advancing imaging informatics

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Clinical Decision Support Progress

Population Health’s Front Lines

Proactive Data Security

November/December 2013

Volume 30, Number 8

ADVANCING IMAGING INFORMATICS:

www.healthcare-informatics.com

SHAPING THE FUTURE OF IMAGES

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CONTENTS November/December 2013 POPULATION HEALTH PERSPECTIVE

COVER STORY

30

Orlando Health’s Rick Schooler shares his views on the lessons learned so far from his organization’s effort to build a scalable, automated population health infrastructure BY MARK HAGLAND

IMAGING INFORMATICS 10

PART 1: ADVANCING IMAGING INFORMATICS As imaging informaticists strategize around new technological trends, they are changing the way images are retrieved, analyzed and exchanged across the medical enterprise forever. What are the emerging challenges of the new imaging landscape? BY RAJIV LEVENTHAL

14

PART 2: PEERING INTO THE FUTURE How will changes taking place today affect the world of imaging in the not-too-distant future? Healthcare leaders look at implications for radiologists, clinicians and care delivery BY MARK HAGLAND

16

THE HOLY GRAIL OF CLINICAL DECISION SUPPORT How progress on standards, tools and strategies is making scalable, interoperable CDS a reality BY DAVID RATHS

22

POPULATION HEALTH PERSPECTIVE

34

ACO PERSPECTIVE

37

INSIDE

8

EDITOR’S PAGE

ACO PERSPECTIVE

39

GUIDING I.T. STRATEGY On the eve of Cleveland Clinic’s annual Innovation Summit, CIO C. Martin Harris, M.D., shares his vision of IT strategy for his organization in an exclusive interview BY MARK HAGLAND

INTEROPERABILITY UPDATE

29

PATIENT MATCHING Panelists at the CHIME Fall Forum discuss various approaches and their “dream solutions” for patient identification BY MARK HAGLAND

FIRST-STAGE ACO DEVELOPMENT IN NEW JERSEY The CMO of Barnabas Health gives his take on his organization’s early efforts in ACO development BY MARK HAGLAND

READMISSIONS UPDATE

41

DISCHARGED WITH A RECORDING How one regional hospital, by using recording devices at patient discharge to reinforce instructions to patients, has decreased its readmission rate and improved its HCAHPS score BY RAJIV LEVENTHAL

BUSINESS INTELLIGENCE UPDATE

43

STAYING ON TOP How the Medical University of South Carolina applies business intelligence to drive care quality BY GABRIEL PERNA

NETWORKING UPDATE

44

CONNECTIVITY REVOLUTION Robert Vietzke, vice president of network services at Internet2, looks to the future of computing capability BY MARK HAGLAND

INNOVATION PERSPECTIVE

27

THE REAL-WORLD EXPERIENCES OF MEDICARE ACOS The executives of three medical groups share their experiences of being part of the Medicare Accountable Care program BY RAJIV LEVENTHAL

DEPARTMENTS 6

DELIVERING DATA IN REAL TIME How can data be leveraged for effective population health management? At this year’s MGMA annual conference, the CIO of Martin’s Point Health Care explained how BY RAJIV LEVENTHAL

DOING MORE WITH DATA SECURITY Why leading provider organizations are moving beyond the “compliance mindset,” and embracing technologies that can drive data security forward BY GABRIEL PERNA

FROM THE FRONT LINES OF POPULATION HEALTH

CAREER PATHS

64

PAYING IT FORWARD The different styles and many benefits of mentoring, a unique relationship between experienced pros and less experienced employees with a hunger to learn BY TIM TOLAN

★ 2014 RESOURCE GUIDE ★ 47 HEALTHCARE INFORMATICS’ ANNUAL COMPREHENSIVE GUIDE TO ALL ESSENTIAL VENDORS IN THE INDUSTRY

Healthcare Informatics (ISSN: print 1050-9135, online 1938-1441) is published 8 times per year in February, March, May, June, August, November/December, November/December, and December by Vendome Group, LLC, 6 East 32nd St., New York, NY 10016. Periodicals postage paid at New York, NY and additional mailing offices. © 2013 by Vendome Group, LLC. Healthcare Informatics is a trademark of Vendome Group, LLC. All rights reserved. No part of Healthcare Informatics may be reproduced, distributed, transmitted, displayed, published, or broadcast in any form or in any media without prior written permission of the publisher. To request permission to reuse this content in any form, including distribution in educational, professional or promotional contexts or to reproduce material in new works, please contact the Copyright Clearance Center at [email protected] or 978-750-8400. For custom reprints, please contact Erin Tyler Beirne at 216-373-1217 or [email protected]. EDITORIAL POLICY: Articles and opinions published in Healthcare Informatics do not necessarily reflect the views of the Publisher or the Editorial Advisory Board. SUBSCRIPTIONS: For questions about a subscription or to subscribe, please contact us by phone 1-888-873-3566, email: [email protected] or write to HEALTHCARE INFORMATICS, PO Box 397, Newton, PA 18940. Subscription rate per year: $99 domestic, $129 outside the US. Single copies and back issues: $20 domestic, $32 outside the US. POSTMASTER: send address changes to HEALTHCARE INFORMATICS, PO Box 397, Newton, PA 18940.

2 November/December 2013 • www.healthcare-informatics.com

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Healthcare

Informatics

INSIDE

Healthcare IT Leadership, Vision & Strategy

Imaging Informatics Charges Ahead

T

his month’s cover story package looks at the cutting edge of imaging informatics. On page 10, Assistant Editor Rajiv Leventhal takes an in-depth look at the emerging challenges of the new imaging landscape, and what informaticists need to know to strategize around technological trends that are changing the way images are retrieved and analyzed across the enterprise. In the companion piece on page 14, Editor-in-Chief Mark Hagland peers into the future world of imaging, transformed by today’s technological trends.

Letter to the Editor To the Editor: The entire crew at BridgeHead Software enjoyed Joe Marion’s thoughtful and inclusive article, “A Framework to Aid VNA Implementation,” in the September 2013 issue. The author took an informative approach to defining the underlying requirements necessary to deploying an effective and scalable VNA. Marion’s article does an excellent job of explaining the different framework components—services, content, infrastructure, accessibility and TCO [total cost of ownership]—and how they all work together to deliver a true VNA [vendor neutral archive]. Like a kaleidoscope, this framework can be focused to deliver the optimal VNA architecture for each organization’s needs. In particular, the end discussion of framework vendors opens up a window on where much of the innovation in VNAs will come over the next few years. As hospitals continue to create and store more data, the interest in cloud-based VNAs will grow. Adapting the VNA Framework to the cloud will require changes to the overall VNA architecture, but it also promises to deliver better scalability and, ultimately, lower TCO. I applaud your attention to this topic, and we look forward to more coverage of its type in the future as we all help evolve the concept and reality of VNA solutions for hospitals. Sincerely, Tony Cotterill Chairman and Chief Product Officer BridgeHead Software Woburn, Mass. and Ashtead, U.K. MORE ONLINE:

EDITORIAL EDITOR-IN-CHIEF Mark Hagland [email protected] MANAGING EDITOR John DeGaspari [email protected] SENIOR EDITOR Gabriel Perna [email protected] ASSISTANT EDITOR Rajiv Leventhal [email protected] ASSOCIATE EDITOR, READER ENGAGEMENT Megan Rozsa [email protected] SENIOR CONTRIBUTING EDITOR David Raths [email protected]

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Make sure you visit www.healthcare-informatics.com for the latest healthcare IT coverage: AHRQ’s report on health IT-enabled quality measurement; population health in the U.K.; revenue performance tools; EHR derived claims management and ACO development; tackling sports injuries with EHRs.

2013 EDITORIAL BOARD Brian D. Patty, M.D. Vice President and CMIO, HealthEast Care System, St. Paul, MN Chuck Podesta SVP and CIO, Fletcher Allen Health Care, Burlington, VT Wes Rishel VP and Research Area Director, Gartner Healthcare, Industry Research and Advisory Services, Alameda, CA Benjamin M.W. Rooks Principal, ST Advisors, LLC, Evanston, IL Rick Schooler Vice President and CIO, Orlando Health, Orlando, FL Patricia Skarulis Vice President and CIO, Memorial Sloan Kettering Cancer Center, NY, NY Fran Turisco G. Daniel Martich, M.D. Director, Aspen Advisors, Denver,, CO Chief Medical Information Officer, UPMC Ferdinand Velasco, M.D. Pittsburgh, PA Chief Health Information Officer, Texas Health Resources, Arlington, TX 6 November/December 2013 • www.healthcare-informatics.com

Marion J. Ball, Ed.D. Professor, Johns Hopkins School of Nursing Fellow; IBM Center for Healthcare Management; Business Consulting Services, Baltimore, MD William F. Bria II, M.D. Chairman, Association of Medical Directors of information Systems (AMDIS) Tina Buop CTO, La Clinica de La Raza, Oakland, CA Bobbie Byrne, M.D. VP for HIT, Edward Hospital, Naperville, IL W. Reece Hirsch Partner, Morgan, Lewis & Bockius LLP, San Francisco, CA Christopher Longhurst, M.D. CMIO, Lucile Packard Children’s Hospital, Clinical Assistant Professor of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

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HEALTH INFORMATION TECHNOLOGY

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EDITOR’S NOTES

Looking Back at a Prediction Gone Awry, Visioning the Future of Imaging WHY THE FUTURE OF DIAGNOSTIC IMAGING, DRIVEN BY INFORMATION EXCHANGE TECHNOLOGY, IS SO COMPELLING

A

bout six or seven years ago, I was wandering through a discount-titles bookstore (yes, that kind of dates that anecdote, doesn’t it?!), when I ran across a book published in 1990 that had predicted a “coming global economic crash” by 1995. I remember chuckling to myself as I very briefly perused the book, which was written by two gentlemen who were described as “futurists” and “noted economists.” Mark Hagland Now, as anyone who was alive and alert at the time will remember, the U.S. and world economies were booming back in 1995, with those economies only crashing in 2007 and 2008, fully 12 to 13 years after those authors had predicted (and for different reasons from the ones they had cited, by the way). So clearly, either those authors were simply completely wrong, or their gypsy fortune-teller crystal ball was giving them a calendar year that didn’t match reality. Yet as easy as it is to mock a remaindered book whose authors had wildly mispredicted a time-specific economic forecast, when it comes to healthcare, don’t we all know of predictions made with extremely firm conviction that later were completely debunked? Our industry is virtually littered with predictions gone wrong. One that had particularly broad ramifications was made in the mid-1990s, when commercial physician practice management companies (PPMs) emerged and took on a big head of steam, before collapsing ignominiously a few years later. Two of the three largest PPMs actually ended up being investigated by federal regulators, based on some rather shady dealings their corporate senior executives had engaged in, as they attempted to wring profits out of bringing physicians together under consolidated corporate roofs, while ultimately not adding value to that aggregation. In any case, a whole lot of “industry experts” ended up with egg on their faces after the three largest PPMs crashed and burned within months of each other, shortly after thousands of practicing physicians had lost massive personal savings by investing in those enterprises. 8 November/December 2013 • www.healthcare-informatics.com

Of course, those who had predicted that these commercial PPMs would conquer the healthcare world had failed to consider two core issues: the immaturity of the economics and physician culture of the time, around what was simply not a sustainable model of capitated payment under the business conditions of that time; and the lack of sophisticated information technology needed to support continuous, intensive physician performance improvement back then. Fast-forward to 2013, and a whole lot has changed. Now, physicians are coming together in a variety of agglomerations—sometimes via employment by hospitals and health systems, sometimes via physician-driven initiatives and enterprises—and the results are making themselves known already. What do physicians want? Among other things, they need access to diagnostic images and to radiologist reports and other imaging-related data and information. Fortunately, the technology to support such information exchange—with the images involved increasingly coming not only from radiology, but also cardiology, pathology, dermatology, and obstetrics/ gynecology, among other medical disciplines—has been roaring ahead recently. Healthcare leaders are not only creating leading-edge systems and architectures right now; some are peering gamely into the future, and visioning the image-facilitated world of the future that lies just ahead. This issue’s cover story package (beginning on p. 10), with a lead article by HCI Assistant Editor Rajiv Leventhal, and a horizon feature by me, looks at where the diagnostic imaging sphere is headed. What is clear is that, unlike the ill-fated PPM concept, the new architectures and arrangements being created in the imaging informatics sphere are founded on sounder concepts and principles. In other words, there’s no need to look for the equivalent of the “global crash” of 1995 that never happened.

Mark Hagland Editor-in-Chief

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COVER STORY

COVER STORY PART 1: IMAGING INFORMATICS

Advancing Imaging Informatics: Looking at the Leading Edge in Accessibility of Images Across the Medical Enterprise HEALTHCARE IT LEADERS ARE CHANGING THE WAY THEY ANALYZE AND EXCHANGE MEDICAL IMAGES—BUT CHALLENGES REMAIN BY RAJIV LEVENTHAL

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s the landscape in imaging informatics continues to shift, the challenge for healthcare IT leaders lies in being aggressive in their strategies to keep up with accelerating new technological and process trends. Imaging informaticists are devoting themselves to looking at how information contained within medical images is retrieved, analyzed, enhanced, and exchanged across—and beyond—the patient care enterprise. The leaders are also looking at how diagnostic images fit into a changing medical practice landscape and the thrust toward patients’ ownership of their images. The most progressive organizations are beginning to explore a universal viewing application to interact with their electronic medical records (EMRs), says Joe Marion, founder and principal of the Waukesha, Wis.-based Healthcare Integration Strategies,

Joe Marion

which assists clients with imaging strategy and implementation. Those who are looking to advance, says Marion, are doing it through a vendor neutral archive (VNA) architecture. Historically, of course, medical image storage has been under the control of individual picture archive and communications system (PACS) applications, requiring management of that data to be completely reliant upon system functionality.

10 November/December 2013 • www.healthcare-informatics.com

Healthcare facilities have now begun to deploy VNA technology to consolidate image archive and data accessibility. As imaging data throughout the enterprise grows, so does the need for a VNA for more cost-effective storage. “Moving to a VNA can reduce migration costs and avoid the proprietary data storage often found in PACS applications, making information more accessible,” says Marion. “If you can store all of the service areas in one environment, there is a cost savings from having that singular platform as opposed to multiple platforms.” As such, according to a recent report from research firm MarketsandMarkets, the global VNA market will hit $165.3 million and will grow by 15.2 percent annually to $335.4 million by 2018. Mark Jacobs, CIO of the Delaware Health Information Network (DHIN), a health information exchange (HIE) that serves all of Delaware’s hospitals

COVER STORY and providers, says that for an HIE, the biggest challenge with medical images is community viewing, which can be described as “a work in progress.” But Jacobs agrees that the VNA is a critical component to community viewing. “If you look at community viewing, just implementing a UniViewer in the community is going to be problematic because of response times, access speeds, and bandwidth issues. Remember, you’re talking big, heavy images. We have learned with an HIE, if you have to wait for anything at the point of care, physicians will get frustrated and not use it. If the world was perfect, we would have the UniViewers, big communication pipes, and also a VNA—those are three success components for community viewing. But it’s a very expensive business proposition.” The next step in image exchange is the rise of HIEs, which has been recently expanding, adds David Mendelson,

David Mendelson, M.D.

M.D., director of radiology information systems at the N.Y.-based Mount Sinai Medical Center. Cross-enterprise document sharing for imaging (XDS-I.b) extends XDS to share images, diagnostic reports, and related information across a group of care sites. Mendelson is also co-chair of Integrating the Healthcare Enterprise (IHE), an initiative designed to im-

prove the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven International (HL7) to address specific clinical needs in support of optimal patient care. When the HITECH (Health Information Technology for Economic and Clinical Health) Act was passed, image exchange became a major agenda item in the White House, and thus for the National Institutes of Health (NIH). Over the last four years, says Mendleson, using NIH funding, IHE has established a small, but growing, network of hospitals that are enabled to export—with patient consent—images into the servers of a few vendors that maintain image-enabled personal health records. The idea moving forward, he says, is to build a network

www.healthcare-informatics.com • Healthcare Informatics 11

COVER STORY

such that it uses an infrastructure that is very similar to the infrastructure used for HIEs, so they can all live on the same national highway. “We are trying to get the vendors to all adopt this XDS standard, so no matter how you exchange images, it’s all the same standard,” he says. As Jacobs notes, though, for many healthcare organizations, cost remains a major barrier when it comes to being progressive with their medical imaging capabilities. At the five-hospital University of Colorado (UC) Health, MariJo Rugh, vice president of application services, says finances are one of the system’s biggest deterrents right

tal sites throughout the really only possible by country by transferring normalizing the termiimages from the hospital nology for studies across sites to its centralized the entire platform on server in Minneapolis, which we deal. That is and then accessing those really the cutting-edge images over the Internet trend now.” using individual workstaRaymond Montecaltions from radiologists’ vo, M.D., medical direchome offices, says Ben tor at vRad, provides Strong, M.D., CMIO of an example: “We may vRad. Those radiologists, have clients for mulBen Strong, M.D. in turn, use a DICOM tiple hospitals. They viewer to analyze the imwill have hundreds of ages and integrated voice different descriptors for recognition software program to create foot X-rays, and they send us this data. reports which are then sent back to the Unless you know on the back end how to turn the same study described in a number of ways into a single descriptor, you can’t conglomerate that data and figure out how many foot X-rays this hospital is doing, or what the national average of this hospital is compared to a national benchmark, or who’s ordering it. There is no single repository of that data in the U.S. [At hospital system that ordered that inter- vRad], we probably have the greatpretation, he explains. est opportunity to conglomerate that The trend considered data and make it useful to be leading in terms of for the [hospital] sites.” the cutting-edge activBoth Strong and Monity, continues Strong, tecalvo acknowledge is the normalization of they were concerned data. “We realized some they would have diftime ago, the key to a ficulty demonstrating managing a practice of the value of normalizathis scope would be to tion and data analysis, normalize data. By that I because over the years, mean know exactly what radiology groups and we’re dealing with, know hospital networks have what kind of study, what been slow to respond Ray Montecalvo, M.D. kind of patient, and what to market forces. “But kind of facility we’re hantoday, everyone is well dling, because an interaware of the pressures pretation can be influenced by all of on medical imaging and healthcare those factors. Precise knowledge about in general,” says Strong. “As a result, there are more efforts to look at your data and analyze the utilization of resources and develop the need to do that analysis.” Montecalvo warns that this is not something that happens in a quantum leap, however, with larger integrations which will only accelerate more in the coming years with the the studies we’re handling and the pre- Affordable Care Act and growth of accise needs that are thus required are countable care organizations (ACOs).

MOVING TO A VNA CAN REDUCE MIGRATION COSTS AND AVOID THE PROPRIETARY DATA STORAGE OFTEN FOUND IN PACS APPLICATIONS, MAKING INFORMATION MORE ACCESSIBLE. —JOE MARION now. “If you look at the cost per study in your own PACS system, and an additional cost for the cloud to share the image, it adds up. Each image you need to store has a significant dollar value associated with the storage and exchange of it. Then, you get into image life management, such as how long you will hold onto it, based on how much storage you’re going to have. It all comes back down to cost.”

