As health officials prepare for the flu season amid the global H1N1 pandemic, technology and new forms of Internet social interaction are transforming how such outbreaks are monitored. Experts say Internet surveillance has the advantage of speed and can detect sick people who might not see a doctor. Google's public Flu Trends system, for example, is designed to pick up early clues by tracking and analyzing Internet searches for flu information.
The University of Pittsburgh Medical Center last week announced the completion of an agreement under which UPMC will acquire majority ownership of Beacon Hospital in Dublin, Ireland.
Beacon Hospital has been renamed UPMC Beacon, and is now officially part of UPMC's 20-hospital network. UPMC representatives said the move will significantly improve treatment options and better access to care for patients.
"This commitment to the health of Irish patients will ensure continued access to UPMC's excellent clinical care and technological expertise," said UPMC Beacon Hospital Chief Executive Officer Joel Yuhas in a statement. "Our plans for significant expansion of UPMC Beacon will free up resources and increase capacity in the public health system for the benefit of patients."
UPMC became the operator of Beacon Hospital Cancer Centre in 2007, and began managing the entire hospital in February 2008. Under the new agreement, UPMC has acquired majority ownership of the hospital management company and the entity that owns the hospital property, according to a UPMC release. UPMC is committing 68 million euros (approximately $96 million) in investment and loan guarantees.
UPMC reports that since it began managing the hospital, it has seen growth in patient admissions and surgical procedures, according to the release. This benefits hospital employees as well, because allows them to provide technologically advanced care, said UPMC officials.
"With the continuing support of our excellent physicians, UPMC Beacon Hospital remains uniquely positioned to serve the needs of our patients," said Mark Redmond, MD, medical director of UPMC Beacon Hospital and director of Beacon Medical Group, in a statement.
Although this announcement is from UPMC, a multi-billion dollar health system and a leading academic medical center, could it still be a signal that the economy is showing at least a slight improvement for healthcare? An August HealthLeaders magazine story ("Spotting the Turnaround") states that "employment has a significant impact on the business of healthcare." And a new report released by The Conference Board shows that online job listings are on the increase in many employment sectors.
And even if the economy continues to lag, perhaps UPMC's confidence in its global realm will boost its revenue, or perhaps even inspire other systems to increase business by looking outside the U.S. for investment opportunities.
The development in Ireland is only one portion of UPMC's efforts to expand business all over the globe. UPMC Beacon Hospital and Cancer Centre are part of UPMC's International and Commercial Services Division, which includes the operation of more than 40 cancer treatment centers worldwide. UPMC also provides emergency services and training in Qatar and is deploying electronic medical record technology at two UK hospitals. In addition, UPMC announced earlier this year an agreement to manage a health center in Cyprus and a partnership with GE Healthcare to develop cancer centers throughout Europe and the Middle East. And even with the recent signals that the economy might be improving, health systems all over the world still need all the help they can get.
Note: You can sign up to receive HealthLeaders Media Global, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.
"Our intention is to become a leader in environmental practices among healthcare companies," says Alan Yuspeh, senior vice president and chief ethics & compliance officer for Nashville-based HCA. He also serves as chair of HCA's Sustainability Steering Committee. "This signals HCA's commitment to have a comprehensive environmental strategy in concert with our mission of the care and improvement of human life."
Each HCA hospital will appoint a sustainability coordinator, who will lead this effort on behalf of his or her facility. As members of Practice Greenhealth, each HCA hospital will have access to resources and expertise. "We know that challenges lie ahead as we implement additional sustainable practices in our hospitals," Yuspeh says.
Bob Jarboe, executive director of Practice Greenhealth, says he is "thrilled" that HCA has joined his group. "We recognize the tremendous commitment this represents and look forward to working with the folks at HCA as they implement and expand their sustainable, eco-friendly practices throughout their system," he says.
Jarboe says 2009 may represent the tipping point for the sustainability movement in the healthcare sector, which has assumed a leadership role in the broader ecology of the planet.
"Historically, the healthcare sector has been one of the largest consumers of energy and water and generates tons of solid and medical waste," Jarboe says. "Practice Greenhealth members are turning the tide on this history, however, with growing evidence that greener facilities improve patient outcomes, decrease lengths of stay, and improve the health and performance of healthcare workers, while saving money and minimizing liability and compliance risks."
HCA facilities include 163 hospitals and 112 outpatient centers in 20 states and England. With the addition of HCA, Practice Greenhealth membership now exceeds 1,000 organizations. Members include individual hospitals, healthcare systems, and businesses in the healthcare sector.
Hospitals downwind of Southern California's wildfires are preparing for an onslaught of patients with respiratory problems starting this weekend as airborne debris exacerbates chronic conditions like heart and lung disease.
But they say they're ready for it because they are well stocked in anticipation of seasonal and H1N1 flu.
"Fortunately, we have the experience of preparing for influenza to help us with this," says James Lot, executive vice president of the Hospital Association of Southern California. "We're well stocked with respirators and masks and other supplies like that."
Lott says that hospitals—especially those immediately downwind of the fire lines, such as Citrus Valley Medical Center and Foothill Presbyterian Hospital—are being regularly surveyed and so far have not reported a surge in patients.
