other stakeholder, must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes. Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both. Failure to improve value means, well, failure.

David Wildebrandt of Berkeley Research Group assists healthcare organizations in developing long-term solutions that will help them enhance their operations and improve value for patients. Learn more about his work on this Facebook page.

REPOST: Healthcare Must Prioritize Operational Analytics

Brian Denton of InformationWeek discusses the ways that health systems CIOs can take full advantage of the wealth of data available to them.

Health system CIOs can access a wealth of data on the use of precious resources, from clinicians to MRI machines. Here are specific steps to start using that data better.

For healthcare CIOs, trying to make operational improvements through better data analysis should be paramount. Optimizing use of expensive resources, improving access for patients, and cutting wait times and red tape are high on the agenda of any hospital executive committee.

There is no shortage of examples of ways to make operational improvements. For example, some health systems have streamlined scheduling to shorten the time it takes for a patient to get in to see a specialist, or for diagnostic procedures such as an MRI or CT scan. Some have collected data on patient no-shows, which are often as high as 20%, to develop ways to overbook and stem the loss of revenues and wasted resources that no-shows can cause.

Others have reorganized the design of their health system to move services such as outpatient surgery into ambulatory surgery centers that can operate efficiently and effectively at lower cost and with increased patient safety.

Many of these projects would not have been easy even five or ten years ago. Now, data collection and analysis techniques have advanced to the point where providers can rapidly implement operational improvement projects, measuring things such as how long it takes from booking an appointment to getting in to see a provider, or the time and steps it takes to get an MRI. However, many health systems are surprisingly still behind the curve in this area of using data to improve operational performance.

Image source: informationweek.com

A lack of data analysis expertise is one reason for this lag, but it doesn't have to be an insurmountable obstacle, even for smaller institutions. What shocks me most after seeing so many successful operational improvements is how many health systems in the United States still do not have the expertise they need. They are missing a major competitive edge. Data is available inside these organizations. But unless they use a scientific approach to turn that data into information and subsequent action, it can mean lower revenue, or even worse, lower quality of care.

So what are the steps that healthcare institutions can take to begin to harness the power of advanced analytics and operations research professionals? Here are a few progressive steps designed to make the move to operational excellence.

Build a center excellence: For large health systems, it is important to build an internal center of excellence charged with measuring performance, identifying best practices, and implementing operational improvement projects. Developing a talent pipeline is a critical activity that takes time and effort, but which holds the opportunity for major improvements to the efficiency and effectiveness of care.

For examples, one can look to some bellwether centers of excellence for this: Mayo Clinic, Duke University, University of North Carolina, and University of Michigan (yes, my very own institution). I've collaborated with all of these institutions.

Partner with universities: For smaller health systems that can't build their own centers of excellence can partner with local, reputable academic organizations to secure student teams and get faculty involved. Student projects are lower cost, yet still quite effective because the student base is at the cusp of moving into the workforce. Student teams get an equal benefit by gaining cutting edge experience, which positions them well for their leap into the workforce. Often the institutions that reach out for assistance from universities end up identifying good students to bring onto their staffs when they graduate.

Partner with nonprofits: Another option is to turn to nonprofit trade organizations, such as INFORMS (the Institute for Operations Research and Management Science), a group I am heavily involved with. Knowledge sharing and peer collaboration is a valuable force in identifying best practices and opening doors to talent. Such groups can also be a source of educational offerings to develop the necessary expertise internally within an organization.

CIOs are increasingly tasked with increasing or at least maintaining revenues associated with high value resources, since that is a crucial component of running any institution. Developing expert professionals in analytics and operations research who are capable of taking on these challenges will require time, effort, and an initial investment. But as other industries have shown, this can have a substantial long term pay off in the form of higher revenues and lower costs, while at the same time improving the quality of care that patients receive.

And there's a new wave of operational understanding coming, where we will predict what may happen months into the future. Imagine getting a glimpse into what impacts proposed system changes will have on your operations: foreseeing the revenue and cost impacts of buying a new MRI, or of hiring additional nurses. This knowledge will help healthcare systems make more informed decisions about which actions to take.

It’s time for health systems to step up and put the same care into the health of their internal operations, as they do for their patients. There are underutilized ways that all health institutions can gain access to analytics brains and brawn, starting with a few ideas suggested in this piece. As an industry, we can bring our analytical minds together. Let's improve the ways that we deliver healthcare by taking advantage of new types of data, making new scientific discoveries in the realm of operational excellence, and leveraging the talent that turns that translates data into better care.

Healthcare operations experts like David Wildebrandt encourage healthcare managers to embrace and make the most of new developments. Follow this Twitter page for more updates on healthcare operations updates and more.