NORMALIZING THE DATA Key to image exchange is interpretation, a service provided by the Carol Stream, Ill.-based Virtual Radiologic (vRad), a technology-enabled national radiology practice working in partnership with local radiologists and hospitals to optimize radiology’s pivotal role in patient

IF YOU LOOK AT THE COST PER STUDY IN YOUR OWN PACS SYSTEM, AND AN ADDITIONAL COST FOR THE CLOUD TO SHARE THE IMAGE, IT ADDS UP. —MARIJO RUGH care. vRad has provided radiology interpretations from more than 2,000 hospi-

12 November/December 2013 • www.healthcare-informatics.com

(Contnued on p. 26)

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COVER STORY

COVER STORY PART 2: IMAGING INFORMATICS

Peering Into the Future IS A NEW WORLD FOR RADIOLOGISTS, IMAGES, AND CARE DELIVERY ON THE HORIZON? BY MARK HAGLAND

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s challenging as it is just 10 or so years has been around volto keep up with the shifts ume-based imaging, and around optiaround imaging informatics mizing our workflow to the T,” Shrestha being required right now of says. “That was conscious, and useful; healthcare and healthcare IT leaders, the reality of PACS [picture archiving peering into the future will perforce and communications systems] and RIS prove very daunting for many. Yet some [radiology information systems] and 3D industry thought-leaders are daring to and reporting was that we needed to peer forward nonetheless. One who is make all that as productive as possible, happy to do so is Rasu Shrestha, M.D., in the last 10 or 15 years. Where it’s govice president for mediing is to a new paradigm cal information technolof value-based imaging.” ogy at the vast, 20-plusIN WORKFLOW, A hospital University of CHANGE IN FOCUS Pittsburgh Medical CenFROM IMAGE TO ter (UPMC) health sysPATIENT tem. Shrestha goes on to Indeed, Shrestha sees note that, “Up to now, imaging informatics from we’ve been very heavily a broad perspective that focused [as practicing incorporates both the radiologists] on dealing concept of value-based with a series of images at purchasing in healthcare, Rasu Shrestha, M.D. a time. We’ve improved and the changing roles of our efficiencies, but practicing radiologists. Not surprisingly, he speaks as one who where things are moving is away from is himself a radiologist. Thus, when an image-centric workflow and towards asked where the U.S. healthcare system a patient-centric workflow, towards needs to be five years and more from treating the patient as a whole. That’s now when it comes to diagnostic im- where it needs to go, in terms of valueage management, he sees the need for based imaging,” by which he means transformative change on that broader radiologists, radiology departments, level that encompasses changes to radi- and the IT and other professionals who ology practice itself. “I truly believe that facilitate such work, “significantly demeverything that’s been done in the last onstrating the value that [they] bring to 14 November/December 2013 • www.healthcare-informatics.com

the healthcare enterprise,” far beyond speed and volume capacity of imaging and of diagnostic study report production. Most importantly, Shrestha notes, “Before PACS, we actually used to be part of the care team, when we were working on film. The surgeon would come down and talk with me about Mrs. Smith. Today, that essentially gets boiled down to an HL7 message through CPOE [computerized physician order entry], and we run the risk of being delegated to the darkest corners of the reading room.” At UPMC, he says, “We’re looking at a number of metrics that might contribute to the value score” of radiologists’ work product, among them, measures of “visibility and transparency,” both related to clinical teamwork. Where IT will be essential going forward, he adds, will be in developing useful measures of radiologist work product that go beyond “volume, speed, and cost.” Fran Turisco, a principal with the Denver-based Aspen Advisors, says she agrees wholeheartedly with Shrestha about the modifications that radiologists will need to make to their role in the new healthcare. “They will have to

COVER STORY think about what their value is to the healthcare equation,” says the Boston-based Turisco, “because in a way, techwaves of images themnology is providing such selves, Turisco notes images and tools that are that “I think what techreally allowing the refernology is doing is that, ring physicians to learn a in terms of the compreslot. I think [Dr. Shrestha sion algorithms, they’re is] right that they have to getting better and better. get into the value equaNo one wants to get rid tion, as opposed to just of anything. The whole saying, here’s what I saw idea now is to keep evon this image—less of a erything forever. I think scientific review of imthere are a number of Fran Turisco ages, and more of a care PACS and storage vendelivery view.” dors who have worked Meanwhile, when it comes to the on improving storage in general, and technology available to help patient care improving the compression algorithms, organizations store the ever-growing so that when they’re stored, they take

up less and less space, and when they’re ‘unzipped,’ you have true diagnostic quality. The compression algorithms are being worked out, and at this point, they aren’t worrying about bandwidth as much anymore. We’re worrying less about bandwidth and storage.”

BEYOND IMAGES, CDS THAT WILL PROVIDE POC SUPPORT George T. “Buddy” Hickman, executive vice president and CIO at Albany (N.Y.) Medical Center, and the chairman of the board of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), sees clinical decision (Continued on p. 26)

www.healthcare-informatics.com • Healthcare Informatics 15

FEATURE

In Pursuit of the Holy Grail: Scalable, Interoperable Clinical Decision Support CONSORTIA MAKING PROGRESS ON STANDARDS, TOOLS, AND STRATEGIES FOR IMPLEMENTATION BY DAVID RATHS

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hen the physicians in the ambulatory clinics of Wishard Health Services in Indianapolis get an alert or reminder in the computerized physician order entry (CPOE) module of their homegrown electronic health record (EHR), they may not be aware that the alert was generated at Partners HealthCare System in Boston, and sent to Indiana as a Web service. The project extracts a limited data set about a patient, including labs and allergies, in the form of a Continuity of Care Document (CCD), which is sent to Partners. Its system adjudicates the rules against that data, and sends back information on which reminders or alerts fire. Although there was a considerable amount of technical and policy work behind the scenes to make it happen, “the physicians’ experience is that the alerts are not a whole lot different than homegrown ones — and that is the goal,” explains Brian Dixon, a research scientist at the Regenstrief Institute in Indiana. “By demonstrating that clinical decision support (CDS) can work as a Web service, we are not trying to

do something magically different. The value is in the economies of scale.” The meaningful use incentives are not enough money for all hospitals, especially community hospitals, to create their own systems for decision support, says Dixon, who is also an assistant

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professor of health informatics at the Indiana University-Purdue University Indianapolis School of Informatics and Computing. “They cannot form the committees or have knowledge management and informatics people to decide on 300 rules.” Then there are the

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IT requirements that stem interactions, “there refrom those decisions, and ally isn’t anything comgetting the rules into Epic, prehensive you can Cerner, or whatever EHR buy off the shelf in one you are using, he adds. place. You still have “That is time-consuming to do a lot of configuand costly.” ration, maintenance Having academic health and updating.” Smaller centers provide CDS as a providers will have to service is one potential sorely on EHR vendors to lution. “The idea of a serprovide out-of-the-box vice is that it can be robust rules or order sets that Brian Dixon content at a reasonable they can quickly implecost that multiple health ment, just to get somesystems on a regional or thing in place, he says. national level could take “Unfortunately, just as advantage of,” Dixon says, in Stage 1,” he says, “we “and a small group could will see some people maintain the knowledge focusing on checking base. That is the dream.” the box, rather than It’s easy to find discourwhat will actually imaging statistics about CDS. prove healthcare.” Outside of four or five Osheroff agrees leading integrated health there are ways people systems and the Veterans can find to check the Administration, robust box to do five intervenCDS use is still quite rare Blackford Middleton, M.D. tions, but adds that, beyond alerts for drug“to really attack this drug interactions and systematically and foldrug-allergy contraindications. Stage low the spirit of meaningful use and im2 of meaningful use requires that pro- prove information flow is going to take viders implement five clinical decision a lot more effort.” support interventions related to four or Yet despite the difficulty provider more clinical quality measures at a rel- organizations and vendors have had evant point in patient care. in designing CDS interventions that Yet most providers know they are no- don’t annoy physicians or lead to “alert where near where they need to be on fatigue,” there is a lot of exciting work CDS, claims Jerry Osheroff, M.D., prin- taking place in CDS research, and many cipal at TMIT Consulting in Cherry Hill, health informaticists see themselves in

ANY HOSPITAL THAT BUYS HEALTH IT HAS A DICKENS OF A TIME WITH DECISION SUPPORT TO TRANSFORM HEALTHCARE BECAUSE THE TOOLS ARE SO DIFFICULT TO USE, AND INFORMATICS EXPERTISE IS IN SHORT-SUPPLY. IT’S LIKE BUYING EXCEL WITH NO MACROS OR FUNCTION KEYS. —BLACKFORD MIDDLETON, M.D. N.J. “Even the ones held up as beacons of light realize they have a long way to go,” Osheroff says. Regenstrief ’s Dixon adds that although vendors offer tools for drug-drug

the early stages of an important journey. Osheroff himself is working diligently to get more CIOs and CMIOs working together on CDS. He heads up the Collaborative on CDS for Performance

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Improvement, a nationwide volunteer initiative encompassing more than 130 individuals representing dozens of hospital organizations and numerous EHR vendors. The collaborative is an outgrowth of work on the second edition of a book called “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide,” published by HIMSS. In the last year, Osheroff also has worked as a subcontractor to Deloitte on worksheets and implementation guides the Office of the National Coordinator will offer on HealthIT.gov for CDS-enabled performance improvement to help providers with meaningful use, Stage 2. Osheroff says wider use of CDS will require both enhancements to technical standards and more process improvement work. “You need both tools and strategy,” he says. “You need a rich marketplace of high-quality interventions and you also need a rich ecosystem of providers working on performance improvement together in a sharing environment to get better faster.”

CLINICAL DECISION SUPPORT CONSORTIUM 2.0 The project between Regenstrief and Partners is just one piece of a larger effort, the Clinical Decision Support Consortium (CDSC), a five-year project funded by the federal Agency for Healthcare Research and Quality (AHRQ) to find ways to make CDS knowledge more easily shareable. The effort actually started as an effort to share CDS modules more easily within Partners, which is well known as a pioneer in CDS. “We had been getting value from CDS at Partners for several years,” explains Howard Goldberg, M.D., senior corporate manager for enterprise clinical informatics infrastructure services at Partners. “But we had little CDS modules all over the institution, and they were hard to maintain and to make sure you were on the most updated version. We wanted to get to one source of truth, so several years ago, we decided to create a central service for all the ambulatory EHRs in use.” Once Partners created a CDS Web service for use internally, AHRQ got interested, Goldberg says. “They said it is wonderful that Partners is doing this,

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but nobody else benefits. How can we find a way to share the benefits on a regional or national scale?” Besides the work with Regenstrief, CDSC projects also include work with the Horsham, Pa.-based EHR vendor NextGen and its customer WVP Health Authority in Salem, Ore., as well as the University of Medicine and Dentistry of New Jersey (now part of Rutgers, the State University of New Jersey, in New Brunswick), a GE Centricity customer. “We are all learning how to do this together,” Goldberg says. “There are technology challenges. They have to be able to consume the CDS as SOAP [Simple Object Access Protocol] services in the EHRs. And that is easy or difficult depending on your platform.”

CDSC VERSION 2.0 Although CDSC’s federal funding ran out in 2013, the project is far from over. Blackford Middleton, M.D., who led the effort while at Partners, has since moved to Vanderbilt University in Nashville, Tenn., and is working on creating CDSC Version 2.0 there. “I got institutional support to rebirth it and continue that work here,” says Middleton, assistant vice chancellor for health affairs and chief informatics officer for Vanderbilt University Health System. Middleton says he is concerned that the great potential of CDS is not being realized yet. “Any hospital that buys health IT has a dickens of a time with decision support to transform healthcare because the tools are so difficult to use, and informatics expertise is in short-supply,” he says. “It’s like buying Excel with no macros or function keys.” There are vendors such as FDB (First DataBank, South San Francisco, Calif.)  working on drug-drug interactions, but Middleton says he is worried that certain aspects of CDS are not being addressed by the marketplace well or at all, and he fears they may never be.  “For instance, creating and maintaining the knowledge base to do pharmacogenomic drug dosing in ambulatory care requires a whole academic medical center,” he says. He envisions the development of an ecosystem of a few large academic medical centers, including Partners and Vanderbilt, maintaining and providing

Health eDecisions’ Standard Development Work The Office of the National Coordinator for Health IT also has turned its focus to the “holy grail” of scalable, interoperable clinical decision support. Its effort, a public-private partnership called Health eDecisions (HeD), “is seeking to define and validate standards that enable clinical decision support at scale,” said Kensaku Kawamoto, M.D., Ph.D., the initiative’s Kensaku Kawamoto, M.D. coordinator. Kawamoto, who is also associate chief medical information officer and director of knowledge management and mobilization at the Salt Lake City-based University of Utah, says one need recognized early was a standard data model that is simple and intuitive for a typical CDS knowledge engineer to understand and use. After considering several possibilities, the team chose the HL7 Virtual Medical Record (vMR), which is a simplified and computable representation of the clinical record relevant for CDS. One focus of HeD has been defining and validating a standard, shareable format for CDS knowledge artifacts, including order sets, documentation templates, and decision rules. HeD has completed several pilot projects in this area, in which CDS content from four suppliers (Zynx Health, newMentor, CDC, and Wolters Kluwer Health) were generated in a standard HL7 format and consumed by EHR vendors. For instance, newMentor developed an artifact around a National Quality Forum rule on the use of aspirin or other antithrombotic for patients with ischemic vascular disease, which was translated and consumed in the Allscripts EHR. In addition, HeD has defined a standard approach for EHR systems to access and consume CDS as a Web service. This type of approach has been evaluated by several groups, including an open source CDS organization Kawamoto oversees at the University of Utah. OpenCDS (www.opencds.org), which has members from over 150 organizations, enables the provision of CDS as a service using the HL7 vMR and Decision Support Service standards. Kawamoto says an example implementation of OpenCDS is the Immunization Calculation Engine (ICE), which is being put to use by organizations including the Alabama Department of Public Health, the New York City Department of Health and Mental Hygiene, and eClinicalWorks. The ICE Web service evaluates a patient’s immunization history and generates the appropriate immunization recommendations for the patient. The use of the standards defined by HeD could enable such CDS Web services to be widely adopted at scale. On a practical level, Kawamoto says, organizations may be hesitant to consume decision support as a service if it involves sending patient data out to another institution’s servers, even if it is de-identified. But the creation of solutions built on open source tools such as OpenCDS may allow those organizations to efficiently deploy the services locally and within their own firewalls. Also, Kawamoto notes that “software as a service” is relatively commonplace today in healthcare, and that the consumption of remote CDS services could easily follow a similar pattern of adoption. —David Raths

CDS content to smaller hospitals and provider organizations via Web services. Of course, organizations that do this work to curate, encode and make the content machine-readable and executable will want to be paid to sustain their efforts. Middleton says that perhaps there could be two levels of service, one that is free to get people started and then tiers or levels for fees. Referring to the meaningful use requirements, Middleton says five inter-

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ventions might not sound like too much to ask, but there are multiple detailed requirements that will make it a challenge for some providers. “Of course, there is also a lot more to do beyond that. We are just scratching the surface, and the challenges of meaningful use Stages 2 and 3 will just further highlight the need for academic medical centers to start making CDS knowledge artifacts available at low cost or even free. It’s part of our mission,” he says. ◆

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Getting Out of the Compliance Mindset: Doing More with Data Security LEADING HEALTHCARE ORGANIZATIONS HAVE TACKLED THE GROWING ISSUE OF DATA SECURITY THROUGH DIFFERENT TECHNOLOGIES BY GABRIEL PERNA

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t West Virginia University (WVU) Hospitals, the traditional barriers of data protection have always been in place, but for Mark Combs that just wasn’t good enough. Combs, the organization’s chief information security officer, says the Morgantown-based multi-hospital, nonprofit health system has tried to stay ahead of the game when it comes to use of electronic health records (EHRs) and the subsequent protection of that data. Even before it implemented its current EHR, from the Verona, Wis.-based Epic Systems, it had a physician order entry system from Eclipsys (now part of the Chicagobased Allscripts). Back then, it did manual audits of user activity from various systems to ensure there was no inappropriate access of protected health information (PHI). Over time, leaders at WVU Hospitals decided they had to strengthen this capability, adding enterprise-wide audit manager software (from the Boxford, Mass.-based Iatric Systems), which al-

lows the organization to monitor access to patient data across multiple applications. Combs says his organization didn’t take this extra step because of a single incident, but just in the realization that it had to do more. “We wanted to be proactive,” Combs

22 November/December 2013 • www.healthcare-informatics.com

says. “We wanted to make sure we are preventing breaches. The mindset I tried to take is that our patients come to us for care and treatment of some pretty sensitive issues at times. If the patient doesn’t trust us with this information, then they are less likely to tell us if they

nologies for data secucal systems. rity comes down to that “Convenience was a notion of patient safety. big driver,” says Philip With the security audit Bierdz, infrastructure manager, the organizamanager at Riverside. tion feeds several differIn the past, to log onto ent clinical and adminisan application, the trative data applications doctor would be pullinto it simultaneously. ing out a small sheet of The data comparison paper with their variplatform allows a team of ous passwords on it. auditors to see when PHI Many times, he says, could possibly being used the physician would Mark Combs amiss, possibly with VIP accidentally leave that patients or in the case of paper at one station neighbor snooping. and have to rush back “The fact that we could to get it. “We had to correlate logs from differmake it as simple as ent applications, when possible for the physiI was picking out a syscian to use the techtem, [this capability] was nology; otherwise, they sort of unique. This pulls were going to rebel everything together and against the whole order gives you that picture of entry process.” what people are doing The system Riverwith the PHI in your orside implemented alganization. That’s imporlows physicians to use Seth Crouch tant. One of the things access an application HIPAA requires is that with a fingerprint and we know where PHI lives one log-in. The use of and how it’s working within our net- their fingerprint allows the system work,” Combs says. to remember their credentials. If the For the diverse healthcare organiza- fingerprint doesn’t read, they have to tions that have gotten out of the com- type in the password themselves. To pliance mindset and taken those extra Bierdz, the use of a secure fingerprint steps, often, there are outlying reasons. scanner wasn’t about regulatory comAt Riverside Medical Center, a 336-bed pliance, but rather protecting patient information and their safety. The added fact that it made the physicians’ lives easier was a win-win.

THIS PULLS EVERYTHING TOGETHER AND GIVES YOU THAT PICTURE OF WHAT PEOPLE ARE DOING WITH THE PHI IN YOUR ORGANIZATION. THAT’S IMPORTANT. ONE OF THE THINGS HIPAA REQUIRES IS THAT WE KNOW WHERE PHI LIVES AND HOW IT’S WORKING WITHIN OUR NETWORK. —MARK COMBS cally needed to know the law and the requirements, and go through it like a checklist. That’s not sufficient anymore.”

