How much should a company handling Protected Health Information (PHI)[1] spend to protect itself from a data breach?  Businesses typically use quantitative methods such as Net Present Value, Internal Rate of Return and Payback Period to make investment decisions.  But investments to prevent breaches of PHI have until now relied on compliance arguments and subjective judgments.  Tools to quantify the probability and cost of potential breaches have not been available from nationally recognized sources.  A loss of data can have reputational, financial, legal, operational and clinical repercussions.  How likely are the various types of losses and how much should a company invest to prevent such losses?

Rick Kam, president and co-founder of ID Experts and Jim McCabe, senior director with the American National Standards Institute needed to find out.  They saw data breaches increasing along with other cyber risks across a range of industries.  ANSI, the Internet Security Alliance, and The Santa Fe Group/Shared Assessments Program Healthcare Working Group issued a report for CFOs[2] which argued that security was an enterprise wide not just a departmental issue.  They found that health care organizations were not keeping pace with security requirements and that there was no research on the at-risk value of PHI.  The literature and anecdotal evidence regarding business decision indicated that decisions were being made based on achieving compliance rather than based upon a quantitative business analysis.

Seeing this need, Rick and Jim and their respective organizations teamed up and initiated a project to delve into this issue and to determine the risks and costs associated with unintended release of PHI.  They decided to use ANSI’s standard approach where ANSI serves as a neutral forum and a project is organized and conducted utilizing a vast collective of interested parties and organizations as well as subject matter experts.  About 100 individuals worked on this project and there were six different working groups including a communications group to interact with the guardians of PHI, a finalization group to make sure that a report was created to document the Project findings and an advisory committee to provide directional input from a wide array of experts and organizations.

Rick and Jim observed that they had some surprises during the project. Initially, while formulating the scope of the project in 2010, they tried to keep things simple by simply collecting data on the incidence and costs of data breaches, identity theft and the disclosure of sensitive PHI.  They found information on the unintended disclosure of Social Security Numbers and credit card data, but very little on the unintended disclosure of clinical information.  This was a surprise, so they decided to hone in on which specific elements of PHI are the most sensitive.

During this process, they found that they needed to understand the role of “PHI Protectors.”  According to the Report, a PHI Protector is, “Any organization or person that creates, handles, transmits, or stores PHI, regardless of size or function, is a member of this health care ecosystem and is responsible for the safeguarding of the PHI entrusted to its care…”  At this point, Rick and Jim realized that supporting and providing tools for the individuals responsible for PHI Protection within each of these organizations had become the primary goal for the Project and the primary audience for the Project’s final Report.

They decided to conduct a survey of these individuals and they found that 54% didn’t feel that they had the resources needed to do their job.  They also felt that they did not have adequate executive support.  The project team realized that the PHI Protectors needed help preparing a business case to determine the level of investment that is appropriate for protecting PHI within their respective organizations.

The resulting report, released March 5th, contains many tools that will be useful for IT Directors, CIOs and CFOs in evaluating projects policies and software needed to better protect PHI.  Chapter 7 describes a 5-Step method for data breach costing.  Chapter 8 explains in detail, with examples, how to calculate the costs of a PHI breach using the PHI value estimator (PHIve).  The “Finale” ends the report with a reminder of the importance of preventing breaches.  “The health care ecosystem is trying to keep in step with today’s technology, reflected in its move to adopt electronic health records…..With the increase in nefarious intent as well as the rewards and opportunities to steal PHI, the likelihood of a data breach for most organizations is very high.”  This report is a must-read for any manager responsible for protecting an organization’s PHI and an important-read for senior executives of any organization which handles PHI during any phase of their business processes.

The report is available for free download at http://webstore.ansi.org/phi/


[1] http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

[2] http://publicaa.ansi.org/sites/apdl/khdoc/Financial+Management+of+Cyber+Risk.pdf

Ed Daniels is a consultant, author and entrepreneur. Daniels is affiliated with Point-of-Care Partners, where he consults with healthcare providers, new business ventures, pharmaceutical manufacturers, health plans and nonprofit organizations.

To herald in the new year, ID Networks has released a list of the healthcare trends that they feel will have the biggest impacts on the industry. The company warns of class action litigations, the growing risk cause by social media’s ubiquity, and the dangers of relying on business associates for outsourcing, among other risk areas.

The release can be found on ID Network’s site. Additionally, the company’s report on the top trends of 2011 can be found here.

Why do we need to look beyond meaningful use when it has taken so long to get electronic record implementation underway?  It seems as though just about everyone is still deeply focused on ensuring that electronic medical record (EMR) functionalities are in lock step with requirements for meaningful use (MU) stage 1. While MU is important, it’s also critical to see what the future will hold for EMRs and where opportunities will lie.

Driven largely by the American Reinvestment and Recovery Act of 2009 (ARRA), EMR adoption will continue to increase but opportunities will change as we progress from the basics called for under MU Stage 1. This paradigm shift will be driven by the functionalities and analytics needed for accountable care organizations (ACOs) and patient-centered medical homes. It is an evolutionary process that can be viewed in three phases.