Only the Los Angeles County-USC Medical Center has reported a slight increase in patients, and that may be because of some very early cases of influenza, not because of the wildfires, Lott says.
"But we expect that they will start showing up this weekend. Two weeks from the time the fires began last week is when we'll start seeing a lot more."
Lott says that air quality in the Los Angeles basin has gone from bad to worse through the week. Outside his Glendale home, he says, "my car is covered with soot every morning. It's horrible."
When it comes to implementing electronic health record systems and exchanging health information electronically, healthcare providers are being incentivized, nudged, or hit with a stick. As everyone reading this probably already knows, healthcare providers have until 2015 to be deemed "meaningful users" of certified EHRs before they are penalized under the regulations outlined in the HITECH Act.
The big question is will we spend this stimulus money in a way that truly makes healthcare more cost effective and improves the quality of care for patients. Almost every one that I talk to makes a point to say that the HIT Policy committee is approaching this the right way—although they may grumble about recommended guidelines being too aggressive or not aggressive enough.
A lot of questions still remain and the final definition of meaningful use and the certification criteria for vendors likely won't be finalized until the first quarter of 2010. So will the HITECH Act—based on where we are headed and the work that has already been done—achieve its goals? I know. It's a tough question to answer and no one has that crystal ball to glimpse into the future. But if we are getting off track, the time to correct the situation is now or we could end up wasting a lot of tax payer money for naught.
"We have a fragmented healthcare system where patient data is not available, so we want informational integration at least," J. Marc Overhage, MD, PhD, director of medical informatics and research scientist at Regenstrief Institute, Inc. and president and CEO of the Indiana Health Information Exchange, told me during an interview for HealthLeaders magazine's August cover story, "Hang On."
We were discussing whether smaller community and rural providers would be left behind and the impact that would have on the healthcare system as a whole.
"It is important that we move the whole market and not just fragments of the market," said Overhage, adding that "if I can send and receive healthcare data, but no one else is out there to do it—the patients won't get any benefit."
The challenges for rural providers are well documented. Certain regions still have limited or no Internet connectivity, many rural providers are barely scraping by financially and have extremely limited access to capital to purchase EHRs or build the infrastructure required to support the EHR, and most do not have the IT support staff to implement and maintain EHR systems or negotiate with vendors to ensure all of the certification requirements for meaningful use will be covered.
There are hardship exceptions available for critical access hospitals in the regulations, vendors are offering flexible payment solutions where providers can pay for systems on the backend, and there are grants for regional extension centers and states to help providers implement EHR systems and achieve "meaningful use" and establish health information exchanges. But time keeps ticking, deadlines are looming, and there is still an enormous amount of work to be done. It seems to me that many of the providers who need the incentive payments the most are probably facing penalties instead.
There will be thousands of hospitals and physicians trying to do the right thing very quickly, says Overhage. "The risk is significant that we won't do it right."
With the likelihood that many rural and small community providers will lag behind, will that threaten to drag the whole effort under or can the early adopters and larger systems achieve enough success to keep the momentum towards a national electronic health system moving forward?
I don't have the answers. And the early adopters of EHRs have concerns of their own. Many do not know whether their existing systems will be certified or if they will have to make major upgrades to their existing systems or even start from scratch.
The demand on vendors from existing clients could be enormous not to mention all the new clients that will want to implement systems—and fast. I know vendors are promising they will have the resources to meet the demand and their systems will be certified. I guess time will tell whether they were right.
Note: You can sign up to receiveHealthLeaders Media IT, a free weekly e-newsletter that features news, commentary and trends about healthcare technology.
The healthcare industry may have two years longer than originally expected to complete the transition to ICD-10, but the 2013 effective date established by the Centers for Medicare & Medicaid Services leaves no room for procrastination.
The transition impacts all segments of the industry, but it will be providers that are the most affected. In addition to getting their own systems and processes in place to accommodate the expanded code set, they must also be prepared to accommodate any variances in transition schedules among payers and vendors.
Indeed, a significant challenge confronting many provider organizations is a lack of definitive information from vendors—technology vendors in particular—that they need to establish strategic transition plans and budgets. The vendor community may be in the midst of its own transition planning, but it has a broader responsibility and immediate role to play in ensuring its healthcare clients can embark on a smooth, seamless and successful move to ICD-10.
For example, provider organizations need to know now:
If their existing systems can support ICD-10.
The cost of any necessary upgrades or replacements to achieve ICD-10 compatibility.
Whether or not upgrades will be covered by existing contracts.
If compatible upgrades or replacements will be available within the necessary timeframe.
Whether existing systems are capable of operating in both ICD-9 and ICD-10 environments to accommodate the transition schedules of payers and billing vendors.
A Call to Action
Providers have not been silent about their concerns regarding vendor readiness and cooperation as they embark on their ICD-10 transition planning. In fact, 55% of hospital CIOs surveyed by the College of Healthcare Information Management Executives identified these as the top hurdles to achieving compliance with the new code and transaction set.