PROTECTING PATIENT SAFETY At WVU, investing in emerging tech-

hospital in Kankakee, Ill., employing biometric dual-factor authentication, single-sign on technology (from the Lexington, Mass.-based Imprivata) made credentialing seamless and easy for its physicians, who were using several different log-ins for different clini-

TEXTING IN TEXAS In terms of proactive measures surrounding data security, Bierdz has his sights set on text messaging in a medical setting. Because of its instant gratification appeal to both practitioners and patients, it’s becoming a desired technology in healthcare settings, but it presents some of the industry’s toughest challenges, he says. “That’s a very difficult area for IT organizations to get their arms around, because text messaging goes through different end-point mediums. Doctors have their own phones. Hospitals some-

www.healthcare-informatics.com • Healthcare Informatics 23

FEATURE

have some sensitive issue going on with their body.” In an increasingly dangerous environment for data protection, this is the mindset providers should take, say multiple data security experts. The stats back them up. A whopping 94 percent of healthcare organizations have had at least one data breach in the last two years, according to a 2012 independent study by the Ponemon Institute. The same study estimated that overall economic impact of a breach has risen sixfold in the last few years and now costs millions. Not just that, but as Jared Rhoads, a senior research specialist with the Falls Church, Va.-based CSC’s Global Institute for Emerging Healthcare Practices, and Mac McMillan, co-founder and CEO of CynergisTek, Inc. and current chair of the HIMSS Privacy & Security Policy Task Force, both explain, the threats to data security are evolving. Cybercriminals are becoming more sophisticated. “It’s much easier to be on offense than on defense,” says McMillan. For all these reasons, he and Rhoads implore providers to go above and beyond. “We’re encouraging organizations to get out of the compliance mindset,” Rhoads says. “For a long time, security and privacy were dealt with as the sort of things you had to comply with. There was HIPAA [the Healthcare Insurance Portability and Accountability Act] and maybe some state level laws. You basi-

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times provide their own phones to end- center, and other specialties. At that users. People have their own personal organization, Chris Akeroyd, director phones,” Bierdz says. Sending PHI over of IT infrastructure at UMC Health Systext messages, in an untem and other IT leaders controlled environment, have similarly invested is not only unsecure, but into secure mobile text a serious concern for promessaging (Imprivata), viders. For this reason, IT as a way to evolve beleaders have struggled to yond the old pager syscome to grips with the tem and adapt securely bring-your-own device to a growing physician movement, says CSC’s need. Rhoads. This app allows pracIn Lubbock, Texas, titioners to instantatwo healthcare organizaneously send out mestions have taken aim at sages, often from nursing Jared Rhoads data security within the units to the physician, confines of mobile text adhering to HIPAA-commessaging. Covenant Medical Group pliant protocols. While the physicians (CMG), a nonprofit medical group have benefited from this, ultimately, the comprised of 182 physicians, adopted patient is the big winner. “We undera comprehensive unified communica- stand the risk with using standard text tions platform across the enterprise message protocols, and we take that pa-

WE’RE ENCOURAGING ORGANIZATIONS TO GET OUT OF THE COMPLIANCE MINDSET. FOR A LONG TIME, SECURITY AND PRIVACY WERE DEALT WITH AS THE SORT OF THINGS YOU HAD TO COMPLY WITH. —JARED RHOADS (from the Knoxville, Tenn.-based PerfectServe). Seth Crouch, CMG’s director of ambulatory services, says the investment came from practitioners’ interest and use of text messaging to each other. Most were using their own devices, over their traditional cell phone networks, not realizing that it was probably inappropriate, he says. Crouch brought in the messaging app, which can be used on both mobile and desktop devices, and got the physicians and nurses to buy-in. The app, he says, has taken off, with nearly 100 percent of the physicians having adopted it within the medical group. Not only has it effectively secured text messaging, it has also improved care coordination across different specialties. Across town is UMC Health, an integrated, 450-bed teaching hospital of Texas Tech University, with a Level 1 Trauma Center, a burn center, a cancer

tient safety element seriously. We want to do what’s best for our patients,” says Akeroyd.

NOT JUST SECURITY Leading edge healthcare organizations have found numerous platforms to enhance data security in the age of digitization. At UMC Health alone, Akeroyd says the health system has implemented data loss prevention software (from Mountain View, Calif.based Symantec) that watches all traffic within the network, focused on potential real-time data leakage. It is also in the process of establishing a computer incident response team that will monitor network traffic for more rudimentary purposes, i.e., virus detection. According to Rhoads from CSC, other providers are looking at managed security systems as a way to tackle data security. This is when providers

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bring in a third-party IT security vendor to manage its operations, whether remotely or onsite. “You’re basically bringing in help from the outside. It’s treating security like a service you would purchase from a vendor. A lot of times it can be cheaper than trying to do it yourself,” he says. Of course, Rhoads points to an issue that all healthcare providers, even the ones ahead of the pack, are encountering when it comes to proactive data security technology: return-on-investment (ROI). As CynergisTek’s McMillan notes, one of the challenges of bringing in these technologies is their perceived cost. With providers spending millions upon millions on EHRs and coding systems to comply with meaningful use and ICD-10, security gets left in the dust. In this vein, McMillan says, healthcare IT leaders have to look at the system beyond the notion of security. Clearly, this is a strategy that has paid off for the UMC Healths, Riverside Medical Centers, and CMGs of the healthcare world. “Don’t look at it as just a security system, look at it like it’s any other system, and do the analysis to identify the benefit and ROI from that technology. We look at other systems, and we say, ‘If we buy this bed tracking system, we’re able to funnel 13 more people through the system and accrue this much more revenue from an operational efficiency perspective.’ Look at security the same way, in terms of what is the cost of an outage or a data breach, and what this technology will do for ROI. We have to do a better job of understanding how these technologies fit into our businesses and contribute to the top and bottom lines,” McMillan says. ◆

For more on how proactive healthcare organizations are taking on the issue of data security head-on, visit Healthcare-Informatics.com, where Senior Editor Gabriel Perna is digging deeper with a series of published interviews.

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COVER STORY

COVER STORY I (Continued from p. 12)

LOOKING TOWARDS PATIENT OWNERSHIP

those with limited Internet skills,” Mendelson says. “But if you had a CT scan because you have a tumor, and you’re shopping for care and going to specialists, the burden is eased if you can move your images around. That becomes important.” Being able to not only potentially share an image that a patient has taken through the portal, but also view their images

through the portal is great, agrees UC Health’s Rugh. “We’re already allowing them to view their images through the portal. I think using the portal and allowing them to view and share from another physician is right where we’re headed.

It’s a way to get patients involved in their care.” It is important to remember that any patient receiving an imaging study has a right to request copies, guaranteed by the Health Insurance Portability and Accountability Act (HIPAA), adds Strong. “It’s in their best interest to keep an archive of their own imaging. There is no national repository or universal medical record number—patient record numbers vary from hospital to hospital or network to network, making it difficult for a patient to travel and have his or her medical record follow him or her in any accurate format. That being said, we would like—and have considered—a system in which a patient could request a second opinion. This has been done by no one in a concerted fashion that I’m aware of. In the future, there could be a portal where a patient could upload images and request a second opinion. I think that day is coming.” ◆

support moving to a whole new plane, So I think the clinician will be doing an as thinking computers like Watson pull ‘over-read,’ whether it’s the pathologist, data and image inputs from a variety of dermatologist, OB/gyn, or radiologist.” sources in enterprise-wide image and Hickman immediately adds that “Of data repositories and course, there’s no replaceuse those inputs to supment at all for the human port physicians’ diagnoskill of interpretation. ses and decision-makBut the initial read will ing at the point of care. change, based on tech“Think about imaging nology. It won’t happen in the form of radiograin five years, but that kind phy and related elements of work is already being like ultrasound, and then done on the cellular level” add dermatology imin some developmental ages, and then add celsituations now. “So I’m lular, pathology images, quite sure that’s where and think about the data things are headed.” Russell P. Branzell associated with those Russell P. Branzell, images,” Hickman says. president and CEO of “What’s going to happen is that those CHIME, says that the federal governkinds of inputs will be fed into these big ment must move forward rapidly on computers like Watson, and Watson is data standards in order to facilitate this going to learn what those images are, and kind of work. Still, “On the micro level, will be able to say when presented with some individual patient organizations an image, there’s 94-percent chance that are already making progress in that this is ‘A,’ meaning a particular condition. area,” Branzell says, speaking of Poudre

Valley Health System (now part of the University of Colorado health system), where he was CIO. “We did this in the organization I was in—radiology, cardiology, pathology, OR films, photos, essentially anything that can be saved as a wav file, image file, or DICOM file, we put into the same storage system, so any primary care physician, trauma surgeon, or OR physician, can then see things. What you see there is, you can reduce the care cycle, the time lag involved in caring for the patient—all of that while reducing the cost, because of reductions in excessive testing; and we were sharing images with most of the health systems in Colorado.” Ultimately, he says, it will be extremely important for healthcare leaders to come together across all the medical specialties, not just radiology, to advance this vision of the easily facilitated sharing of images of all types, and data, for a new world of clinical decision support and collaborative, team-based care delivery. ◆

One of the next steps in imaging informatics is giving patients some form of ownership over images and reports, through image-enabled personal health records, an idea that is embedded as a goal in Stage 2 of the meaningful use process under the HITECH Act.

KNOWLEDGE ABOUT THE STUDIES WE’RE HANDLING AND THE PRECISE NEEDS THAT ARE THUS REQUIRED ARE REALLY ONLY POSSIBLE BY NORMALIZING THE TERMINOLOGY FOR STUDIES ACROSS THE ENTIRE PLATFORM ON WHICH WE DEAL. THAT IS REALLY THE CUTTING-EDGE TREND NOW. —BEN STRONG, M.D. Patient portals and meaningful use are drivers to accessibility, as providers now want it, says Mendelson. “We have learned there is a large constituency of patients who want ownership of their data. Certainly, it’s not for everyone—there are

COVER STORY II (Continued from p. 15)

26 November/December 2013 • www.healthcare-informatics.com

INNOVATION PERSPECTIVE

Guiding I.T. Strategy AT THE HELM OF THE VAST CLEVELAND CLINIC, CIO C. MARTIN HARRIS, M.D. REFLECTS ON NEXT STEPS BY MARK HAGLAND

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n October, leaders at the Cleveland Clinic—the large integrated health system based in Cleveland that encompasses 10 owned hospitals and one affiliate hospital, with 4,450 beds, plus more than 75 outpatient locations in northern Ohio, as well as more than 3,000 physicians and scientists, and serves 5.1 million patients a year—presented its annual Cleveland Clinic Medical Innovation Summit, under the theme, “Finding Balance through Innovation: Obesity, Diabetes, & the Metabolic Crisis.” On the eve of the organization’s innovation summit, HCI Editor-in-Chief Mark Hagland interviewed C. Martin Harris, M.D., the organization’s CIO and chairman of its information

technology division, to learn his perspectives on the bold innovations taking place at Cleveland Clinic. Below are excerpts from that interview.

I.T. STRATEGY AS A DRIVING FORCE FOR TRANSFORMATION Healthcare Informatics: Overall, as CIO, what is your vision of the IT strategy that you’re helping to facilitate at Cleveland Clinic, at what many are regarding as an exciting and a challenging time in healthcare? C. Martin Harris, M.D.: You’re absolutely right, it’s both an exciting and a challenging time; but from my point of view, www.healthcare-informatics.com • Healthcare Informatics 27

INNOVATION PERSPECTIVE it’s absolutely the right time to be in healthcare is aware of that now. The greater challenge is and healthcare IT. As I think about strategy, I working as an interdisciplinary team, and we really think about only one strategy, and that’s have to get everyone in that team to practice the strategy of the organization, of the actual at the top of their license. healthcare delivery organization, the Cleveland A SHARED SENSE OF TEAMWORK Clinic. The basic challenge all healthcare delivIS CRUCIAL ery organizations face right now is this: how we HCI: As we move towards that new model, the maximize the quality of care we deliver, that we old turf wars around the old “guild” system of provide a great patient experience, and that we clinical prerogatives are beginning to disapbe as cost-effective as possible. Healthcare IT pear, right? is really critical to achieving that strategy; and Harris: Yes, absolutely; in order to hit that it really is focused on redesigning that care deC. Martin Harris, M.D. value target in the new value-based healthlivery model, giving us opportunities to interact care, you have to think about maximizing with patients at different points in time and in teamwork. different ways, that will meet all those objectives. HCI: Meanwhile, even those physicians in practice who are The simple example I’ll share here is around orthopedic care—patients who are going to be getting knee and hip on board with the new healthcare—the emerging accountable replacements. Historically, someone would develop a care, care-managed, system—say that the clinical IT tools problem, see a primary care physician, eventually get a they’re being given aren’t helping them to do their jobs better. Harris: Just as getting to value-based healthcare is a journey, consultation with an orthopedist, and eventually, come providing optimal IT tools for physicians is a journey. It’s around to the decision to get a replacement. We start with the idea that someone will see an orthope- highly unlikely that a computer company will be able to build a tool that is ready to cover the gamut of healthcare. That’s why this is a really exciting time, particularly at the Cleveland Clinic—we are completing the journey of getting the needed tools to everyone, physicians, nurses, pharmacists, allied health professionals—and that’s why I could give you that example of the orthopedic knee and hip replacement situation. IT can cover all the transitions of care; and dist, and we have the ability to send to them over the Web what is constant are the management of the person and a a survey that assesses their functional status, and a general shared sense of teamwork, based on having all the informasense of their activities of daily living. Related to your hip tion, and that the information is organized in a way so that you and knee, how much can you do? If you’re going to have see what you need to do. Yes, an EMR does not come delivered an outcomes-driven process that really drives quality, the like that today. Somewhere in the next five to 10 years, you’re patient is really going to be a big part of that success. Now we likely to see that. collect that information over the Web; and let’s say a patient HCI: What are your biggest strategic IT challenges right now needs a hip replacement. They’re now put into that care path, at Cleveland Clinic? which is a series of tools inside the electronic medical record Harris: The challenge element is partly being driven by the (EMR) designed to maximize the clinical outcome and mini- complexity of the challenges in this value-driven world. All the mize the variation in getting to that. If we do that, we will care providers belonging to this collaborative probably will optimize the outcome and minimize the expense. not belong to the same organization; so the biggest challenge HCI: Do you think that most physicians affiliated with to my mind right now is the effectiveness of interoperability. Cleveland Clinic understand your strategy? We talk about it a lot, but the effectiveness and sophistication Harris: That’s a journey. Most physicians understand the are going to have to improve considerably. need to manage care in a different way. They’re getting that HCI: We’re still doing a lot of interfacing now, to be honest, input through report cards coming out of Medicare and out right? of independent organizations. There is this sense that you’re Harris: Yes, point to point—and that’s even worse. going to be measured by objective data, and every physician HCI: Can you articulate your philosophy and strategy around

I BELIEVE THAT WE HAVE THE OPPORTUNITY, THROUGH THIS TRANSFORMATION PROCESS, TO TAKE THE PRECIOUS FINANCIAL RESOURCES WE HAVE, AND REAPPLY THEM, AND ACTUALLY GET A BETTER OUTCOME FOR PATIENTS AND FOR SOCIETY, THAN WE DO TODAY. —C. MARTIN HARRIS, M.D.

(Continued on p. 36) 28 November/December 2012 • www.healthcare-informatics.com

INTEROPERABILITY UPDATE

Patient Matching CHIME PANEL DISCUSSES POTENTIAL APPROACHES AND ‘DREAM’ SOLUTION TO A GROWING CHALLENGE FOR CIOS BY MARK HAGLAND

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n Oct. 10, during the CHIME Fall CIO Forum, being held “We’ve heard suggestions that a whole community should adopt at the Westin Kierland Resort and Spa in Scottsdale, a common technology. That could be effective, but it could really Ariz., healthcare IT and health information manage- be prohibitively costly.” ment (HIM) leaders discussed a topic whose Asked about the role of the federal government, importance has been receiving increasing all the panelists agreed that it had a role in this attention lately, in what was billed as a “Special area, though with different emphases. Durkin Plenary Session: The Future of Patient Identificasaid, “I liken it to federal involvement in highway tion: Challenges and Strategies for Achieving safety. You establish the rules of the road for evTrue Interoperability.” erybody.” Sudomir said, “In the end, work on this Russell P. Branzell, president and CEO of the really needs to be harmonized with  meaningful College of Healthcare Information Management use and care management efforts.” Executives (CHIME) chaired a panel discusIn his final question to the panel of discussants, sion along with industry leaders, on the topic Branzell said this to them: “If you could define of patient matching. Joining him on the panel your dream for patient-matching identification, were Stacie Durkin, R.N.-C, founder, Durkin & what would it look like? And give a realistic timeAssociates, Kansas City, Mo., and a member of frame.” Spooner said, “I think it’s most important Bill Spooner the Patient Identity Practice Brief Work Group at that I achieve accuracy within my own comthe Chicago-based American Health Information munity. I’d just really like to find a solution, and Management Association (AHIMA); Joey Sudomir, vice president, I really think there could be some good pilots, in a community Texas Health Partners, Arlington, Texas; and Bill Spooner, senior like my own. I applied to Farzad [Mostashari, M.D., then National vice president and CIO, Sharp HealthCare, San Diego. Coordinator for Health Information Technology] for a million Among the numerous topics discussed were the role of ven- dollars last year, but he gave it to someone else; but you could do dors  in resolving the issue; the large element of patient safety; that short of Congress having to pass some law. And there would the potential for biometric technologies to aid in establishing be a role for HIEs. The HIE could definitely be the clearinghouse.” community-wide patient matching systems; and the roles of the “My goal,” said Durkin, “would be that there’s one record for federal government and of health information exchanges (HIEs) one person, no matter where the sources of information are comin advancing the U.S. healthcare system forward in the patient ing from. A timeframe for that I would hope that we could do it matching arena. sooner than later, but if we continue down the path and there’s With regard to  vendors, Durkin said that “I think our  ven- a lot of active work around identity management, realistically, it dors really need to understand what we go through as providers.” could be done in three years.” Spooner averred that, with regard to Sharp, “I think our  ven“Just give us a national patient identifier and we’ll knock it out dors have been really good” on the issue. “I’d have to push them in 12 months, right?” Sudomir responded. “But I agree with Bill, really hard to make them better.” it’s important to start at the community level. I think it’s realistic Biometrics was clearly seen by the panel as being embryonic to say that within five years across enterprises, we would have the in its potential to resolve patient matching issues. When Bran- ability to, within 75-to-80-percent accuracy, match identities. But zell asked Durkin whether she had seen any best practices for it’s going to take collaboration, and some quick work. The governthe use of biometrics in patient matching initiatives, she said ment obviously is going to operate with a little bit more efficiency that she had not. Sudomir offered that Texas Health Resources, than they have been, because I think it’s very important for this “our parent company, is using the palm-vein matching system, work to catch up with meaningful use criteria. Perhaps in Stage but that’s within one organization, so it’s only effective for one 3? But it’s a worthy cause.” system; but there is beginning to be some potential guidance “It's a worthy cause,” Spooner replied, “but I wouldn't want us on thumbprints and fingerprints.” Spooner quickly added that to put this into Stage 3 without thinking this through carefully.” ◆ www.healthcare-informatics.com • Healthcare Informatics 29

POPULATION HEALTH PERSPECTIVE

Population Health from the Front Lines ORLANDO HEALTH’S SCHOOLER SPEAKS EXCLUSIVELY WITH HCI ABOUT POPULATION HEALTH BY MARK HAGLAND

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n Oct. 10, Rick Schooler, the vice president and CIO of the seven-hospital Orlando Health integrated health system, gave an educational track presentation at the CHIME Fall CIO Forum, being held at the Westin Kierland Resort and Spa in Scottsdale, Ariz.  In his presentation, titled, “Building a Scalable and Automated Population Health Infrastructure for Clinical Integration and Care 30 November/December 2012 • www.healthcare-informatics.com

Management Under Value-Based Care,” Schooler spoke in depth about the broad initiative that his organization has been engaged in to move towards a population health and care management strategy as a core operating principle for the organization. Indeed, as Schooler noted, the strategy that he and his colleagues embarked upon has been formally articulated in a

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POPULATION HEALTH PERSPECTIVE statement of purpose, thus: “Orlando Health’s ity Assurance (NCQA) via Phytel’s NCQA journey will create a patient-first, clinically auto-credit solution; integrated model of care in collaboration with • Enabled management to determine our medical staff, to pursue seamless, quality physician quality bonuses by tracking outcome-driven, extraordinary care.” compliance with quality measures; Among the steps already taken, the health • Achieved an 83.6-percent success rate system’s leaders have: of contact with at-risk patients, while • Formed a regional clinically integrated closing 6,928 chronic and preventive network with the University of Florida, gaps in care; encompassing 1,300 employed physicians; • Enabled MSSP ACO reporting mini• Acquired the largest primary care group in mizing physician work and clinical central Florida, with over 38 locations and documentation steps, providing dual Rick Schooler over 500 employed physicians; documentation for ACO development • Initiated participation in a Centers for and for meaningful use; and Medicare & Medicaid Services (CMS) patient-centered • Increased net revenue for the organization while acmedical neighborhood; complishing all of the above. • Been approved as a Medicare Shared Savings Plan As Schooler told his audience, in order to succeed at (MSSP) accountable care organization (ACO), begin- population health, “It is going to take technology not availning operations in January 2013; able to us today, and you [CIOs and other senior healthcare • Executed, or are negotiating, shared-savings contracts IT executives] are going to have to make some investments, with Cigna (effective 2013), and with Aetna and Blue and you’re going to have to move in some different direcCross Blue Shield (effective 2014); and tions. This is new to most of us.” • Selected and implemented the population management Schooler told his audience that six barriers needed to technology platform from the Dallas-based Phytel. be overcome in the drive to make population health and Schooler and his colleagues are combining the risk accountable care an overall organizational strategy: stratification capabilities that they’ve been using for several • Alignment and commitment of physicians, i.e., clinical years already, from the Jersey City, N.J.-based Verisk Analytintegration; ics, with the care coordination and patient engagement • Shift of mentality to proactive care—e.g., the patientcapabilities available through the Phytel platform. Within centered medical home; • The need for technologies beyond the electronic health record (EHR) and practice management, and with a different perspective; • Appropriate data to proactively manage populations and to ultimately assume risk (analytics and predictive modeling); • Patient engagement; and • Short-term pain for long-term success. “Clinical integration is the foundation” for any population health management strategy,” he told his audience; and, he immediately addthe next several months, Schooler expects the programs to ed, some strategic and financial “alignment is essential,” be fully live in operation together. whether it involves physician contracting or physician Among the results that Schooler reported to his audi- employment. ence, that have been documented as occurring between After the session concluded, Schooler spoke exclusively December 2012 and July 2013 are the following: with  HCI  Editor-in-Chief Mark Hagland, and shared with • An on-time, on-budget rollout of solutions across 100 him additional insights and perspectives. Below are exphysicians; cerpts from that interview. • A 52-day implementation process, with 40 feeds across EARLY TAKEAWAYS FROM six inpatient and ambulatory information systems; • Facilitated the patient-centered medical home (PCMH) THE POPULATION HEALTH JOURNEY certification through the National Committee for Qual- Healthcare Informatics: When you look at this early phase of

