Key Health Care Trends Impact Computing August 1, 2009
Posted by gonzalezloumiet in Helath IT.Tags: Data Integration, Health IT
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Patty Thierry, MBA, RHIA, CCS
Keeping an eye on health care trends has never been more important. We are accustomed to constant change but nothing compares to the changes predicted for the next few years. Already, there are new requirements for information technology (IT) and the sharing and management of data. In addition, clinical information systems have matured and new vendors are on the scene. Key standards will be regulated this year (transaction standards and code sets), and the Internet will pave the way for new health care delivery models.
Most of all, the transformation taking place in health care is creating the need to improve the quality of information systems. Exactly what kind of transformation is taking place?
- Under managed care, the lines are beginning to blur as payers are becoming actively involved in patient care and providers are developing managed care plans.
- Providers continue to consolidate at rapid speeds creating the need to tie information systems together at their disparate locations (creating integrated delivery networks [IDNs]).
- Consumers and competition are driving the need for information systems to share data with one another.
- Managed care and capitation are requiring providers to take on more financial risk and thereby changing their current business model and information management requirements.
- Y2K efforts have kept information system (IS) departments busy updating financial and billing systems. As a result, other purchases or upgrades were put on hold, creating a pent-up need to implement clinical information systems and other applications. Providers are investing in information systems to improve their business and provide a competitive edge, and to respond to the Balance Budget Act of 1997 (e.g., ambulatory payment classification-APC-implementation) and Health Insurance Portability and Accountability Act (HIPAA) (e.g., electronic transactions, security, privacy, identifiers, etc.).
- The Internet enables patients to be involved with their health care and facilitate communications between providers, patients and payers. The Internet reinvents the patient-provider relationship and empowers consumers to make choices about their health care.
New Doors for HIM Professionals
The focus on IT as a health care business enabler will open new doors for health information management (HIM) professionals who are comfortable marrying their HIM skills with technology initiatives. For example, as health care moves to the Web, HIM professionals can help their employers organize their content rich Web sites, implement security and confidentiality measures and develop policies and procedures to support personal health records. There are plenty of opportunities for HIM professionals in physician settings, IDNs and managed care organizations (MCOs). To help you think about the possibilities, let’s take a more specific look at some of the top health care trends and their technology solutions.
The survival of health care organizations (HCOs) will depend on their ability to adopt Internet-derived technologies (see ADVANCE, Feb. 7, 2000, Hands-on Help). A business model of the future will include HCOs participating in networks that include patients/members and infomediaries. Routine transactions will be carried out and include eligibility, referrals, claims processing and updating personal health records owned by patients.
Preliminary results of the 2000 Healthcare Information and Management Systems Society (HIMSS) Leadership Survey indicate that 62 percent of respondents listed deploying Internet technology as the most important IT priority.
PHRs are individually owned and generally contain subsets of an individual’s health information. There are many dot-com companies and health plans that provide consumers with the ability to store their health information on the Internet, making it accessible. The computer-based patient record (CPR) is different in that it is owned by the care delivery organizations (CDO) and is designed to meet operational needs. PHRs will become more useful when CPRs have the capability to send data to and receive data from PHRs. In other words, there should be a two-way exchange of information so that PHRs contain at least some of the data collected by each CDO with which the patient/member comes into contact.
The Institute of Medicine’s (IOM) report estimated that 45,000 to 98,000 patients die each year from preventable medical errors (Healthcare Industry Research & Advisory Services, "2000 Top 10 List." Gartner Group). In response to the report, President Clinton established the Quality Interagency Coordination Task Force (QuIC), which will focus on improving the quality of care. Health care providers realize that the only way to reduce the level of errors is through better access to information. Installing clinical information systems provides the ability to capture prescription information electronically and alert physicians to existing drug allergies or any drug-drug interactions. Automated order entry also addresses some of the drawbacks of paper documentation such as illegible and misinterpreted handwriting. In addition to capture systems, medical error reporting systems will need to be implemented.
Many organizations haven’t started thinking about HIPAA yet, but those that have realize it will take at least two to three years to implement initiatives to comply with proposed regulations. The first step is to conduct a risk assessment similar to the assessment methodology used for Y2K.
Increased demands on MCOs call for a shift toward customer relationship management strategies. Consumers are asking for improved efficiencies, timely problem resolution and online transaction processing. Customer relationship management strategies will necessitate a change in culture, investment in new technology for the front and back offices and revamped processes.
New and Matured Systems Show Promise
There are several IT systems that require close monitoring. HIM professionals have the skills to participate in the implementation and use of the following technologies:
- Speech recognition systems, which take the spoken word and translate them into text.
- Natural language systems, which take text and translate them into codes (ICD-9-CM, CPT-4).
- Integration of picture archiving and communications systems (PACS) and radiology information systems (RIS)-until now these systems have had to stand alone.
- Hand-held devices-radio frequency and/or the Internet provides new ways to use hand-held devices. Look for them as low cost solutions in nursing, home health, nursing homes, materials management and physician offices.
- Clinical decision support-now that these systems are able to store large amounts of clinical data, it is predicted that the focus will shift away from clinical departments to the patient.
- Integrated billing systems-until recently we needed two independent systems to handle both hospital and physician billing.
- Integrated patient registration-finally there are a few products that can handle registration from all types of health care providers (i.e., home health, physician office, hospital, long-term care facility etc.) Today, some IDNs have as many as five or more registration systems installed throughout the enterprise.
Learning Plan
The American Health Information Management Association (AHIMA) describes HIM professionals to the public as professionals who "hold many diverse roles, yet all share a common purpose: providing reliable and valid information that drives the health care industry." All of the trends outlined in this column require the use of information systems and the ability to turn data into reliable information. With that in mind, it’s time to assess your skills to make sure you are keeping pace with industry needs. You can carve out a niche for yourself by keeping on top of change and updating your skills portfolio on a regular basis. Here’s how to get started:
- Self-assessment is the single most important professional activity you can do in 2000. Use a tool such as AHIMA’s 1999 professional development inventory to help you rate your current and desired skill level and customize your career path.
- Focus your self-assessment on the following six HIM competencies: Information Technology, Health Information Systems, Coding Classification and Reimbursement, Health Care Information Requirements and Standards, Clinical Quality Assessment and Improvement, and Health Care Statistics and Research.
- Conduct an Internet search on the topics discussed in this article. Look for organizations that are implementing solutions.
- Find out how your employer is dealing with current health care trends. Evaluate opportunities and make sure your employer is aware of what you have to offer.
- Network, Network, Network. Find out what your peers are doing to keep their skills fresh. Discuss current health care trends and how they affect the HIM profession and the doors they open for you.
Patty Thierry is director of information management at Care Communications Inc., Chicago. She can be contacted via e-mail at pthierry@care-communications.com.