That survey also found that 60% of CIOs had not been alerted to vendor implementation timelines. Further, 72% didn't know if their vendors would include ICD-10 in annual software upgrades, and 53% t didn't know if the changes would be covered by "federal and state" clauses in their contracts. These clauses generally leave vendors responsible for government-related software updates.
Physicians are also concerned about IT vendor readiness, and with good reason. A survey of physician practices by the Medical Group Management Association found that 95% would, at the very least, require software upgrades to ensure their practice management systems were compatible with ICD-10. Further, 64% indicated they would need to purchase code-selection software.
For these reasons, the healthcare industry is calling upon software vendors, particularly those whose applications link directly to the documentation, coding and billing processes, to take a proactive role in their clients' transition strategies. Top tier technology vendors are preparing now to answer that call—if they haven't already done so.
Proactive Vendor Engagement
In an ideal world, vendors would already have publicized their specific transition schedules. They would also step up to manage the heavy lifting by providing upgrades that allow clients to automatically produce coder-ready documentation appropriate for ICD-10. These upgrades would also accommodate the dual-coding environment that will likely be necessary during the early days of deployment.
In the real world, not every vendor is able or willing to do so. Nonetheless, vendors have a responsibility to at least inform their provider clients whether or not the systems they have in-house can support ICD-10, or if upgrades will be made available and the cost of those upgrades. Early notification is particularly important if systems are not and cannot be made ICD-10 compatible to allow clients ample time to undertake the lengthy process of identifying and installing replacements.
A realistic solution is for vendors to reach out to their provider clients and assume a proactive role in transition planning. Doing so allows vendors and clients to work together to determine what is needed to achieve compliance, how much it will cost and what the various deliverables will be. This, in turn, allows them to reach mutually beneficial agreements on who is responsible for executing each element of the transition plan and the timeline for that execution.
To maximize the time spent in these vendor meetings, provider organizations should first conduct a thorough evaluation of any IT applications that will potentially be impacted by the change to ICD-10, including:
Practice Management/Billing
Registration/Scheduling
Documentation/Coding/HIM
CPOE/EHR/EMR
Hospitals and practices should also identify which systems may need to operate in a dual environment and for how long. They need to determine how long the ICD-9 system will need to be accessible and by whom, as well. For example, anyone responsible for data analysis will likely require access to the old system for longer than coding and billing personnel. The billing department may also require longer access to ICD-9 to process older claims and to manage any necessary re-billing.
Armed with this information, hospitals and software vendors will be better able to work together to hammer out a plan of action, budget and timeline for the IT aspects of the ICD-10 transition. This includes identifying which software modifications will be needed to accommodate format changes, new diagnostic codes, etc.
For the most part, modifications will include expanding field sizes, changes to alphanumeric composition, decimal use, redefining code values and interpretations, edit and logic changes, table structure modifications, etc. Reports or forms may also require modification or redesign. For example, practices that utilize superbills will need to make significant changes to accommodate the expanded number of codes contained within ICD-10.
Vendors can also assist in determining if and how the transition to ICD-10 might be leveraged to introduce additional enhancements to the IT infrastructure. One example is deployment of new applications, such as service-line specific automated procedure documentation and coding tools, which can ease the transition to ICD-10, while also delivering streamlined workflow processes and increased revenue.
The transition to ICD-10 will affect every segment of healthcare, including providers, vendors and payers. Success will depend upon how accurately and efficiently providers are able to implement the technology changes required to accommodate the new code set.
For this reason, software vendors must recognize the critical role they play in transition planning and get involved with their clients now to ensure they are building a solid foundation for a smooth transition.
Sean Benson is co-founder and vice president of consulting with ProVation® Medical, which is part of Wolters Kluwer Health. He can be reached at sean.benson@provationmedical.com.For information on how you can contribute to HealthLeaders Media online, please read ourEditorial Guidelines.
The EMR market is expected to grow in major ways with a $20 billion infusion from the Health Information Technology Act. The Bureau of Labor Statistics says employment for medical records and health information technicians is expected to grow faster than average for all occupations, with an 18% increase through 2016. Within the field there are 125 job titles in more than 40 settings, experts say.
Minnesota-based health provider and insurer HealthPartners has announced it has saved $430,000 over the past year by including electronic X-rays, MRIs, CT scans, and radiology reports in patients' electronic health records. Savings included $130,000 that no longer had to be spent on transcribing radiologist reports, and $300,000 that was no longer needed for film storage costs.
The Certification Commission for Health Information Technology is moving forward with plans to launch a new, less comprehensive electronic health records software certification program in response to the federal economic stimulus package. In October, the commission plans to launch a more limited, modular inspection program for EHR software, focusing only on compliance with standards required for "meaningful use" of EHRs under the American Recovery and Reinvestment Act.
Claire Miley, a member of the healthcare practice of Bass, Berry & Sims law firm in Nashville, TN, says it's still too early for any technology vendor to say their products will meet the federal certification requirements for electronic health record systems under the HITECH Act. Providers should pay close attention to the preliminary certification requirements that the Centers for Medicare & Medicaid Services should be unveiling this fall to gauge whether their vendor's products will be certified, she says.