FOR A LOT OF DOCTORS, MAKING THAT SHIFT FROM ENTREPRENEUR TO BEING PART OF THE BIG MOTHER SHIP, WITH THE LOSS OF CONTROL AND AUTONOMY—THE SMART ONES ARE ALREADY GETTING IT, THOUGH; THEY SEE THE VALUE OF THE LONG-TERM. —RICK SCHOOLER

32 November/December 2012 • www.healthcare-informatics.com

POPULATION HEALTH PERSPECTIVE your organization’s journey into population health management and accountable care, what would you say are some of the biggest lessons you’ve learned so far? Rick Schooler: With regard to clinical integration, there’s a lot of difference of opinion across physicians, mainly, about what is reasonable and what is really required, to get to the outcome—what they’re willing to go at risk for. Of course, you’ll always have the question of the data, but beyond that, if you go into markets where the old fee-for-

HCI: What advice would you offer to colleagues right now in other organizations beginning to move down the path towards population health management and accountable care? Schooler: If your organization isn’t talking about clinical organization, and they’re not actively engaging in aligning, either through contracting or employment ( full integration), and if you’re not having discussions with payers about quality and getting incentives, and getting reimbursement for quality outcomes, and if you’re not actively pushing to really improve your organizations’ quality outcomes, you’d better find somebody who is. Also, I really want to give credit to three senior executives in our organization for their assertive leadership in all of this: Wayne Jenkins, M.D., Jennifer Endicott, and Cynthia Powell, M.D. Dr. Jenkins is over our entire physician enterprise; Dr. Powell is over the medical group that includes our salaried physicians; and Jennifer Endicott is our vice president of clinical integration. They’ve really been pushing this thing forward. ◆

WHEN YOU CAN BRING TOGETHER YOUR RISK MANAGEMENT AND YOUR CARE MANAGEMENT, YOU’VE GOT BOTH THE MATERIAL AND THE CATALYST, IN ORDER TO DO INTERVENTIONS. —RICK SCHOOLER service is still dominant, which is still a lot of markets, doctors will need to get the message about the importance of hospital-physician alignment. There will be some who won’t need to align, quite frankly—like my ophthalmologist, for example—some of the super-specialists, like orthopedic surgeons. But that’s hard work. Then you have to decide, which of these do you we actually need to employ as part of our permanent health team? For a lot of doctors, making that shift from entrepreneur to being part of the big mother ship, with the loss of control and autonomy—the smart ones are already getting it, though; they see the value of the long-term. HCI: Tell me about your path towards creating an analytics and care management interface with two vendors. Schooler: Historically, we would work with the folks at our owned health plan, HealthChoice, to help us to monitor claims and to see who was utilizing us the most—for example, with human growth hormone utilization. That helps us understand where the money is going and how we’re utilizing the health system, using claims-based data; so you have that historical information, and now you couple that with the clinical data. For example, we need to be able to predict which patients whose care we’re managing, who is most likely to have a hospitalization or an ED visit. We now, with both types of data, can say, your a1c is off the charts; or your BMI is changing rapidly, you must be retaining water. When you can bring together your risk management and your care management, you’ve got both the material and the catalyst, in order to do interventions. HCI: Are you live yet with the combined capability? Schooler: We’ve been live for years with Verisk as an embedded system. We went live with Phytel in January and February, and we’re pushing to be able to use that capability, live, within a matter of months.

Need a new job? Need to fill a job opening? If you’re in healthcare information systems and it’s time for a career change, get in touch with us at Belle Oaks of America. If you’re a healthcare software vendor, a health system, or a consulting firm put our 33 years healthcare IT recruiting experience to work on your hard to fill openings. Check us out at www.belleoaks.com Ed Simmons, CPC 772-492-1844 [email protected] Peter Converse 323-369-3447 [email protected]

www.healthcare-informatics.com • Healthcare Informatics 33

POPULATION HEALTH PERSPECTIVE

Delivering Data in Real Time HOW MARTIN’S POINT HEALTH CARE HAS LEVERAGED ITS DATA FOR EFFECTIVE POPULATION HEALTH MANAGEMENT BY RAJIV LEVENTHAL

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any healthcare organizations at the Medical Group Management Association (MGMA) annual conference, held in October in San Diego, Calif., have been moving forward with their population health initiatives. At the core of these initiatives are a number of common elements, one of them being the ability to provide physicians in practice with real-time data on their patients. Martin’s Point Health Care, based in Portland, Maine, is a provider organization with three health plans and nine health centers spread across the Northeast. In 2000, at a time when most healthcare organizations weren’t investing in data management and informatics, Martin’s Point built a data warehouse as part of an effort to better understand the data it had, says president and CEO David Howes, M.D. Moving forward, Martin’s Point needed the right data at the right fingertips at the right moment—a system-wide standard solution—that would allow providers to see their data at all levels. Without that capability, the goal of effective practice-based population health management was not possible. Enter the Madison, Wis.-based population health management solutions provider Forward Health Group (FHG), which deployed its PopulationManager tool at Martin’s Point, allowing the organization to “unfreeze” its patient population data and see it from any altitude. According to Michael Barbouche, founder and CEO of FGH, despite working with many of the big names in the healthcare policy circles, only Martin’s Point could walk the walk when it came to having its data there. Martin’s Point has advanced the idea of looking at performance improvement. “They have measures they have to report on, called reporting 34 November/December 2012 • www.healthcare-informatics.com

measures, defined by a PDF somewhere. But they also have opportunities to do better. These opportunity measures are a second shot, and that is where Martin’s Point is unique,” Barbouche says. At the conference, HCI Assistant Editor Rajiv Leventhal had a chance to sit down with Martin’s Point’s Howes and FGH executives to talk about the organization’s population health vision, the key aspects and challenges to it, and effective population health management strategies. Below are excerpts from that interview.

POPULATION HEALTH PERSPECTIVE TRANSITION FROM MANUAL PROCESSES

came to Martin’s Point (I came as physician Healthcare Informatics: When did you realize and wound up being the president quite by you needed to step up your population health accident), it struck me that we had to build management efforts? standards of care, and that we had to collect David Howes, M.D.: We are a medical group the data in granular enough form to display it with about 50 physicians and 20 mid-level back to clinicians. [providers]. We have been in business as an In 2000, when we built the data warehouse, independent medical group for about 32 years, we only had business data. But we built it beand have had a long-standing set of manual procause we wanted to understand how to mancesses that we use to keep track of our medical age a data warehouse before we had the clinical risks. We weren’t doing bad work relative to the data. When we put in the EHR, we collected all rest of the market, but there were still a lot of the granular data and had an infrastructure David Howes, M.D. gaps and weaknesses. in place to collect it. Now, all of the EHR data In 2000, we began building a data warehouse, is dropped into the warehouse daily and then before we had the ability to put electronic health goes into the PopulationManager tool. That’s an record (EHR) data into it. Then six years into it, we put all the enormous contrast from where most clinical practices are, as granular EHR data into it, and built a form set that included the health plans give them the data. They’re taking it out of all the frequent diseases. Even with that, we weren’t very suc- billing records, not clinical records. With that, it’s very hard to cessful. get really specific, and the claims lag is three months. Then we decided to hook up with Forward Health Group. But this is timely, it’s as accurate as can be in a real world, We were set up well to use their services because we had a and it’s actionable. Our nurses go through PopulationManager data warehouse with all the granular, clinical data in it. We each day and they look at what’s in the hopper, who needs to be had a culture of population health in place because we were seen first, where the largest gaps are, what are the oldest gaps, an at-risk entity. It’s been a lot of fun, too. We really know every etc. They begin to plug those people into physician practices diabetic we have, for the first time now. At the organizational with a conversation either electronically or face-to-face with a level, we have a good picture of who’s in good control, and physician, discussing what needs to be done for each patient. who’s not. At the level of the front line, physicians know the So yes, it’s about the data. You have to capture the granular, critical data elements. If you don’t know the lab studies on a patient with renal failure, or you don’t know the medications for a patient with congestive heart failure (CHF), you won’t be able to do this. The data needs to be in the warehouse. You need to capture it and care about it. list of people they have with each chronic disease and which That’s been a mantra we have followed for a long time, and if people have overlaps, allowing them to identify highest-risk you’re not there, you better be going there. folks. Our quality committee has come to recognize that managing CLINICIAN BUY-IN this well is probably the most powerful tool we have in reduc- HCI: And how do clinicians feel about all this? Howes: They’re good with it. Clinicians are anxious to do beting the total cost of care. As an at-risk entity, that matters. Our health plan partners are demanding that, in order to collect ter work and improve the care of populations, but they don’t our risk savings, we meet our quality standards; and our board have the time. They have an overwhelming amount of people wants to know what our numbers are like. At the macro level, flowing in the door for their acute needs. We use the data to it’s the board. At the micro level, it’s the physician who wants report back to them about where their gaps in care are, what to understand the condition of the patient and what needs to their percentages are, who’s doing well, and who’s not doing well. They’re competitive fellows, and they really want to be happen in order for his or her care to be optimally managed. HCI: It sounds like having the data is the underlying aspect. successful. HCI: What are the IT challenges you face? Would you agree? Howes: Well I’m a country doctor by trade, so I’m not an IT Howes: I’m a family doctor and a son of a family doctor, in a rural practice. Our performance data was always locked up guy. From my perspective, the IT pieces of this don’t seem to in handwritten charts that were in our offices. By the time I be the largest challenge. There is much harder work. We began

OUR QUALITY COMMITTEE HAS COME TO RECOGNIZE THAT MANAGING THIS WELL IS PROBABLY THE MOST POWERFUL TOOL WE HAVE IN REDUCING THE TOTAL COST OF CARE. —DAVID HOWES, M.D.

www.healthcare-informatics.com • Healthcare Informatics 35

POPULATION HEALTH PERSPECTIVE running the data warehouse 13 years ago when we were very small. Replicating what we have today would probably be a challenge. We have invested a lot in informatics for a little organization such as ourselves—I believed it would be our competitive advantage down the road. HCI: What is Martin’s Point vision going forward when it comes to population health management?

ency within your entity, you’ll be in trouble in five years. That transparency will be the law of the land. It motivates clinicians and clinician teams, and it makes a monstrous difference in performance. It may not be the right data—we have measured the wrong things a lot of times and have had to junk it and come back. But getting something relevant out there and beginning to discuss it, beginning to build processes to improve it is where you have to go right now. Between now and the end of 2015, we have determined we are no longer going to try to grow our practice in terms of patients. We are instead going to try to close all gaps in care. What is so striking is that in order to close all gaps, we estimate that we will have a 40 percent increase in visits. There are just too many gaps. It’s a unique way to think about it. We have a health plan system where we have 70,000 members of whom 40 percent are over the age of 65. In that population, we have roughly 3,500 gaps in care around CHF alone.  For instance, there are people who are not getting their ACEs or ARBs, or people who haven’t been educated around managing their weight. The list goes on and on. Hospitalizations can be reduced, quality of lives can be improved, and in fact, even in a fee-for-service world, the economics can be beneficial to a practice that is offering that. ◆

YOU HAVE TO CAPTURE THE GRANULAR, CRITICAL DATA ELEMENTS. IF YOU DON’T KNOW THE LAB STUDIES ON A PATIENT WITH RENAL FAILURE, OR YOU DON’T KNOW THE MEDICATIONS FOR A PATIENT WITH CONGESTIVE HEART FAILURE (CHF), YOU WON’T BE ABLE TO DO THIS. —DAVID HOWES, M.D. Howes: I would say first that the healthcare value proposition is entirely changing. You won’t succeed without the data in the next generation. You have to collect the data at a granular level, you have to warehouse it, and you have to extract it. If you don’t start today to begin the process of data transparINNOVATION PERSPECTIVE (Continued from p. 28)

co-development, per your Innovation Alliance Program? Harris: Absolutely. I would come back to that example of orthopedics. It’s really important to recognize it as a process. A lot of people think that engaging the physician means getting them to look at a screen and tell you how to organize an EHR, for example. That’s just one piece. In the orthopedic situation, it started out

fice? That causes you to rethink where you locate resources. And only after you’ve done all that, then you’re ready to go think about how you enable that in the computer. That is the process that you need to go through, to get to that enabling piece. If you skip over that and just get to the optimization of the screen, that will do nothing in terms of absolutely transforming the care delivery process. HCI: Do you use performance improvement methodologies as part of that? Harris: Yes, we have a continuous improvement, or CI, team, and they’re there all through the process, working with the clinicians and others on every aspect of any care transformation process. HCI: On a spectrum of optimism to pessimism over what needs to be done, and the challenges in healthcare in the next several years, where do you fall? Harris: I am optimistic, and I will tell you why. I believe that we have the opportunity, through this transformation process, to take the precious financial resources we have, and reapply them, and actually get a better outcome for patients and for society, than we do today. I’m incredibly optimistic. I’m not naïve; there is extremely hard work ahead of us, but I believe we’ll get there. ◆

ALL THE CARE PROVIDERS BELONGING TO THIS COLLABORATIVE PROBABLY WILL NOT BELONG TO THE SAME ORGANIZATION; SO THE BIGGEST CHALLENGE TO MY MIND RIGHT NOW IS THE EFFECTIVENESS OF INTEROPERABILITY. —C. MARTIN HARRIS, M.D. with the clinicians sitting down and writing what we here call a care guide—a pathway. Everyone—physicians, nurses, etc.—was involved in creating that care guide. And medicine is still an art, not a science, still. There are still a lot of areas where you need that interpretation, and it’s good for that interpretation to share information together. That’s a first step; then you get to analysis, a paradigm change, and then the transformation of the process. The analysis says, if we are going to be caring for patients across the continuum, what’s the most efficient way to do those things? What could I do at home? What could I do in the physician’s of36 November/December 2012 • www.healthcare-informatics.com

ACO PERSPECTIVE

The Real-World Experiences of Medicare ACOs EXECUTIVES OF THREE MEDICAL GROUPS DISCUSS THEIR EXPERIENCES AND THE CHALLENGES OF BEING PART OF THE MEDICARE ACCOUNTABLE CARE PROGRAM BY RAJIV LEVENTHAL

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n Oct. 7 at the Medical Group Management Association (MGMA) conference, in a packed room at the San Diego Convention Center that included a standing-room-only audience, practice executives representing three medical groups currently participating in a Medicare accountable care organization (ACO) program—established by the Centers for Medicare & Medicaid Services (CMS)—shared experiences, insights, and challenges that come with participating as a Medicare ACO. The panel of executives included: Gary Gaspard, CEO, Clinics of North Texas (Wichita Falls, Texas); Donald Stumpp, manager of payer contracting, American Health Network in Indianapolis; and Stephen Nuckolls, CEO, Coastal Carolina Health Care in New Bern, N.C. Anders Gilberg, vice president of MGMA government affairs, Washington, D.C., moderated the panel. Below are excerpts from the panel discussion.

MANY REASONS FOR JOINING THE PROGRAM Anders Gilberg: Can you talk about your experiences when you first became a Medicare ACO? Gary Gaspard: We were big on training and educating, because you can’t just hire someone who knows about this stuff—they don’t exist. Stephen Nuckolls: We started in April 2012. When it comes to funding, you have to look at where you want to spend your money. For us, one big aspect was bringing in care managers. We carried 11, and each would care for between 70 and 100 Medicare patients. We set up a 24/7 call line to help patients at night, and expanded urgent care hours and capabilities. Early

on, one of the big mistakes we made was with regard with that line. The care managers didn’t have access to our electronic health record (EHR) after hours, and they would quickly refer patients to emergency room (ER) services. But once we brought the data in-house, we were able to cut down on that. Donald Stumpp: When all this started, the vendors with solutions weren’t out there. It does look like they’re finally catching up and understanding the needs of ACOs. www.healthcare-informatics.com • Healthcare Informatics 37

ACO PERSPECTIVE Gilberg: What are some of the strategies you attracted like minds. We wanted to stay indehave deployed? pendent and deliver quality care. Our results Nuckolls: For our ACO, with 11,000 members, weren’t always what we wanted, so we got towe must show savings of greater than 2.9 pergether and said we have to have the right cocent before we are to achieve savings. Some of ordination and the team must come together. the strategies include how do we reduce ER visThe motivation is in the numbers; physicians its and unnecessary hospitalizations? Having want the money, yes, but they also want to be one hospital, we have it a little easier than othassociated with a high-level Medicare group. ers. We have someone who looks at emergency Gaspard: The closer you are to the physician’s department (ED) summaries and admission practice, the more likely for buy-in. My physisummaries every day for opportunities. We have cians will take their laptops home and work found many opportunities, where patients can until midnight, but to get them to come to an go to the doctor rather than the ER. Once we see ownership meeting, you better be voting on Anders Gilberg those things, we can create the right culture. The something. We have to manage to those personmore access you have for patients, the better— alities. It’s key for physicians to lead physicians. they don’t want to go to the ER and wait for six hours. Nuckolls: It’s important to show the physicians the bottom Stumpp: We do have multiple communities and different line. At the end of the day, there is a reward for changing behospitals, so it’s a different challenge. The little things matter havior. too, such as, what your answering machine says. For instance, Gilberg: Have you seen your first-year results yet? Nuckolls: We have not gotten numbers for our first year yet. We were supposed to get them last week, but government shutdown affected that. We have seen hospitalizations and ER visits down, though. Being in a rural, underserved area creates a challenge, too. Pioneers have S different benchmarks than we do. But have we saved money? Absolutely. Stumpp: We had some preliminary data, and if it says, “If this is an emergency, call 9-1-1,” that is urging them we were right at the minimum threshold. Our benchmark was to run. We try to revamp those things, particularly for high- also low, compared to the national average. Our doctors were risk patients. We want to make sure care coordinators are en- griping that they have done a good job, they have wrung the gaged with them, and let them know that it’s okay to call your towel dry, and it’s hard to get anything more from it. My addoctor and not run to the ER. We are deploying the strategies vice is that if you’re going to become a Medicare ACO in 2015, of a patient-centered medical home (PCMH), even though spend like hell in 2014. we’re not really one. Gaspard: CMS warns you that you can’t calculate to see if Nuckolls: Remember, under our program, you have to im- you will have savings. That seems odd, since you’re a business. prove the quality of care, or you don’t get a dime. Also, when But you’re not privy to part of the CMS formula. Few startups you save CMS money, you save the patients money. It’s an make money in year one. 80/20 model. It works for them, and it’s a great program, which Gilberg: What would your advice be to the people in the I really enjoy. Our group has a point of care dashboard, so this room who are considering the program? enables us to see any gaps in care. The goal for the nurses and Gaspard: I think you have to consider it as an option. Healthphysicians is to take the red (gaps) and turn it to green. care is changing, and we know the direction it’s going in. This Stumpp: You need to meet quality measures, or you don’t get is a good place to start. You can’t turn a blind eye to what is paid for anything, Of course, CMS hasn’t told us what we have going on in the industry. We were lucky enough to receive upto hit yet, but we do know what the 33 measures are. We’re going front funding, but that’s not always necessary. Physicians do to have a natural bell curve in terms of physician performance. want to practice this way, anyway. I really think the ups and downs are well worth your future. GETTING PHYSICIANS ON BOARD Stumpp: It’s where we’re going. You have to look at your marGilberg: Physician buy-in is such a key aspect to this. How were ket, and if it can give you a competitive edge. If so, you might you able to achieve it? as well jump on board. We tell our doctors that this isn’t someStumpp: To be honest, there may not be 100 percent buy-in, thing that’s being forced or that we’re picking on them. Everybut there is a majority. We’re an independent group, so we have one is headed in this direction. ◆

