The Canadian House of Commons has passed emergency legislation to reopen the Ontario nuclear reactor that produces the majority of the world's supply of medical isotopes. The site was shut down for safety maintenance, and the bill required all party support to override the advice of the Canadian Nuclear Safety Commission and restart the 50-year-old reactor.
According to a study only 20 RHIOs in the United States are fully functional and a dozen are self-sustaining. The study questions many of the prevailing assumptions about how a nationwide health information network will emerge.
One of the objections to the implementation of speech recognition software in a radiology practice is that it generates more errors than traditional transcription methods, but new research disputes this claim. According to a scientific presentation at the 93rd scientific assembly and annual meeting of the Radiological Society of North America, transcribed reports show higher error rates than automated speech recognition applications.
Recently, the Physicians of Douglas County (DCIPA) in Roseburg, OR, implemented software designed to build a healthcare community network, dramatically improve patient safety and service, and raise the bar for great healthcare. The main goal of the initiative was connecting all of a patient's records so that healthcare professionals would have a thorough patient history at their fingertips.
In Douglas County, as in most communities, when a patient walks into a doctor's office and needs a diagnosis, the first thing a physician needs is information. For example: What medications is the patient taking? Has he been to the emergency room in the past? And has he received treatment for previous conditions at other healthcare providers?
The good news is this data is usually available. But the bad news is the data is usually scattered in dozens of computer systems at different healthcare organizations.
We felt compelled to resolve that challenge and help our physicians cope with the changing landscape of healthcare delivery. When we considered some of the industry drivers, such as EHR adoption, interoperability, quality improvement mechanisms, and pay-for-performance trends, it was clear that DCIPA members needed an integrated EHR and practice management system that functioned on a community-wide basis. And most importantly, the EHR system needed to gather data from many disparate data systems and put the right person's details into the right record.
We began developing a vision of how healthcare could be delivered to better serve the county's residents, while at the same time complying with the federal government's mandate for an electronic health record solution with interoperable systems.
Challenge: enterprise data sharing DCIPA includes nearly 98 percent of all healthcare providers in Oregon's Douglas County. These 145 physicians serve the health needs of roughly 105,000 citizens throughout the county. The goal was to integrate more than 60 individual practice management systems and other disparate health and clinical information sources across the single-chart electronic health record enterprise.
To accomplish this, DCIPA started building a regional health record network in which each of Douglas County's residents would have a single record that could be accessed, shared, and updated by all DCIPA physicians. DCIPA named this community-wide health information network "UmpquaOneChart."
When we started this project, our physicians were open to the idea but were very vocal about the need for data integration among practices. If they could not share information with other primary care doctors and specialists within the community, the value of a decentralized EHR would be greatly diminished. Physicians also wanted to be able to easily access and share information at the hospital and other service arenas to enhance the continuity of care in Douglas County.
DCIPA chose GE Centricity Physician Office Electronic Medical Record and Practice Management software for its enterprise-wide EHR. The next piece of the puzzle was to implement the concept of Enterprise Master Patient Index (EMPI). While this sounds complex, the concept is simple and well-designed. The EMPI indexes the places that data resides for any given individual. Then, those databases are queried using Service Oriented Architecture (SOA) to update the EHR patient history in real-time.
From the perspective of the healthcare professional, this approach gives a current and comprehensive picture of a patient: Did the emergency room prescribe medication for the patient last week? And what was the medication? This approach was clearly better than relying on patient memory or using batch data updates that can lag behind the times by hours or days.
Getting the index system right Making the system work meant finding the right solution for the EMPI. Our selection was based on the software being secure, reliable, and able to share accurate information across the DCIPA community. One of the most important things about UmpquaOneChart was being able to access the right information, on the right patient, at the right time at the point of care. We placed a lot of value on patient identification. In mid-2006, we selected Initiate Identity Hub software based on those criteria and, in large part, due to Initiate Systems' breadth of healthcare customer experience. Now that the Initiate Hub is deployed, we are integrating more than 80 disparate databases on more than 30 separate server subsystems to create a single, complete and accurate patient view for each person. The result has been enhanced patient safety and improved operational efficiency throughout the organization.