WHEN ALL THIS STARTED, THE VENDORS WITH SOLUTIONS WEREN’T OUT THERE. IT DOES LOOK LIKE THEY’RE FINALLY CATCHING UP AND UNDERSTANDING THE NEEDS OF ACO . —DONALD STUMPP

38 November/December 2013 • www.healthcare-informatics.com

ACO PERSPECTIVE

ACO Development in New Jersey: First-Stage THE CMO OF BARNABAS HEALTH IN NEW JERSEY HAS MUCH TO SAY REGARDING LESSONS LEARNED IN ACO DEVELOPMENT THUS FAR BY MARK HAGLAND

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he West Orange-based Barnabas Health is the largest integrated health system in New Jersey, encompassing seven acutecare hospitals, two children’s hospitals, a freestanding behavioral health center, ambulatory care centers, geriatric centers, the state’s largest behavioral health network, and comprehensive homecare and hospice programs. In May, it signed a definitive agreement for Jersey City Medical Center in Jersey City to become a member of the health system, with completion of the transaction scheduled for this fall. Barnabas Health has created two accountable care organizations (ACOs) and three ACO programs. Barnabas Health ACO North encompasses three acute-care hospitals and 400 physician partners, and currently serves about 10,000 Medicare beneficiaries. The Central New Jersey ACO consists of three Barnabas Health hospitals, as well as the participation of CentraState Medical Center, a non-Barnabas hospital. That ACO encompasses 200 doctors and serves about 20,000 Medicare beneficiaries. Both Barnabas Health ACO North and Central New Jersey ACO are Medicare Shared Savings Program (MSSP) ACOs (with the program being sponsored by the federal Centers for Medicare & Medicaid Services, or CMS), with Barnabas Health ACO North joining the MSSP in July 2012 and Central New Jersey ACO joining in January 2013. Barnabas Health also recently announced a relationship with Horizon Blue Cross and Blue Shield of New Jersey to create a Medicare Advantage program together. What’s more, Barnabas Health ACO North’s collaboration

in NJ-HITEC, the state’s regional extension center and a statewide health information exchange (HIE), has been so successful that it was cited by the then National Coordinator for Health IT Farzad Mostashari, M.D., in a statement he gave on July 17 to the U.S. Senate Finance Committee. The Piscataway, N.J.-based IGI Health has been providing software platforms for both the ACO and the regional extension center (REC). www.healthcare-informatics.com • Healthcare Informatics 39

ACO PERSPECTIVE Recently, Anthony Slonim, M.D., vice president and chief medical officer at Barnabas Health, spoke with HCI Editorin-Chief Mark Hagland regarding all these initiatives and the broad strategies and the implications for U.S. healthcare of these types of collaborations. Below are excerpts from that interview.

We decided to work with IGI to help us with connectivity, analytics, and other aspects. It’s a consulting company that works with us in-depth, to help us advance our infrastructure, connectivity, and data warehouse structure. They’re a partner with us, as are NJ-HITEC, the HIE, and [San Francisco-based] Advantis International, the IT staffing company, which helps to facilitate data analytics and integrity for multiple ACOs.

A FOCUS ON INFORMATION TECHNOLOGY Healthcare Informatics: I understand that you’ve been exceptionally involved in IT implementations and initiatives as a CMO. Anthony Slonim, M.D.: Yes, I’ve done 16 EHR [electronic health record] implementations in my career: eight each with Cerner and Epic [the Kansas City-based Cerner Corporation and the Verona, Wis.-based Epic Systems Corporation]. I did the design-and-build for Cerner for Children’s Hospital Medical Center, Washington, D.C., when I was there [2003-2005, 18-month implementation]; I then supervised the design-andbuild at Carilion Clinic in Roanoke, doing an eight-hospital install, using Epic, when I was CQO [chief quality officer] there in 2007-2009. And here, we’ve been on a journey for about two

CHALLENGES ALONG THE LEARNING CURVE HCI: Once you get up and running, what are the biggest challenges in ACO operations in the first year or two? Slonim: Putting the infrastructure together, making sure we had seamless connectivity and communications, and making sure we had a portal infrastructure to make sure we could allow the providers to communicate with one another. We had a major deliverable for CMS, to make sure we were submitting our performance reports on time. HCI: Have you had any challenges around supporting quality measure reporting? Slonim: There are 33 quality measures in the MSSP program. They fall into three major buckets: clinical, patient satisfaction, and utilization measures; and CMS puts them into four different domains. Those 33 quality measures are objective measures of quality. They tend to focus as diabetes, CAD, and CHF. The data bundles that CMS prescribes are actually pretty clear and well-represented measures of those disease states; they’re tried, true and tested measures. HCI: Have there been any big challenges working with CMS? Slonim: I hesitate to be too critical of CMS for a variety of reasons, and one is that everybody in the program is learning, which is good. It’s all about everybody learning together; and CMS hasn’t actually done a program like this before. They’re bringing people in from around the country, and it’s about learning, not criticisms. HCI: What have the main strategic IT challenges been? Slonim: I think the IT challenges are made more difficult if you go about building the IT infrastructure yourself. We decided we would partner with a consulting team to get the show up and running. While we were focused on getting the ACO put together, they were focused on putting together the infrastructure and analytics elements. HCI: What are other ACO leaders saying to you, and what are you saying to them, at this stage? Slonim: I was actually interviewed as part of a group of five ACO leaders, and there were amazing similarities. We all recognize how important data is to advancing the quality of care. Ensuring that your IT infrastructures and analytics are as robust as possible, is incredibly important, because you need

WE’RE ALL GOING TO GET A LOT BETTER. WE HAVE NEVER AS AN INDUSTRY HAD OUR HANDS AROUND DATA THAT RATES THE PERFORMANCE ON SPECIFIC MEASURES OUTSIDE THE HOSPITAL. THIS IS REVOLUTIONARY. —ANTHONY SLONIM, M.D. years; I’ve been here about two-and-a-half years altogether, and we’ve just implemented our last ED. We’re now live in six acute-care hospitals and a behavioral health center—EMR [electronic medical record], CPOE [computerized physician order entry], and EDs [emergency departments], using Cerner. And we’re also on a journey to use Cerner ambulatory among our employed physician practices. At Barnabas Health, the CIO actually reports to me. HCI: How many people does your CIO have in IT? Slonim: The IT division is system-wide, and we have over 200 employees. It’s the one department that’s system-wide, across all seven hospitals and the behavioral hospital. HCI: What have been the biggest strategic learnings overall, around ACO development, to date? Slonim: You experience several key learnings as you start up an ACO. I’ve often been quoted as saying, when you’ve seen one ACO, you’ve seen one ACO; they’re all structurally different. In the first year, we spent time hiring people, setting up committee structures, creating data linkages, and making sure we had the appropriate structure for analytics. Ultimately, this leads into the IT discussion, because we decided that rather than building new infrastructures, we would find partners.

(Continued on p. 46) 40 November/December 2013 • www.healthcare-informatics.com

READMISSIONS UPDATE

Discharged With a Recording HOW CULLMAN REGIONAL IS OPTIMIZING READMISSIONS WORK BY RAJIV LEVENTHAL

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ecreasing preventable hospital readmissions is at the forefront line of the Affordable Care Act’s (ACA's) effort to eliminate unnecessary care and curb Medicare’s growing spending. Recently, Medicare identified 2,225 hospitals that will have payments reduced for a year starting Oct. 1, totaling approximately $227 million in penalties. As a result of these penalties, in addition to providing the proper care that patients deserve when they are discharged, hospitals have been realizing that reducing unnecessary hospital readmissions requires integrated, intelligent technology that empowers patients and families in their own medical care. However, that proper care cannot be possible if patients aren’t following their post-discharge instructions. This has become a recurrent issue in healthcare; the Centers for Disease Control and Prevention (CDC) reports that nine out of 10 adults who receive medical advice find it incomprehensible, creating a revolving door for healthcare institutions. To help address this, in October 2011, the 145-bed Cullman Regional Medical Center (CRMC) in Cullman, Ala., became a beta site for the San Jose, Calif.-based Vocera’s Good to Go technology, which records discharge instructions for patients, families, and other care providers to review any time using any device.

LEAVING PREPARED Using Good to Go on an Apple iPod device, CRMC caregivers capture “live” audio instructions as well as educational videos, pictures, and documents that are specific to the care of each patient. After hospital discharge, patients can listen to or review their personal care instructions at any time using

any phone, mobile device, or computer to clarify follow-up appointments, medication information and more. Family members and other caregivers can also access the recorded instructions using the patient’s unique ID number and login information, says Cheryl Bailey, R.N., chief nursing officer of CRMC. Bailey says that when the nurse goes in to provide the discharge teaching to the patient, he or she will stop by the charge nurse area and obtain an iPod device. “I keep two or three of these devices in each nursing unit,” Bailey says. “Nurses will then tell their patients they will record their discharge teaching, so when patients go home they, along with their families, can log in or call and read about their diagnosis. We have an ADT [Admit Discharge Transfer] feed that comes from our electronic medical record [EMR] into the solution, and when the nurse logs on with her secure password and pin, she’ll choose the patients name, which is loaded in there. This is all cloud-based technology, so nothing is residing on the iPod www.healthcare-informatics.com • Healthcare Informatics 41

READMISSIONS UPDATE device. It’s all HIPAA-regulated.” says the discharge teaching is being recorded, the patient is Nurses choose from several templates, each of which con- more likely to really listen, thinking that if it’s being recorded, tains a specific diagnosis. For example, a template for conges- it must be important. Rather than focus on the door to go tive heart failure (CHF) will include educational information, home, the patient is now focusing on the teaching the nurse such as constructing a low-sodium diet or learning the impor- is giving.” tance of weighing oneself every day. This is in addition to the nurse’s discharge instructions, so there is a wealth of informa- A COMMUNICATION IMPROVEMENT tion, Bailey says. The nurse also has the option to include the Previously, Bailey says, patients weren’t really listening, and email address and cell phone number of a family member, so that had become a common problem in hospitals. “They are he or she has the same secure access. Bailey says the “multi- just ready to get home, not listening to what we’re saying. disciplinary approach to help better inform our patients and Now, we are finding that most patients do comply and go help them understand if they possibly forget something when back and re-listen to the instructions. When it’s over, the nurse encourages the patient to log on and they get home. They can log on the Internet or ask any follow-up questions, too. Listening to can phone in and listen to this information as it immediately helps with that comprehenmany times as they need.” sion, since we flood patients with informaDepending on which unit it is, Bailey says she tion. To be honest, it’s hard to remember can see anywhere between a 50- to 80-percent everything, and this system really helps with pickup rate of patients getting the information; that,” she says. 60 percent of the information is accessed by Communication between medical staff and phone and 40 percent by Internet, and patients patients has undoubtedly deteriorated over access it more than once 30 percent of the time. the years, but an under-talked-about aspect of “I can see which patients received the discharged that is simple listening, says Bailey. “We comrecording, which nurse gave it, if patients have municate every day, but we often fall flat on access to the information, and how they acour face. When people talk, there are so many cessed it, as well as how often,” she says. Cheryl Bailey, R.N. other things we’re thinking about. You have So far, the desired results have been there, the young patient who might have their head Bailey says. “With 30-day readmissions, we have seen a 15-percent decrease; and we have also seen an increase elsewhere, and you have the elderly patient who’s sick and just in patient satisfaction. Two questions on the HCAHPS [Hos- wants to be home. I think it’s a problem for people of all ages, pital Consumer Assessment of Healthcare Providers and everywhere. Everyone I talk to about this solution can relate to Systems] survey focus on the discharge process. We have seen this—it’s a common problem.” With factors like HCAHPS and value-based purchasing increases of 62 and 63 percent, respectively, on improvement of satisfaction. Our initial goal was to reduce 30-day readmis- hovering over the industry, hospitals are paying close attention to their readmissions rates. “If hospitals can streamline sions, but patient satisfaction has also increased.” Bailey attributes the positive results that to the account- technology to help, all the better,” she says Bailey recalls one instance when a physician called her ability factor. “The staff knows we randomly listen to these recordings, as we want to make sure they are doing a great about a nurse giving a patient certain discharge instructions for when the patient got home. The patient ended up being readmitted because of that very thing the nurse said to do, causing the physician to repair the damage. “The physician asked me to write up the nurse for this mishap,” remembers Bailey. Fortunately, though, because of the recordings given, Bailey was able to job providing the teaching. So they do a better job teaching, compare the nurse’s discharge instructions with the physician’s knowing we are listening. We have heard patients or family orders. As it turned out, they were exactly the same, absolving members tell the nurse on the recording, ‘You did a great job the nurse of all blame. Despite the patient being readmitted, Bailey says “it turned out to be a home run for us. The nurse did with that information. Thank you.’” Just as importantly, Bailey says she sees an accountability her job perfectly and used this technology as a backup resource improvement with regard to the patient. “When the nurse for patients.” ◆

NURSES WILL THEN TELL THEIR PATIENTS THEY WILL RECORD THEIR DISCHARGE TEACHING, SO WHEN PATIENTS GO HOME THEY, ALONG WITH THEIR FAMILIES, CAN LOG IN OR CALL AND READ ABOUT THEIR DIAGNOSIS. —CHERYL BAILEY, R.N.

42 November/December 2013 • www.healthcare-informatics.com

BUSINESS INTELLIGENCE UPDATE

Staying on Top USING BUSINESS INTELLIGENCE TO IMPROVE QUALITY OF CARE BY GABRIEL PERNA

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n order to stay atop the mountain, you have to constantly compare yourself to others. That’s the mentality at the Medical University of South Carolina (MUSC), an academic health center in Charleston, S.C. which has a 709-bed inpatient medical center, various specialty centers, a separate site facility, and a children’s hospital. MUSC has created a culture of business intelligence (BI) to do just that—stay on top. The number one hospital in South Carolina, according to U.S. News and World Report’s famous rankings, MUSC puts the proof in the proverbial pudding: two specific BI platforms used to drill down on quality metrics from an organizational and physician perspective. This allows the hospital to compare itself to other leading medical centers on quality metrics. One platform is through its association with the United Health Consortium (UHC), an alliance of 118 academic medical centers and 299 of their affiliated hospitals. According to Amy Wilson, director of enterprise analytics at MUSC, every month the provider sends its billing data for hospitalizations (diagnosis, procedure codes, demographics) to UHC. UHC uses historical data from all of the participating hospitals to calibrate risk-adjustment models and then applies those models to MUSC’s monthly submissions.  For instance, if a patient has particular set of comorbidities, the UHC BI platform determines how much care for that patient should cost, as well as what his or her length-of-stay and what his or her mortality risk should be. Other metrics include readmissions and patient safety indicators. MUSC uses that information to benchmark against the UHC estimates and other organizations.  Sitting on top of that BI platform is another one from the Falls Church, Va.-based Harris Healthcare. This platform is more distinctly focused on physician and patient profiling, says Wilson. “We’re looking at many metrics by physician, including readmission rates, resource utilization, and risk-adjusted outcomes such as length of stay, cost, and mortality,” she adds.

AN ACTIVE USER IS RECRUITED AS LIAISON There are many distinct elements of this platform, which can capture documentation and coding information on diagnosisrelated group (DRG) reimbursement. Various practitioners like Phyllis “PJ” Floyd, R.N., the director of health information services

and clinical documentation improvement at MUSC, began to use the Harris platform on their own for this purpose. She understood its impact and started breaking down the DRG data to see where various issues were occurring in the realm of care. Soon after, Floyd became an active user of the platform, and those in the analytics group, such as Wilson, began to notice her name frequently pop up in the system. They asked her to partner and act as a sort of liaison between the clinical and analytics sides. “What we do is we use the BI system, and we go out to different specialties—maybe it’s CT surgery, neurosurgery, or pediatrics— and use it to compare data on various metrics,” Floyd says. “We try to determine if it’s a quality-of-care issue or if it’s just a data issue, in terms of capture of right verbiage in the medical record.” For her role, Floyd says, she helps clinicians understand how the system fits into operations, in terms of coding and documentation. According to Wilson, it’s all part of a multi-part collaborative between CDI, physicians, and analytics teams essential to the success of BI in the organization. “[Floyd] sits in between the coders and the physicians, and says, ‘Dr. So and So, you need to write this, so the coders can do that,’ and then we, the data people, do the leg work to try and be smarter about how we look for the opportunities,” says Wilson.

MANY STAKEHOLDERS, ONE GOAL The various stakeholders of this initiative are ultimately looking at the same goal: improving the quality of care. This is where that comparative element comes into place, and indeed, Wilson says one of the organization’s goals is to be a Top 25 hospital as measured by UHC. According to Floyd, MUSC is trying to see what those organization are doing that it could do better. It uses benchmarks on readmissions, length-of-stay, cost-index, and patient safety metrics. Already, MUSC has used the BI platforms to improve severity of illness by and risk of mortality. While these metrics certainly affect reimbursement, she says, the technology goes beyond that. “The reality is that reimbursement drives a lot of what we do, but I think more importantly nowadays, our mantra is ‘quality.’ Because we’re a non-profit referral center, we want to improve what we do and have better patient outcomes, and the best way to do that is to compare yourself to other places and see where they’ve had success,” Floyd says. ◆ www.healthcare-informatics.com • Healthcare Informatics 43

NETWORKING UPDATE

Connectivity Revolution: Internet2 and its Bold Transformation Initiative ROBERT VIETZKE OF INTERNET2 SHARES HIS PERSPECTIVES ON THE TRANSFORMATION OF COMPUTING CAPABILITY BY MARK HAGLAND

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arlier this summer, HCI Editor-in-Chief Mark Hagland interviewed Gigi Lipori, the University of Florida Health’s senior director for operational planning and analysis, and Erik Deumens, Ph.D., the University of Florida’s director of research computing, regarding the work that they and their colleagues are currently involved in around their organization’s participation in the creation and forward evolution of Internet2. Lipori and Deumens and their colleagues have been involved in a very exciting initiative along with leaders at 26 universities (and in some cases, the medical centers affiliated with those universities) that is opening up a whole new area of endeavor, as all those involved with Internet2 are working on developing new channels for communication and connectivity. As its Web site indicates, the collaborative known as Internet2 encompasses more than 240 U.S. universities, 60 leading corporations, 70 government agencies, 38 regional and state education, networks, and “more than 100 research and education networking partners representing over 50 countries.” The Web site also notes, “Internet2 is an exceptional community of U.S. and international leaders in research, academia, industry, and government who create and collaborate via innovative 44 November/December 2013 • www.healthcare-informatics.com

technologies. Together, we accelerate research discovery, advance national and global education, and improve the delivery of public services. Our community touches nearly every major innovation that defines our modern digital lives, and we continue to define ‘what’s next.’” Meanwhile, Hagland also spoke earlier this summer with Robert Vietzke, vice president, network services, at Internet 2, which has offices in Washington, D.C., Ann Arbor, Mich., and Emeryville, Calif. The West Hartford, Conn.-based Vietzke provided him with a broad overview of the strategic goals and objectives of the Internet2 initiative and collaborative. Below are excerpts from that interview.

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NETWORKING UPDATE A FOUNDATION FOR TECHNOLOGY INNOVATION Healthcare Informatics: Tell me about the origins of Internet2 as an initiative. Robert Vietzke: If you go back to the birth of the commercial internet, where the government agencies—the defense industry and the NSFNET, allowed the research network to spin out to be commercial, well, in this case, the leading research universities—26 of them—met in a basement room in Chicago, and founded Internet2 to make sure there was always an organization available to build leading-edge Internet technologies that would always be a step ahead of the commercial Internet. It’s not competitive with the commercial Internet; it’s actually creating new markets. The first meeting took place back in 1996, before I was personally involved. HCI: What are the key pieces of the organization? Vietzke: Let me start with people. One of the things we are that’s unique is that we’re a community-based organization. Our staff is very small, but the resources come from the universities. We have fewer than 100 staff, but there are thousands of people at the leading universities who are absolutely a part of Internet2. Our folks are struggling with how to move these very large data sets, as with genomics, around; so it’s a current challenge, not necessarily a future one. HCI: Where are you technologically right now with the initiative? Vietzke: Internet2 has spent a lot of time thinking about what the key aspects are of supporting data-intensive science research, as opposed to supporting millions of consumers in the home. We’ve spent a lot of time in the last couple of years thinking about, what is the platform? And what are the key aspects? The University of Florida is on the leading edge in that regard. They’re the first to complete the three components in

home voice calls, right? Most of us no longer pay per minute. And for the most part, we’re uncapped in terms of data use in the way we use data online, as consumers. The second element involves being intentional about using data in your network. We call it “science DMZ” [demilitarized zone]; or, support for data-intensive science. This is really about security, and the realization that network security is critically important, especially in the healthcare environment, right? Most of the security has been about protecting millions of small flows online, but the support for these big data flows is very different. You can’t think of everything as one class of science, you’ve got to think differently. HCI: Erik Deumens was talking about the functional need to not have to inspect every data packet. Vietzke: I’m really rather agnostic about that issue, but these big data flows—you’ve got to be intentional about the way you architect your security regime, to make sure that you look at your own campus’s data flows and security protocols and make sure the big flows are treated differently from little data packets. The third element involved is software-defined networking, which is a big trend. That means a lot of things to a lot of different people; but what it could be, and where we’re focusing a lot of energy, is, if you think about computing and storage and visualization, and a lot of the work that genomics is involved in, often, the network was a black box. They understood how much data was involved, but in terms of moving the data from one place to another, they didn’t have much knowledge or control; it was a black box. You want to rethink your network environment, especially when you’re working in the cloud, or when you’re working with some genomics institutes—you’ve got a couple of very large genomics centers inside and outside the country and a couple of large hospital institutes in that area, and coordinating data across those sites is very important. We should think about that system-wise, and optimize it together. The concept of software-defined networking means that the application should be aware of what resources, including the network, are available to finish the job for the user, and the network should be programmable and controllable by the application. This is a little bit farther out there than network abundance or “science DMZ”; but if we’re really going to do genomics worldwide, we’re going to need to the network to be more adaptable.

INTERNET2 HAS SPENT A LOT OF TIME THINKING ABOUT WHAT THE KEY ASPECTS ARE OF SUPPORTING DATA-INTENSIVE SCIENCE RESEARCH, AS OPPOSED TO SUPPORTING MILLIONS OF CONSUMERS IN THE HOME. —ROBERT VIETZKE the innovation platform, as we call it; it’s really an enabling platform that allows an institution to participate with others in this. There are three elements to the platform: the first element is bandwidth abundance; we’re talking about 100 gigabits a second. Think about a home user: they’re thinking about megabits a second. The small clinical site is using dozens of megabits a second; a hospital is probably in the gigabit range; but if you’re moving these genomic data sets, you need a much higher bandwidth. Think about what’s happened with our

SIGNIFICANT PROGRESS MADE HCI: On a scale of 1 to 10, where are you now? Vietzke: With regard to the capabilities that are available nationally through a network like Internet2 today, we are probably a 9. We’ve got a 100-gigabit national backbone www.healthcare-informatics.com • Healthcare Informatics 45

NETWORKING UPDATE that’s available to every state and that can quickly go to 88 times that, to 8.8 terabits. It’s fully configurable and ready to go. When we built this in part with the help of a stimulus program from the ARRA [American Recovery and Reinvestment Act], using the network doesn’t change the cost; so we’re ready to go in terms of supporting these capabilities and use cases. HCI: So they need to catch up to your capabilities? Vietzke: Yes, absolutely. We feel really good about that. In terms of supporting the applications for genomic science, this thing is ready to go. When you start thinking about hundreds

state of the art, we’re in really good shape. HCI: You’ve been collaborating with Brocade, correct? Vietzke: Yes, the folks at Brocade [the San Jose, Calif.based Brocade Communications Systems, Inc., a network solutions provider] have been   part of the solution on a couple of fronts. One is that they get this importance of creating the 100-gig market. They’ve really invested in the idea of bandwidth abundance, by the way they’ve airconditioned their products; they’re also heavily invested in working on software-defined networking. HCI: What should CIOs and CMIOs be thinking about all this, as Internet2 develops and evolves forward? Vietzke: They may not feel they can relate to all of this, but I actually think that what we do in Internet2 is a collaborative community of folks, and that that is a very common theme in healthcare. When folks go to clinical meetings and talk about rare findings and such, what we do is very much the same. Helping to enable the IT workers to think collaboratively, could be really helpful in transforming that part of the discipline in the next few years. Plus, this is fun to do! ◆

I ACTUALLY THINK THAT WHAT WE DO IN INTERNET2 IS A COLLABORATIVE COMMUNITY OF FOLKS, AND THAT THAT IS A VERY COMMON THEME IN HEALTHCARE. —ROBERT VIETZKE of thousands of sequencers (personal sequencers), and potentially millions and millions of gene sequences a year that you want to compare and contrast to one another, we’ve got work to do to set that up; but in terms of supporting the current

ACO PERSPECTIVE (Continued from p. 40)

to be able to improve the care that those measures represent. HCI: Do you think some of the trade press coverage has given an impression that is darker than the reality? Slonim: The coverage is valuable, because we’re all learning together. And because of that, you get disparate information, right? I try to be as concrete and clear as possible. No one’s ever done this before. If healthcare had already been fixed, and it was running like a smooth engine, we wouldn’t even be dealing with these challenges; but we are dealing with them, because healthcare is largely inefficient, and we have the opportunity to improve value through improving care quality at the same or lower costs.

SIZING UP THE FUTURE HCI: What do you see happening for your own two ACOs and ACOs across the country, in the next two years? Slonim: We’re all going to get a lot better. We have never as an industry had our hands around data that rates the performance on specific measures outside the hospital. This is revolutionary, and if you don’t have the data, you can’t get your arms around that challenge; and we’re getting our arms around the data. Where will we be? Critics have suggested that ACOs will be gone in two years when the program is retired, but the value proposition is here to say. We have to figure out how to get rid of the estimated one-third of the cost of healthcare that is wasteful, so the conversation will persist long after the term “ACO” is gone. 46 November/December 2013 • www.healthcare-informatics.com

I got a call from someone not long ago who’s a graduate student and who said to me, “Dr. Slonim, I’ve decided that my career in healthcare is in ACOs.” I said, “Well, you may have a very short career, but on the other hand, if you focus on how we improve quality, improve patient satisfaction, and lower costs, you’ll have a very long career.” To the extent that CMS is driving us to think about these issues, via the ACA [Affordable Care Act] legislation—to the extent that healthcare reform is driving us to think creatively about solutions and to be able to innovate—that’s good for healthcare. While the CMS MSSP program is just one program, we now have private payers, like Horizon, coming to us, to do the same thing. It won’t be long before the states, through Medicaid, and the health insurance exchanges, come to us as well; and they’ll continually up the ante in terms of the deliverables. CMS started the conversation; and congratulations to them to advance the conversation on a national level, and we all have to continue it. Even at the local, Region 2, level of CMS, I give great credit to our partners. I’ve been to the White House, and I think people are continuing to reach out to us. This morning, we just kicked off our optimization initiative, to take a clinical lens to how the information system works and meets the needs of providers. Rather than look at this through an informatics lens, I want to look at this through a clinical lens. ◆

2014 RESOURCE GUIDE

I

nterested in information on a particular product or service? The 2014 Resource Guide will help you research key vendors quickly and easily. You can also access the Resource Guide online at http://directory.healthcare-informatics.com, where you may contact vendors directly through e-mail and social media, and view additional detailed product information. We hope you will find this to be a valuable resource.

RESOURCE GUIDE INDEX ACO/HIE Data Analysis/Predictive Modeling Software ........................

Dietary and Nutritional Management ................................

Messaging .......................................

Acute ..............................................

Disease Management .......................

Asset Tracking—Bar Coding/ RFID ............................................

Document Imaging/Management .......

Nursing/Patient Information Systems .......................................

Billing ..............................................

EMR/EHR ........................................

Business Continuity/Disaster Recovery ......................................

Enterprise Content Management .......

Care Management ............................

Education/Compliance/Legal ............

Enterprise Imaging ...........................

Nurse Call Systems ..........................

Pathology Information System ........................................ Patient Monitoring and Connectivity .................................. Payroll .............................................

Clinical Decision Support/ Evidence-Based Medicine ..............

Enterprise Resource Planning / Business Intelligence / Business Process Management ................................

Clinical Information System/Hospital Information System .......................

Enterprise Revenue Management ......

Provider Data Management ...............

E-Prescribing ....................................

RAC Management.............................

Executive Search ..............................

Radiology Information System ...........

Coding.............................................

Fraud and Abuse Detection and Analytics ......................................

RCM—Claims Management ..............

Computer-Based Provider Order Entry ............................................

Healthcare Facility Data ....................

RCM—Payer Contract Management ................................

HIE/RHIOs/NHIN..............................

RCM—Self Pay .................................

HIM .................................................

Revenue Cycle Management .............

Consulting—Outsourcing...................

Human Resources Management ........

Revenue Management ......................

Consulting—System Implementation.............................

ICD-10 Compliance ...........................

Scheduling—Procedures ...................

Imaging/PACS ..................................

Scheduling—Staff ............................

Consulting—User Adoption/ Workflow ......................................

Interactive Patient Systems ...............

Secure File Transfer ..........................

IS Management and Consulting .........

Security ...........................................

Dashboards—Census/Labor/ Financials.....................................

Lenders/Financial Institutions ...........

Software Development ......................

LIS ..................................................

Systems Integration .........................

Long-Term Care ................................

Telehealth/Telemedicine ...................

Data Encryption................................

Managed Care .................................

Television Systems ...........................

Data Solutions .................................

Master Patient and Provider Index ...........................................

Wireless Devices ..............................

Medication Carts..............................

Workstations, Wall-Mounted ..............

Clinical/Patient Portals ..................... Cloud Computing Providers ...............

Computer Carts/Mobile Computing ....................................

Dashboards—Revenue Cycle Management ................................

Dictation/Transcription .....................

www.healthcare-informatics.com

Pharmacy Management Systems ....... Practice Management .......................

Workforce Solutions .........................

Healthcare Informatics

November/December 2013

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SPECIAL ADVERTISING SECTION

ACO/HIE DATA ANALYSIS/ PREDICTIVE MODELING SOFTWARE

BUSINESS CONTINUITY/ DISASTER RECOVERY GNAX

InfoMC, Inc. Conshohocken, PA Contact: JJ Farook (484) 530-0100 E-mail: [email protected] Web: www.infomc.com

CLINICAL INFORMATION SYSTEM/HOSPITAL INFORMATION SYSTEM

Atlanta, GA Contact: Matt Mong (855) 280-4629 E-mail: [email protected] Web: www.gnax.net

MedeAnalytics Emeryville, CA Contact: Randy Hamamoto (310) 930-1769 E-mail: [email protected] Web: www.medeanalytics.com

3M Health Information Systems

Summit Healthcare

NextGate Pasadena, CA Contact: Richard Garcia (626) 376-4100 E-mail: [email protected] Web: www.nextgate.com

ACUTE

Braintree, MA Contact: Jason Behan (866) 925-9375 E-mail: [email protected] Web: www.summit-healthcare.com

CARE MANAGEMENT

Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

InfoMC, Inc. Conshohocken, PA Contact: JJ Farook (484) 530-0100 E-mail: [email protected] Web: www.infomc.com

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

CLINICAL DECISION SUPPORT/ EVIDENCE-BASED MEDICINE

ASSET TRACKING— BAR CODING/RFID Futura Mobility Fort Washington, PA Contact: Daria Cuda (215) 642-3363 E-mail: [email protected] Web: www.futuramobility.com

BILLING Optum Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com

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Health Care Software Inc. (HCS) Farmingdale, NJ Contact: Thomas Visotsky (800) 524-1038 E-mail: [email protected] Web: www.hcsinteractant.com HCS has delivered healthcare information technology to providers since 1969. HCS Interactant™ is an integrated platform of clinical and financial modules exceeding the expectations of facilities across the spectrum of care including long-term acute care, inpatient, outpatient, long-term care, behavioral health, and rehabilitation.

Elsevier Clinical Solutions Maryland Heights, MO Contact: Toni Barrale (866) 416-6697 E-mail: [email protected] Web: www.clinicaldecisionsupport.com Elsevier Clinical Solutions is a market-leading provider of world-class, point-of-need HIT solutions that help healthcare organizations to provide meaningful care for a patient-centered approach to achieving the triple aim.

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

Healthcare Informatics

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SPECIAL ADVERTISING SECTION

CODING

Elgin, IL Contact: Elizabeth Hobson (888) 871-0963 E-mail: [email protected] Web: www.obix.com Care providers ranked the OBIX system number one among perinatal information systems in the December 2012 KLAS® report, “Best in KLAS Awards: Software and Professional Services.” Visit www.KLASresearch.com for more information. OBIX combines enterprise-wide surveillance and alerting with comprehensive, point-of-care patient charting, data archiving, and Internetbased physician access. It is ideally designed for interfacing to other hospital systems. Exclusive E-Tools provide decision support and promote safety. Superior education and service assures user satisfaction and success.

Psyche Systems Corporation Milford, MA Contact: Lisa-Jean Clifford (508) 473-1500 E-mail: [email protected] Web: www.psychesystems.com

Viziflex Seels Saddle Brook, NJ Contact: Devin Gonzalez (800) 627-7752 E-mail: [email protected] Web: www.viziflex.com

CLINICAL/PATIENT PORTALS Allen Technologies Austin, TX Contact: Krista Weirman (512) 258-7019 E-mail: [email protected] Web: www.allentek.com

CLOUD COMPUTING PROVIDERS GNAX Atlanta, GA Contact: Matt Mong (855) 280-4629 E-mail: [email protected] Web: www.gnax.net

www.healthcare-informatics.com

PhoneTree Winston-Salem, NC Contact: Sales Department (800) 951-8733 E-mail: [email protected] Web: www.phonetree.com See our ad in this issue

Prime Care Technologies Inc. Duluth, GA Contact: Keith Farley (877) 644-2306 E-mail: [email protected] Web: www.primecaretech.com PCT’s powerful cloud-based IT infrastructure and services help providers save money, increase revenues, and insure compliance through managed hosting; digital dashboard reporting; T&A, HR, and payroll solutions; automated procurement services; claims management automation; and more.

Emp o

OBIX by Clinical Computer Systems, Inc.

w

er

3M Health Information Systems Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

HRS Baltimore, MD Contact: Abby Coplan (800) 329-0373 E-mail: [email protected] Web: www.HRScoding.com

ed

R by

Optum

Recondo Technology Greenwood Village, CO Contact: Terry Truman (303) 974-2815 E-mail: [email protected] Web: www.recondotech.com Recondo innovative technologies connect providers, payers, and patients throughout the revenue cycle. Cloud software services ensure prompt, proper payments, delivering efficiencies and savings. Recondo rules architectures, integration, and data mining provide interoperability for 650+ hospitals/500+ payers.

Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com Optum™, a leading health services business, has been providing coding solutions for 25 years. We offer a range of solutions—from innovative print and electronic resources to sophisticated technology, including computer-assisted coding, a powerful web-based encoder, and ICD-10 mapping software.

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SPECIAL ADVERTISING SECTION

COMPUTER CARTS/MOBILE COMPUTING

Practice Management Information Corporation (PMIC) Los Angeles, CA Contact: Meta Rias (800) 633-7467 E-mail: [email protected] Web: www.pmiconline.com PMIC, the nation’s leading independent publisher of medical coding and compliance solutions since 1989, offers a variety of comprehensive IT solutions including data files, e-books, and software. Our e-books can be delivered at low cost to thousands of users from your document servers. Our #1-rated Flash Code software can be accessed via the internet by an unlimited number of users. We have ICD-10 ready solutions for your IT staff.

Sedona Learning Solutions

ALTUS Walker, MI Contact: Eric Kahkonen (888) 537-1311 E-mail: [email protected] Web: www.altus-inc.com ALTUS designs and manufactures mobile and wall-mounted technology workstations at our state-of-the art facility in Grand Rapids, Michigan. ALTUS Functionology is successfully optimizing EMR/CPOE initiatives and efficiency in thousands of healthcare facilities around the country.

Futura Mobility

Phoenix, AZ Contact: Kerry Kuehn (602) 840-1000 E-mail: [email protected] Web: www.sedonalearning.com Sedona Learning Solutions offers EMR educational services. Sedona’s project managers, instructional designers, and instructors work with you to design and deliver customized training and support for your EMR. Sedona delivers instruction on site or online.

VCPI Milwaukee, WI Contact: Katey Sidesky (877) 908-8274 E-mail: [email protected] Web: www.vcpi.com

Fort Washington, PA Contact: Daria Cuda (215) 642-3363 E-mail: [email protected] Web: www.futuramobility.com

CONSULTING—SYSTEM IMPLEMENTATION

Wolters Kluwer Health Denver, CO Contact: Kristina Sherwood (720) 446-2564 E-mail: [email protected] Web: www.healthlanguage.com Health Language®, part of Wolters Kluwer Health, provides terminology management solutions and professional services that normalize data into standardized code sets, enabling healthcare organizations to simplify management and analysis of critical clinical and operational information.

CONSULTING—OUTSOURCING

3M Health Information Systems

3M Health Information Systems

COMPUTER-BASED PROVIDER ORDER ENTRY

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

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November/December 2013

Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

Claricode Needham, MA Contact: Andrew Needleman (800) 635-5284 E-mail: [email protected] Web: www.claricode.com

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION

CONSULTING—USER ADOPTION/ WORKFLOW

DASHBOARDS—REVENUE CYCLE MANAGEMENT

3M Health Information Systems

CareFusion

Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

San Diego, CA (888) 876-4287 Web: www.carefusion.com Alaris® Infusion Viewer for Charge Capture Through our ability to wirelessly communicate infusion administration information, we’ve developed a web-based dashboard to help hospitals minimize lost charges in areas where recording actual time (start/stop) of IV administration is necessary. The Alaris® Infusion Viewer for Charge Capture provides a patient-specific infusion report to help the process of documenting and auditing the patient record for improved reimbursement opportunities, and enables adherence to the CMS outpatient prospective payment system guidelines.

Cumberland Consulting Group Franklin, TN Contact: Jim Lewis (615) 373-4470 E-mail: [email protected] Web: www.cumberlandcg.com Cumberland Consulting Group, LLC is a national technology implementation and project management firm serving ambulatory, acute, and post-acute healthcare providers. Cumberland provides strategic information technology planning, systems selection, implementation, and optimization services. Through the implementation of new technologies, Cumberland helps providers nationwide advance the quality of patient care they deliver and improve overall business performance.