Regardless of where the patient receives care in the DCIPA community, the information is entered into the system. The Identity Hub uses high-level algorithms to validate the patient identity and deliver the information to the correct patient chart within the EHR. Patient identification is a step that, if you don't get it right, can cause a lot of problems downstream. The EMPI takes all of the data streams, identifies the patient associated with that information, and gets the information into the right medical record in real time.
We're getting a lot of value from the software because it enables us to manage disparate data sources. We take data sources that aren't necessarily like our own and manage them through the Hub.
Enabling technology for a single EMR The EMPI is an enabling technology for our system, and it makes EHR adoption much easier for our physicians. Now, when a patient is entered into the UmpquaOneChart, all of that information is available to any other physician or provider in our network.
To DCIPA physicians, the portability and on-demand access of patient information through a Web interface has also been a hit. For example, when a doctor goes on vacation, he or she is able to authorize prescription refills from their laptop regardless of their location. When it comes to sharing chart notes, viewing lab results, and more, we're truly realizing the vision of a connected medical community.
Brent Eichman is chief financial officer of DCIPA. He can be reached at beichman@dcipa.com.
Last week I reported on consumer mistrust of health organizations, a gap some are trying to bridge with Web portals. That gap may get bigger, if a recent study that crossed my desk has any merit. Now, the analysis may not have the sexiest title: "Automated billing/payment process can reduce U.S. health care costs without sacrificing patient care." Furthermore, it was commissioned by PNC. Considering that PNC is a financial services firm whose product line includes electronic claims processing may give rise to skepticism. Borrowing a simile from my editor, it's like an orange grower commissioning a study on the merits of OJ in the morning.
However, there is one finding in this report that is truly outstanding. After interviewing 150 hospital executives and 50 commercial health plan executives, the researchers at Chadwick Martin Bailey discovered that an extraordinary amount of claims resubmission is taking place. I've heard this plenty of times anecdotally, but do not recall a comprehensive study on the topic. "Respondents reported submitting 5,000 claims per month to insurance companies for payment. Hospital executives reported that, on average, one in five claims they submit is delayed or denied, and that 96 percent of all claims they submit in an average month must be resubmitted at least once. Insurance companies go back to providers twice, on average, to get all the information they need to pay a claim."
Written in the dry language of a white paper, this report is sparing on the exclamation points and adjectives of disbelief. Yet, when I read that virtually all claims are resubmitted at least one time, I know that something is seriously wrong. The problem, asserts PNC, is the absence of electronic data interchange transactions along the food chain that connect providers and payers. Even hospitals that use EDI to submit claims struggle: They average three re-submissions per claim. Hospitals without EDI technology resubmit an average of 11 times! (My exclamation point.)
According to the study, all this administrative inefficiency is costing the industry dearly. The executives on both sides of the aisle estimated that "just over 30 cents of every dollar spent on healthcare in the U.S. currently goes toward administration." The ticking time bomb here is consumers. In a corollary study, PNC asked 1,000 consumers how much administrative overhead would be warranted in our healthcare system. Answer: less than 10 cents on the dollar. "Seven in 10 said they would be 'highly upset' if overhead hit 30 percent." Is that a mob forming outside the hospital?
Ironically, the facilitation of electronic submissions was one of the cornerstones of the original HIPAA legislation. More than a decade ago, in the name of administrative simplification, the legislation called for standardized electronic formats for claims submissions. Apparently we have a long way to go. You may be interested in hearing the thoughts of Lisa Miller, whom I recently interviewed on this topic. Lisa, chief technology officer at Payformance Health, was honored by the Workgroup for Electronic Data Interchange for her analysis of the ROI of HIPAA electronic claims standards. Her cost benefit analysis, done for the National Committee on Vital and Health Statistics, focused on technological conversions related to the HIPAA legislation. "We mandated a standard that had not been tested and we paid a price for that," she told me. "We have not recouped the ROI potential that was there."
The industry jumped full bore into the privacy provisions of HIPAA. It may be time to revisit the basics of electronic claims submissions. That issue may not be as sexy as a stolen computer with identifiable health data. It is a critical business issue nevertheless. If we can't unravel the claims submission tangle, consumers may have one more reason to feel estranged from the healthcare system they rely on. And CEOs will have even more difficulty financing the care we all cherish.
Oak Hill Hospital in Brooksville, FL, has made $700,000 in improvements to its surgical department. The investment includes upgrades to thecystoscopy department and other improvements to the facility's operating rooms.