MedeAnalytics

Optimizing the business of healthcare

DASHBOARDS—CENSUS/LABOR/ FINANCIALS Hayes Management Consulting Newton Center, MA Contact: Wendy Loveland (617) 559-0404 E-mail: [email protected] Web: www.hayesmanagement.com

Prime Care Technologies Inc. Duluth, GA Contact: Keith Farley (877) 644-2306 E-mail: [email protected] Web: www.primecaretech.com

VCPI Milwaukee, WI Contact: Katey Sidesky (877) 908-8274 E-mail: [email protected] Web: www.vcpi.com

Emeryville, CA Contact: Randy Hamamoto (310) 930-1769 E-mail: [email protected] Web: www.medeanalytics.com

DATA ENCRYPTION Linoma Software - GoAnywhere Managed File Transfer Solution Ashland, NE Contact: Brian Pick (800) 949-4696 E-mail: [email protected] Web: www.GoAnywhere.com

InfoPartners, Inc.

DATA SOLUTIONS

Franklin, TN Contact: James Baxter (615) 807-2389 E-mail: [email protected] Web: www.infopart.com

CDW Vernon Hills, IL (800) 500-4239 Web: www.cdwcommunit.com See our ad in this issue

www.healthcare-informatics.com

Healthcare Informatics November/December 2013

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SPECIAL ADVERTISING SECTION

DICTATION/TRANSCRIPTION

DEA Lookup.com, Inc. Wilmington, DE Contact: Gregory Merritt (877) 482-5400 E-mail: [email protected] Web: www.dealookup.com

FolioMed Hyannis, MA Contact: Paul Rooker (508) 862-8200 E-mail: [email protected] Web: www.foliomed.com

MEALTRACKER Dietary Software 3M Health Information Systems Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

Hornell, NY Contact: Cole Racho (800) 755-3284 E-mail: [email protected] Web: www.mealtracker.com

DISEASE MANAGEMENT Claricode Needham, MA Contact: Andrew Needleman (800) 635-5284 E-mail: [email protected] Web: www.claricode.com

InfoMC, Inc. Conshohocken, PA Contact: JJ Farook (484) 530-0100 E-mail: [email protected] Web: www.infomc.com

Georgia, USA Atlanta, GA Contact: Carol Henderson (877) 592-0809 E-mail: [email protected] Web: www.georgia.org/hit See our ad in this issue

HealthLine Systems Inc. San Diego, CA (800) 733-8737 E-mail: [email protected] Web: www.healthlinesystems.com HealthLine Systems, Inc. provides credentialing software, contact center software and quality management software and support to the healthcare industry. With our wide selection of healthcare software solutions, find the tool that meets your organizations needs.

Alpharetta, GA Contact: Michaela Kraft (877) 773-3242 E-mail: [email protected] Web: www.philips.com/dictation Philips voice technology solutions are indispensable daily tools for healthcare users. Our digital dictation solutions, including the new SpeechMike Premium and smartphone apps, are equipped with state-of-the-art technology for use in a medical setting.

DIETARY AND NUTRITIONAL MANAGEMENT Dietary Management Software by Brimstone Allon Enterprises, LLC Finksburg, MD Contact: Bill Valway (800) 752-5121 E-mail: [email protected] Web: www.dietarymanagementsoftware.com

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DOCUMENT IMAGING/ MANAGEMENT

Speech Processing Solutions USA Inc.

3M Health Information Systems Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION Interaction Information Technology - Pace+ Mesa, AZ Contact: John Hopkins (866) 359-3829 E-mail: [email protected] Web: www.pace-plus.com

ChartMaxx, a division of Quest Diagnostics, Inc. Mason, OH Contact: ChartMaxx Sales and Marketing (800) 444-6235 E-mail: [email protected] Web: www.chartmaxx.com

University College Denver, CO Contact: Irene Frederick, MD (800) 347-2042 E-mail: [email protected] Web: universitycollege.du.edu

EMR/EHR Accumedic, Inc. Great Neck, NY Contact: John Teubner (516) 466-6800 E-mail: [email protected] Web: www.accumedic.com

Fujitsu Computer Products of America Sunnyvale, CA Contact: Inside Sales (888) 425-8228 See our ad in this issue

InterSystems Corporation Cambridge, MA Contact: Jackie Gentile (617) 621-0600 E-mail: [email protected] Web: www.intersystems.com InterSystems Corporation is a global leader in software for connected care. InterSystems HealthShare® is a health informatics platform for information exchange and active analytics within hospital networks or across a community, region, or nation. See our ad in this issue

CareFusion

EDUCATION/COMPLIANCE/LEGAL Linoma Software - GoAnywhere Managed File Transfer Solution Ashland, NE Contact: Brian Pick (800) 949-4696 E-mail: [email protected] Web: www.GoAnywhere.com

San Diego, CA (888) 876-4287 Web: www.carefusion.com/emrinteroperability Infusion EMR Interoperability Alaris® System infusion interoperability enables bi-directional wireless communication with electronic medical record (EMR) systems for the pre-population of infusion order parameters and the transfer of infusion status for documentation. These capabilities reduce manual programming steps and automate infusion documentation to the EMR. Discover how Alaris EMR Interoperability can help promote improved safety, efficiency and cost control at your hospital.

Sedona Learning Solutions Phoenix, AZ Contact: Kerry Kuehn (602) 840-1000 E-mail: [email protected] Web: www.sedonalearning.com Sedona Learning Solutions offers EMR educational services. Sedona’s project managers, instructional designers, and instructors work with you to design and deliver customized training and support for your EMR. Sedona delivers instruction on site or online.

www.healthcare-informatics.com

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

SigmaCare Henry Schein MicroMD Boardman, OH Contact: Dawn Domitrovich (800) 624-8832 E-mail: [email protected] Web: www.micromd.com

New York, NY Contact: Bernie Mangano (877) 432-5858 E-mail: [email protected] Web: www.sigmacare.com

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SPECIAL ADVERTISING SECTION

ENTERPRISE CONTENT MANAGEMENT ChartMaxx, a division of Quest Diagnostics, Inc. Mason, OH Contact: ChartMaxx Sales and Marketing (800) 444-6235 E-mail: [email protected] Web: www.chartmaxx.com

ENTERPRISE IMAGING

Infor Healthcare

Health Care Software Inc. (HCS)

New York, NY (800) 260-2640 E-mail: [email protected] Web: www.infor.com/industries/healthcare/

Farmingdale, NJ Contact: Thomas Visotsky (800) 524-1038 E-mail: [email protected] Web: www.hcsinteractant.com HCS has delivered healthcare information technology to providers since 1969. HCS Interactant™ is an integrated platform of clinical and financial modules exceeding the expectations of facilities across the spectrum of care including long-term acute care, inpatient, outpatient, long-term care, behavioral health, and rehabilitation.

Kronos Incorporated Chelmsford, MA Contact: Mitch Moffett (800) 225-1561 E-mail: [email protected] Web: www.kronos.com/healthcare

MedeAnalytics Agfa HealthCare Greenville, SC Contact: Jim Banghart (877) 777-2432 E-mail: [email protected] Web: www.agfahealthcare.com Agfa HealthCare delivers proven enterprise and department imaging informatics to advance improved efficiencies and the safety of care. Our PACS-neutral, vendor-neutral archive ICIS™ workflow-centric services platform lifts imaging data consolidation and image distribution to the enterprise, to drive powerful clinical advances and IT efficiencies. ICIS delivers multi-disciplinary images via the EMR to anyone along the care continuum, in an intelligent, clinically relevant, patient-centric context.

Emeryville, CA Contact: Randy Hamamoto (310) 930-1769 E-mail: [email protected] Web: www.medeanalytics.com

Infor Healthcare

Optum Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com

ENTERPRISE REVENUE MANAGEMENT

ENTERPRISE RESOURCE PLANNING / BUSINESS INTELLIGENCE / BUSINESS PROCESS MANAGEMENT ChartMaxx, a division of Quest Diagnostics, Inc. Mason, OH Contact: ChartMaxx Sales and Marketing (800) 444-6235 E-mail: [email protected] Web: www.chartmaxx.com

Dimensional Insight, Inc. Burlington, MA Contact: Ed O’Brien (781) 229-9111 E-mail: [email protected] Web: www.dimins.com

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New York, NY (800) 260-2640 E-mail: [email protected] Web: www.infor.com/industries/healthcare/

ZirMed

Experian Healthcare Austin, TX Contact: Merideth Wilson (800) 930-9095 E-mail: [email protected] Web: www.experian.com/healthcare Experian Healthcare’s comprehensive suite of revenue cycle products and consultative services backed by data and analytics enables healthcare organizations to redefine financial performance and transform payment processes so they can optimize collections from patients and payers.

Louisville, KY Contact: Kent Rowe (877) 494-1032 E-mail: [email protected] Web: www.zirmed.com ZirMed is one of healthcare’s premier health information connectivity and management solutions companies. ZirMed’s industry-leading technology and client support have been recognized by KLAS, Black Book Rankings – Top Large Hospital & Academic Centers Vendor and THINKstrategies’ Best of SaaS Showplace (BoSS) Award. ZirMed solutions include clinical communications, comprehensive analytics, eligibility, claims management, coding compliance, reimbursement management and patient payment services including credit card processing, online payments, statements, estimation, and payment plan management. For more information about ZirMed, visit www.ZirMed.com.

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION

E-PRESCRIBING

FRAUD AND ABUSE DETECTION AND ANALYTICS

HIE/RHIOS/NHIN

SigmaCare New York, NY Contact: Bernie Mangano (877) 432-5858 E-mail: [email protected] Web: www.sigmacare.com

EXECUTIVE SEARCH

3M Health Information Systems Experian Healthcare

Belle Oaks of America Inc. Vero Beach, FL Contact: Ed Simmons (772) 492-1844 E-mail: [email protected] Web: www.belleoaks.com See our ad in this issue

Austin, TX Contact: Merideth Wilson (800) 930-9095 E-mail: [email protected] Web: www.experian.com/healthcare Experian’s Precise ID for healthcare portals helps healthcare organizations comply with Meaningful Use Stage 2 security requirements by automating the enrollment and authentication process to enhance the patient experience and satisfaction by protecting online patient data.

Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

HEALTHCARE FACILITY DATA Linoma Software - GoAnywhere Managed File Transfer Solution Ashland, NE Contact: Brian Pick (800) 949-4696 E-mail: [email protected] Web: www.GoAnywhere.com

Waltham, MA Contact: Natalie Pietrzak (855) 935-5644 E-mail: [email protected] Web: www.alereacs.com

Witt/Kieffer Oak Brook, IL Contact: Linda Hodges (630) 990-1370 E-mail: [email protected] Web: www.wittkieffer.com Witt/Kieffer is the nation’s leading executive search firm dedicated to finding IT leaders who can translate healthcare business and leadership needs into successful IT solutions. For more information, visit www.wittkieffer.com.

www.healthcare-informatics.com

Alere Accountable Care Solutions

MARZ American Fork, UT Contact: Paul Shumway (877) 668-2723 E-mail: [email protected] Web: www.marzvna.com The MARZ Vendor Neutral Archive is a leading VNA solution created through a partnership of Dell and Novarad. This partnership affords a safe, secure and affordable VNA for any size facility.

Certify Data Systems Inc. San Jose, CA Contact: David Caldwell (408) 236-7494 E-mail: [email protected] Web: www.certifydatasystems.com Certify Data Systems is a pioneer in health information exchange (HIE) technology. The company’s HealthLogix™ Enterprise HIE platform has been adopted by the nation’s leading hospitals, physicians and laboratories. The HealthLogix platform provides bi-directional semantic interoperability between disparate EHR systems, enabling all providers to exchange essential health information in real-time.

Healthcare Informatics November/December 2013

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SPECIAL ADVERTISING SECTION SmartLinx Solutions

HIM

N. Charleston, SC Contact: Jaime Johnson (952) 406-8624 E-mail: [email protected] Web: www.smartlinxsolutions.com

ICA Nashville, TN Contact: Sandra Lillie (615) 866-1487 E-mail: [email protected] Web: www.icainformatics.com ICA offers industry leading strategic interoperability and informatics solutions. The CareAlign® platform empowers existing technologies to connect disparate healthcare enterprises, collect a wide range of patient information, and leverage data within and across networks. CareAlign helps support Transitions of Care communication, readmissions reduction, Meaningful Use, and PCMH/ACO operations.

ICD-10 COMPLIANCE 3M Health Information Systems Murray, UT (800) 367-2447 E-mail: [email protected] Web: www.3mhis.com 3M Health Information Systems delivers software and consulting services to help organizations improve clinical documentation, quality, and financial performance. We offer expertise in coding, ICD-10, dictation, transcription, speech recognition, medical terminologies, and data exchange to support electronic health records. With more than 25 years of healthcare experience, we work as a trusted and stable business partner to provide reliable implementation, training, and support to our clients.

HRS Baltimore, MD Contact: Abby Coplan (800) 329-0373 E-mail: [email protected] Web: www.HRScoding.com

MedeAnalytics Emeryville, CA Contact: Randy Hamamoto (310) 930-1769 E-mail: [email protected] Web: www.medeanalytics.com

Haugen Consulting Group

Infor Healthcare New York, NY (800) 260-2640 E-mail: [email protected] Web: www.infor.com/industries/healthcare/

Denver, CO Contact: Mary Beth Haugen (720) 502-7690 E-mail: [email protected] Web: www.thehaugengroup.com

HIM Connections Birmingham, AL Contact: Kayce Dover (888) 655-4722 E-mail: [email protected] Web: www.himconnections.com

HUMAN RESOURCES MANAGEMENT InterSystems Corporation Cambridge, MA Contact: Jackie Gentile (617) 621-0600 E-mail: [email protected] Web: www.intersystems.com InterSystems Corporation is a global leader in software for connected care. InterSystems HealthShare® is a health informatics platform for information exchange and active analytics within hospital networks or across a community, region, or nation. See our ad in this issue

HealthcareSource Woburn, MA (781) 756-6333 E-mail: [email protected] Web: www.healthcaresource.com

Kronos Incorporated Chelmsford, MA Contact: Mitch Moffett (800) 225-1561 E-mail: [email protected] Web: www.kronos.com/healthcare

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November/December 2013

Medical Coding & Compliance Solutions, LLC (MCCS) Turlock, CA Contact: Karlen Bailie, M.D. (800) 711-7873 E-mail: [email protected] Web: www.flashcode.com Flash Code™, the #1-rated medical coding software, is used daily by thousands of physicians, medical groups, hospitals, and third party payers for comprehensive coding and compliance tasks. Flash Code users will find the transition to ICD10 easy with our ICD-10-CM coding module, ICD-9-CM to ICD-10-CM code mapping (GEM), ICD-9-CM to ICD-10-CM Side-by-Side™ display, and our ICD-10-PCS Code Builder™ module.

IMAGING/PACS

Agfa HealthCare Greenville, SC Contact: Jim Banghart (877) 777-2432 E-mail: [email protected] Web: www.agfahealthcare.com

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION

IS MANAGEMENT AND CONSULTING

LENDERS/FINANCIAL INSTITUTIONS

Ashvins Group Inc. ASPYRA, LLC Jacksonville, FL Contact: Joy Wallace (888) 731-0731 E-mail: [email protected] Web: www.aspyra.com Your Workflow—Your Data—Your Way Evaluating PACS? Compliance Concerns? Consider ASPYRA’s AccessNET PACS; after all, it’s your data. • Powerful portability—Convert reports/ scanned documents to DICOM • Save Money—No HL7 report interface • Full Content—text, logos, etc. • Make money—helps your Customer Outreach • 100% Data from Disaster Recovery—with offsite Archive/VNA Bottom Line—Own your data, get Peace of Mind with AccessNET PACS. Call ASPYRA or an Authorized Reseller.

Infinitt North America Inc. Phillipsburg, NJ Contact: Diane Sappah (908) 387-6960 E-mail: [email protected] Web: www.infinittna.com INFINITT web-based image management solution offers RIS, PACS, Cardiology PACS, Mammo PACS, 3D/Advanced Visualization and more—on a single database that simplifies workflow and reduces cost and support requirements. Ranked #1, KLAS Community Hospitals, 2009-2012.

Miami, FL Contact: James Berlin (877) 274-8467 E-mail: [email protected] Web: www.ashvinsgroup.com

Winthrop Resources Corporation

InfoPartners, Inc. Franklin, TN Contact: James Baxter (615) 807-2389 E-mail: [email protected] Web: www.infopart.com Founded in 1986, InfoPartners, a subsidiary of Santa Rosa Consulting Company, provides information systems management and consulting services to hospitals. Through our IS Management Partnership, we provide a collaborative, advocate-driven service focused on supporting IT leadership, adopting best practices and operational improvements. We currently serve more than 45 hospitals. Benefits include: IS Leadership Support, Operational Assessments, Strategic Planning, Vendor Relationship, Technology Infrastructure & Security Assessments, Staffing Analysis and Organization, Systems Selections, and Implementation services.

VCPI Milwaukee, WI Contact: Katey Sidesky (877) 908-8274 E-mail: [email protected] Web: www.vcpi.com

Minnetonka, MN Contact: Brad Swenson (952) 656-7689 E-mail: [email protected] Web: www.winthropresources.com Technology changes rapidly, post-warranty maintenance is expensive, and interdepartmental connectivity causes ripple effects through your organization that drive unplanned change. Winthrop provides custom technology leasing solutions to hundreds of leading healthcare organizations.

LIS

PathView Systems Anna, TX Contact: Michael Mihalik (800) 798-3540 E-mail: [email protected] Web: www.pathview.com From specimen tracking to web/EHR reporting, Progeny by PathView Systems is a comprehensive LIS solution for today’s Anatomic Pathology, Cytology, and Molecular laboratories. Realize LEAN efficiencies and empower your business to compete in a dynamic marketplace.

Psyche Systems Corporation NovaRad Corporation American Fork, UT Contact: Paul Shumway (801) 642-1001 E-mail: [email protected] Web: www.novarad.net

Milford, MA Contact: Lisa-Jean Clifford (508) 473-1500 E-mail: [email protected] Web: www.psychesystems.com

INTERACTIVE PATIENT SYSTEMS Allen Technologies Austin, TX Contact: Krista Weirman (512) 258-7019 E-mail: [email protected] Web: www.allentek.com

www.healthcare-informatics.com

SCC Soft Computer Clearwater, FL Contact: Ellie Vahman (727) 789-0100 E-mail: [email protected] Web: www.softcomputer.com

Healthcare Informatics November/December 2013

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SPECIAL ADVERTISING SECTION

MEDICATION CARTS

PATHOLOGY INFORMATION SYSTEM

Futura Mobility

Sunquest Information Systems, Inc. Tucson, AZ (800) 748-0692 E-mail: [email protected] Web: www.sunquestinfo.com

LONG-TERM CARE SmartLinx Solutions N. Charleston, SC Contact: Jaime Johnson (952) 406-8624 E-mail: [email protected] Web: www.smartlinxsolutions.com

Fort Washington, PA Contact: Daria Cuda (215) 642-3363 E-mail: [email protected] Web: www.futuramobility.com

MESSAGING ClientTell Inc. Valdosta, GA Contact: Chad Greer (877) 244-9178 E-mail: [email protected] Web: www.clienttell.net

Psyche Systems Corporation Milford, MA Contact: Lisa-Jean Clifford (508) 473-1500 E-mail: [email protected] Web: www.psychesystems.com

PATIENT MONITORING AND CONNECTIVITY

Iatric Systems, Inc. VCPI Milwaukee, WI Contact: Katey Sidesky (877) 908-8274 E-mail: [email protected] Web: www.vcpi.com

MANAGED CARE InfoMC, Inc. Conshohocken, PA Contact: JJ Farook (484) 530-0100 E-mail: [email protected] Web: www.infomc.com

RAM Technologies Inc. Fort Washington, PA Contact: Mark Wullert (215) 654-8810 E-mail: [email protected] Web: www.ramtechnologiesinc.com

MASTER PATIENT AND PROVIDER INDEX NextGate Pasadena, CA Contact: Richard Garcia (626) 376-4100 E-mail: [email protected] Web: www.nextgate.com

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November/December 2013

HipLink Software Los Gatos, CA Contact: Vaughn Marie Gouff (408) 399-6120 E-mail: [email protected] Web: www.hiplink.com HipLink paging software enables encrypted communication peer-to-peer manually via any browser or automatically from any software. Messages can also go via voice or SMS text to smartphones, iPads, land phone, or pagers.

Boxford, MA Contact: Jeff McGeath (978) 674-7205 E-mail: [email protected] Web: www.iatric.com See results in your EMR from vital sign monitors, ventilators, IV pumps, anesthesia machines, and more. Accelero Connect® integrates medical devices with your EMR—regardless of device type, manufacturer, or EMR system your hospital uses.

NURSE CALL SYSTEMS Masimo Allen Technologies Austin, TX Contact: Krista Weirman (512) 258-7019 E-mail: [email protected] Web: www.allentek.com

NURSING/PATIENT INFORMATION SYSTEMS

Irvine, CA Contact: Charles Schmidt (949) 297-7369 E-mail: [email protected] Web: www.masimo.com Masimo Patient SafetyNet remote monitoring and clinician notification system combines the performance of Masimo SET® pulse oximetry with ventilation monitoring and wireless clinician notification, providing an unmatched level of patient safety on the general floor. See our ad in this issue

Allen Technologies Austin, TX Contact: Krista Weirman (512) 258-7019 E-mail: [email protected] Web: www.allentek.com

PAYROLL Kronos Incorporated Chelmsford, MA Contact: Mitch Moffett (800) 225-1561 E-mail: [email protected] Web: www.kronos.com/healthcare

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION SmartLinx Solutions

RAC MANAGEMENT

N. Charleston, SC Contact: Jaime Johnson (952) 406-8624 E-mail: [email protected] Web: www.smartlinxsolutions.com

Henry Schein MicroMD

PHARMACY MANAGEMENT SYSTEMS

Boardman, OH Contact: Dawn Domitrovich (800) 624-8832 E-mail: [email protected] Web: www.micromd.com

Rycan Marshall, MN Contact: Jody Heard (800) 201-3324 E-mail: [email protected] Web: www.rycan.com

RADIOLOGY INFORMATION SYSTEM CareFusion San Diego, CA (888) 876-4287 Web: www.carefusion.com Alaris® Infusion Viewer for Pharmacy Logistics is the first module available as part of the Infusion Viewer platform. The first near real-time* software to work with the Alaris System, it provides a webbased dashboard that displays pump and syringe status and infusion data from across the hospital, including Guardrails® soft alerts. * Subject to internet connection, devices variability and selected settings.

PRACTICE MANAGEMENT Accumedic, Inc.

NovaRad Corporation Optum Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com Optum™, a leading health services business, has been providing coding solutions for 25 years. We offer a range of solutions—from innovative print and electronic resources to sophisticated technology, including computer-assisted coding, a powerful web-based encoder, and ICD-10 mapping software.

Availity, LLC

Vistar Technologies

American Fork, UT Contact: Bill Nixon (770) 715-5345 E-mail: [email protected] Web: www.dentrixenterprise.com

www.healthcare-informatics.com

RCM—CLAIMS MANAGEMENT

PROVIDER DATA MANAGEMENT

Great Neck, NY Contact: John Teubner (516) 466-6800 E-mail: [email protected] Web: www.accumedic.com

Henry Schein Dentrix Enterprise

American Fork, UT Contact: Paul Shumway (801) 642-1001 E-mail: [email protected] Web: www.novarad.net

Wellington, FL Contact: Jim Gifford (888) 266-4532 E-mail: [email protected] Web: www.vistartech.com Vistar Technologies offers powerful Provider Data Management solutions with comprehensive end-to-end functionality for all aspects of provider and network management. The eVIPs™ system offers robust workflow solutions that will streamline recruiting, enrollment, provider relations, contracting, contract fulfillment, credentialing, ongoing monitoring, quality management and communication management to provide a central provider data repository. Vistar’s solution will serve as a core source system for integration, quality analysis, data access and reporting.

Jacksonville, FL Contact: David Johnson (904) 470-4910 E-mail: [email protected] Web: www.availity.com Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. See our ad in this issue

Healthcare Informatics November/December 2013

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SPECIAL ADVERTISING SECTION

Capario Santa Ana, CA Contact: Patrick Malecky (800) 586-6870 E-mail: [email protected] Web: www.capario.com For more than 20 years, Capario has been helping healthcare providers get paid more quickly and more accurately. Through CaparioOneSM, its premiere web application, providers can check eligibility in real time, submit and track claims, manage rejections and denials, and take patient payments in the office, online or over the phone, all from one place with one solution. CaparioOne also provides a powerful reporting suite that helps you monitor performance issues impacting your bottom line.

Navicure Atlanta, GA Contact: Jackie Perkins-Piper (678) 427-3150 E-mail: [email protected] Web: www.navicure.com Navicure, the #1-rated clearinghouse by healthcare providers*, helps hospitals, health systems and physician practices maximize revenue and profitability. Navicure’s RCM solutions accelerate cash flow and decrease A/R days for ambulatory physicians by mirroring practice work flows and addressing practice-specific RCM needs. Navicure’s technology is backed by a client services team that provides unparalleled 3-Ring support and resolves 95% of issues on the first call. *2012 Best in KLAS Awards: Software & Services report (www.KLASresearch.com)

Experian Healthcare Austin, TX Contact: Merideth Wilson (800) 930-9095 E-mail: [email protected] Web: www.experian.com/healthcare Experian Healthcare Contract Management and Analysis enables healthcare organizations to verify payer compliance with contract terms, value claims, audit remittance, appeal potential underpayments and increase cash flow across multiple payer contracts and reimbursement models.

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com Optum™, a leading health services business, has been providing coding solutions for 25 years. We offer a range of solutions—from innovative print and electronic resources to sophisticated technology, including computer-assisted coding, a powerful web-based encoder, and ICD-10 mapping software.

Fort Washington, PA Contact: Mark Wullert (215) 654-8810 E-mail: [email protected] Web: www.ramtechnologiesinc.com

November/December 2013

ZirMed Louisville, KY Contact: Chandler Jenkins (877) 494-1032 E-mail: [email protected] Web: www.zirmed.com ZirMed is one of healthcare’s premier health information connectivity and management solutions companies. ZirMed’s industry-leading technology and client support have been recognized by KLAS, Black Book Rankings – Top Large Hospital & Academic Centers Vendor and THINKstrategies’ Best of SaaS Showplace (BoSS) Award. ZirMed solutions include clinical communications, comprehensive analytics, eligibility, claims management, coding compliance, reimbursement management and patient payment services including credit card processing, online payments, statements, estimation, and payment plan management. For more information about ZirMed, visit www.ZirMed.com.

Optum

RAM Technologies Inc.

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Marshall, MN Contact: Jody Heard (800) 201-3324 E-mail: [email protected] Web: www.rycan.com

RCM—PAYER CONTRACT MANAGEMENT

InfoMC, Inc. Conshohocken, PA Contact: JJ Farook (484) 530-0100 E-mail: [email protected] Web: www.infomc.com

Rycan

Experian Healthcare Austin, TX Contact: Merideth Wilson (800) 930-9095 E-mail: [email protected] Web: www.experian.com/healthcare Experian Healthcare Contract Management and Analysis enables healthcare organizations to verify payer compliance with contract terms, value claims, audit remittance, appeal potential underpayments and increase cash flow across multiple payer contracts and reimbursement models.

Healthcare Informatics

www.healthcare-informatics.com

SPECIAL ADVERTISING SECTION

Emp o

REVENUE CYCLE MANAGEMENT

Optum Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com

Avantas

ed

Omaha, NE Contact: Larry Punteney (888) 338-6148 E-mail: [email protected] Web: www.avantas.com

R by

NTT DATA Healthcare Technologies Hauppauge, NY Contact: Larry Kaiser (800) 699-5329, ext. 5329 E-mail: [email protected] Web: www.nttdata.com/ ushealthcaretechnologies

w

er

SCHEDULING—STAFF

Recondo Technology Greenwood Village, CO Contact: Terry Truman (303) 974-2815 E-mail: [email protected] Web: www.recondotech.com Recondo® innovative technologies connect providers, payers, and patients throughout the revenue cycle. Recondo software ensures prompt, proper payments, delivering efficiencies and savings. Recondo rules architectures, integration, and data mining provide interoperability for 650+ hospitals/500+ payers.

Kronos Incorporated Chelmsford, MA Contact: Mitch Moffett (800) 225-1561 E-mail: [email protected] Web: www.kronos.com/healthcare

SmartLinx Solutions

REVENUE MANAGEMENT Optum Marshall, MN Contact: Jody Heard (800) 201-3324 E-mail: [email protected] Web: www.rycan.com

RCM—SELF PAY

Eden Prairie, MN Contact: Sales Info (800) 765-6793 E-mail: [email protected] Web: www.optuminsight.com

Emp o

Rycan

w

er

Austin, TX Contact: Merideth Wilson (800) 930-9095 E-mail: [email protected] Web: www.experian.com/healthcare Experian Healthcare Self-Pay Coverage FinderSM leverages in-depth eligibility knowledge and payer relationships, combined with data and analytics, to automate the process of reviewing information, correcting errors and identifying active coverage to avoid misclassifying patients as self-pay.

www.healthcare-informatics.com

SECURE FILE TRANSFER

ed

R by

Recondo Technology

Experian Healthcare

N. Charleston, SC Contact: Jaime Johnson (952) 406-8624 E-mail: [email protected] Web: www.smartlinxsolutions.com

Greenwood Village, CO Contact: Terry Truman (303) 974-2815 E-mail: [email protected] Web: www.recondotech.com Recondo Trilogi® Revenue Recovery Services combine clinical, legal, and financial recovery experts to resolve slow pay, no pay, and denied claims, reducing accounts receivable, improving case management efficiency, and maximizing payer collections quickly and accurately.

Linoma Software - GoAnywhere Managed File Transfer Solution Ashland, NE Contact: Brian Pick (800) 949-4696 E-mail: [email protected] Web: www.GoAnywhere.com Simplify, automate and encrypt file transfers while meeting HIPAA compliance regulations with the GoAnywhere Managed File Transfer Solution. It’s a thin client that runs on virtually any platform and supports popular protocols and encryption standards. Fully functional free trials are available at www.GoAnywhere.com.

SCHEDULING—PROCEDURES Unibased Systems Architecture Inc. St. Louis, MO Contact: Stephanie Speth (800) 489-6069 E-mail: [email protected] Web: www.unibased.com

Healthcare Informatics November/December 2013

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SPECIAL ADVERTISING SECTION

SECURITY

TELEHEALTH/TELEMEDICINE

CynergisTek, Inc.

Claricode

Austin, TX Contact: Jana Langhorne (512) 402-8550 E-mail: [email protected] Web: www.cynergistek.com

Needham, MA Contact: Andrew Needleman (800) 635-5284 E-mail: [email protected] Web: www.claricode.com

WORKSTATIONS, WALL-MOUNTED

Futura Mobility

SOFTWARE DEVELOPMENT Ashvins Group Inc. Miami, FL Contact: James Berlin (877) 274-8467 E-mail: [email protected] Web: www.ashvinsgroup.com

Fort Washington, PA Contact: Daria Cuda (215) 642-3363 E-mail: [email protected] Web: www.futuramobility.com

TELEVISION SYSTEMS

Claricode

Allen Technologies

Needham, MA Contact: Andrew Needleman (800) 635-5284 E-mail: [email protected] Web: www.claricode.com

Austin, TX Contact: Krista Weirman (512) 258-7019 E-mail: [email protected] Web: www.allentek.com

SYSTEMS INTEGRATION

WIRELESS DEVICES Futura Mobility Fort Washington, PA Contact: Daria Cuda (215) 642-3363 E-mail: [email protected] Web: www.futuramobility.com

Infor Healthcare New York, NY (800) 260-2640 E-mail: [email protected] Web: www.infor.com/industries/healthcare/

Strongarm Designs, Inc. Horsham, PA Contact: George Peel (215) 443-3400 E-mail: [email protected] Web: www.strongarmhealthcare.com Only arm solution with 100% internal cable management. Crevice-free for optimal cleanability, and comes pre-cabled and fully assembled to save you installation time and money. Robust aluminum construction-perfect for larger displays. Secure lock-in-place feature for sitting or standing height adjustment. Integrated work surface with keyboard drawer. Antimicrobial powder coat finish. Customer-specified track lengths and color available.

WORKFORCE SOLUTIONS Avantas Omaha, NE Contact: Larry Punteney (888) 338-6148 E-mail: [email protected] Web: www.avantas.com

Summit Healthcare Braintree, MA Contact: Jason Behan (866) 925-9375 E-mail: [email protected] Web: www.summit-healthcare.com

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Kronos Incorporated Chelmsford, MA Contact: Mitch Moffett (800) 225-1561 E-mail: [email protected] Web: www.kronos.com/healthcare

Healthcare Informatics

www.healthcare-informatics.com

Healthcare

Informatics Healthcare IT Leadership, Vision & Strategy

Get weekly news with Healthcare Informatics E-Newsletter To sign up simply visit www.healthcare-informatics. com/enewsletter

AD INDEX Amcom Software ................................................................................................................. 25 Availity ................................................................................................................................. CVR 3 Belle Oaks ........................................................................................................................... 33 Bright House Networks, LLC ............................................................................................... 19 CDW Healthcare ................................................................................................................. CVR 4 Comcast Cable ................................................................................................................... CVR 2 Fujitsu Computer Products of America ............................................................................... 9 Georgia Department of Economic Development ............................................................... 7 InterSystems Corporation ................................................................................................... 1 Masimo ................................................................................................................................ 4, 5 Nuance Communications, Inc. ............................................................................................ 3 PhoneTree ........................................................................................................................... 21 Suntrust ............................................................................................................................... 13 Time Warner Cable Inc. Business Class............................................................................... 31 Verizon Wireless .................................................................................................................. 17 www.healthcare-informatics.com • Healthcare Informatics 63

CAREER PATHS

Paying It Forward THE DIFFERENT STYLES AND MANY BENEFITS OF THE MENTORING PROCESS BY TIM TOLAN

I

am a huge fan of mentoring—always have been. I try to mentor in part to pay homage to the great mentors I’ve had, and to whom that I owe an extreme amount of gratitude. Mentoring, in a nutshell, is a unique relationship between an experienced person in your organization and a less experienced person hungry to soak up their healthcare information technolTim Tolan ogy (HCIT) knowledge like a dry sponge. The mentor’s role is to guide, instruct, encourage, and provide constructive feedback to the protégé. The protégé in turn, should be willing to listen to the constructive feedback, learn from it and understand that it’s never intended as personal criticism when they make a mistake; nor should they feel bad when they ask basic questions in their endeavor to learn. The mentor is (hopefully) using the mistakes as a learning and teaching opportunity. You can’t learn unless you make mistakes. Promise! There are lots of styles and ways to mentor, and while I don’t purport to be an expert mentor, I know what has worked for me in the past. Here are a few methods commonly used: One-on-One: One of the most common mentoring models is one-on-one mentoring. Simply match a mentor with a protégé based on the HCIT knowledge you want to transfer. Most people prefer this model because it allows both the mentor and protégé to develop a personal relationship, and communicate regularly while the mentor provides individual guidance and support. Usually the primary challenge is the availability of quality mentors who match the need. However, this model is one of my favorites, as the results and outcome are both qualitative and measurable. Group Mentoring: Group mentoring requires a mentor to work with several protégés at a time. The group meets regularly to discuss various topics and exchange ideas. The biggest challenge with a group model is it lacks the personal relationship of one-on-one mentoring. Knowledge transfer can be more challenging as some members of the 64 November/December 2013 • www.healthcare-informatics.com

group may excel and assimilate the information while others struggle to keep pace. Executive Mentoring: Top-down mentoring is clearly the best way for an organization to create a mentoring culture. It should be used by leadership to set the tone on the importance of information sharing and cultivate skills to help the organization grow and scale. It is also an effective tool for building a strong management bench. Succession-planning can be another benefit to the organization. Having a bench that is deep and wide in knowledge learned by the executive leadership can minimize the downside when a key employee decides to leave or retire. Mentoring is a great retention tool for organizations. If an employee does the same thing day in and day out, eventually he or she will become bored and move on. Often clients tell me the reason they’ve decided to hire my firm to find a key executive is because they don’t have the talent to promote from within. That would not always be the case if they had a solid mentorship program. There are other benefits to having a mentoring program in addition to the reasons I’ve already covered: Onboarding: This greatly speeds up the process of bringing on new hires. The first month of a new hire is critical to the employee’s overall success. Employees view the first month as a preview of upcoming attractions. Make it count. Employee Productivity: Employees participating in mentoring programs have an effective mechanism for getting answers quickly, allowing them to move on quickly and not waste time trying to “wing it.” Winging it is never a good plan. Quality: You cannot improve your internal processes if everyone is doing them the wrong way. The best way to insure consistency is to make sure new employees are mentored on the right way to accomplish their tasks early in their employment. Always. Reduce Frustration: Employees who don’t understand their jobs and don’t know where to go for help become discouraged and eventually leave. Frustration also causes morale problems. Never good.◆ Tim Tolan is senior partner of Sanford Rose Associates-Healthcare IT Practice. He can be reached at [email protected] or (904) 875-4787. His blog can be found at www.healthcare-informatics.com/tim_tolan.

A BURST OF CLARITY Gain a clear view in an ocean of uncertainty. As a trusted intermediary serving the health care market, Availity helps hospitals, health plans, physicians and billing services maintain consistent revenue flows with greater predictability, to manage financial performance more effectively. Revenue Cycle Management Clearinghouse Web Portal

availity.com © 2013 Availity, LLC

TRAVERSING TELEHEALTH A physician can only be in one place at any given time. But just because they can’t reach a patient doesn’t mean they can’t provide treatment. We can help you build a telehealth solution to make your medical staff more accessible and your patients happier.

NOW THEY’RE DEMANDING IT. The number of patients using telehealth will double between now and 2016. 2

TELEHEALTH CAN BENEFIT YOUR PATIENTS. 30-day readmission rates for patients with three chronic illnesses declined by 62%.1

AND IT’S ALREADY TAKING OFF.

10 BILLION

$

The remote patient monitoring market grew from $4.2 billion in 2007 to more than $10 billion in 2012.3

WE GET IT.

WE ASSESS IT. WE DESIGN IT. WE IMPLEMENT IT. WE SUPPORT IT. We can help you build a telehealth solution that streamlines patient communication with specialists regardless of their location. From remote monitoring to cross-country consultations, telehealth can greatly increase efficiencies and improve patient care. Plus, it can be seamlessly integrated with your current infrastructure without disruption.

THE PEOPLE — We have teams of dedicated healthcare specialists who work with institutions just like yours.

PLAN — From assessment to implementation and beyond, we offer support throughout the entire lifecycle of your solution.

THE PRODUCTS — Our partnerships with a variety of leading vendors allow us to bring you the latest technology in everything from video conferencing to networking.

MORE — Our Collaboration offerings can deliver VoIP and UC applications to streamline communication and help improve staff collaboration.

Learn more about our telehealth offerings at CDW.com/telehealth 1

Newbergh, Carolyn. Bringing Telehealth to Scale: Th ree Pioneering Health Systems. Public Health Institute, 4 Feb. 2013 Myers, Britni. Consumer-Driven Strategies Prove Successful in the Convoluted Remote Health Monitoring Market. FierceHealthIT. Web. 27 Aug. 2013 Kalorama Information, Advanced Remote Patient Monitoring Systems. Mar. 2013 ©2013 CDW, LLC. CDW®
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