  • Phase 1: Basic EMR functionalities. This is essentially automating fundamental functions through basic EMRs. These are closely in sync with stage 1 requirements and include patient history and demographics, patient problem lists, physician clinical notes, computerized provider order entry (CPOE), and the ability to view lab and imaging results.
  • Phase 2: Advanced EMR Functionalities. This evolutionary phase begins with such MU functionalities as those found with ePrescribing. It then transitions to computerized orders for lab tests and radiology and to the electronic return of those results, with out-of-range values that are highlighted.
  • Phase 3: EMR functionalities for patient-centered accountable care. This phase moves beyond the traditional route of automating the paper-based clinical workflow with health information technology as an enabler. It will require a major leap forward – one that is more transformational than evolutionary. It transcends stage 3 functionalities into uncharted territory where an EMR is not sufficient for the requirements of tomorrow’s care models and thus cannot be just a jerry-rigged version of today’s advanced EMRs. The new standard will be an electronic health record (EHR) in the true sense — one that is interoperable with health information exchanges. As a result, innovations emphasizing analytics will be needed, such as electronic reporting from the EHR to registries for patients, public health and specific diseases; clinical guidelines at the point of care; post-visit care management, which identifies gaps in care and patient nonadherence; and tools for patient self-support management, including a personal continuity of care record. New technologies will also be needed to help shift the paradigm from today’s incredibly complex and inadequate referral management systems, in which a patient’s continuity of care record and gaps in care follow him or her throughout the referral process.

So, where do the opportunities lie? The initial opportunities for vendors will be in closing the functionality gap between basic and advanced EMRs. This window will be open for the next 2 to 4 years, resulting in a convergence somewhere between 2016 and 2020. At the same time, another set of opportunities will arise in creating EHRs that will be the heart and soul of patient-centered medical homes and ACOs as they get off the ground.

These opportunities will not be limited to vendors. New kinds of workers — beyond those traditionally found in the path of care — will be needed to access this wide array of information and handle the advanced analytical functionalities that will help tomorrow’s care organizations meet their quality and cost targets.

By Michael Solomon, PhD, MPH.   First appeared in Point of Care Partners Newsletter.  Edited and reposted with permission. 

Mr. Solomon is the author of numerous articles, including “The Case for Pharma’s Participation in Collaborative Care for Chronic Disease” (HealthLeaders, 2006) and “Information Technology to Support Self-Management in Chronic Care” (Disease Management Health Outcomes, 2008). Presently Michael is the chairperson of the HIMSS’ Personal Health Record Committee.

This article was originally published by Point of Care Partners and has been edited for re-posting on MedHealth World.


Formed in 2008, Health Care DataWorks is dedicated to reducing the distortions of cost and quality that are caused by healthcare organizations ineffectively holding their troves of information. We spoke recently with Van Chappell, Health Care DataWorks’ Vice President of Sales. Van described HCD’s Enterprise Data Warehouse appliance and the role that it is playing in medical centers and hospitals, specifically in Children’s Medical Center Dallas where the hospital uses HCD to integrate multiple data sources in efforts to improve their informed decision making capabilities.

What solutions do HCD business intelligence tools provide to medical centers and hospital settings?

Most medical centers and hospitals today have a separate BI environment for each of their major systems.  For some of the clients we work with, this numbers anywhere from 30 to 100 sources of data.  Trying to do any analytics that spans that data can be extremely difficult–which is where an Enterprise Data Warehouse comes in.  Because our EDW has a data model that provides a landing place for each of these data elements, we can bring those disparate sources of data together.

What specific solutions will HCD be providing to Children’s Medical Center Dallas?

The EDW Appliance is our primary offering presently and is the solution that CMCD chose.  Their immediate interest is in leveraging some of our pre-built dashboards around Revenue Cycle, Quality and Productivity.  They are really focused on enabling the organization to make informed decisions based on the integration of multiple data sources.  Historically, we see organizational usage of an EDW explode after several groups get their hands on meaningful data.  That’s the CMCD team vision as well.  The power of our EDW Appliance is that it is easy to add content, either by using more of our pre-built dashboards or by building their own.

Of course, an EDW really shines when you get data from multiple areas and you begin to analyze such measures as the cost of quality — the type of analytics that is increasingly in demand in an ACO world.

Please describe HCD’s Enterprise Data Warehouse application. What would a typical use-case scenario be? Are there common characteristics and traits across all of HCD’s applications?

Our goal when creating the EDW Appliance was to bundle all of the hardware, software and services you need to build an Enterprise Data Warehouse in such a way that we could become a one-stop shop for Data Warehousing in healthcare. Children’s is a great example of the common use case: multiple source systems, a desire to become an information driven organization, and a belief that if they don’t start now to get a grasp on their data it will be too late.

As for HCD’s applications, the core of all of our products is the Enterprise Data Warehouse.  Sometimes our clients only want a single dashboard.   In those cases the power of the EDW is still what is powering that dashboard, but the process of loading all the data becomes much simpler.  The great thing is if that same client wants to add a new subject area or dashboard a year later those data elements are all linked by the underlying data model. If you are working with a typical dashboarding vendor you don’t have that advantage.

How does HCD outrank its competition?

The market space we occupy is interesting.  It is largely occupied by mega-vendors whose primary focus is not healthcare.  We focus exclusively on healthcare.  Our clients appreciate the fact that we come from healthcare and have walked a mile in their shoes.

Our customers also tell us that the way we have bundled our solution is very attractive to them.   When IT evaluation teams first start looking at an EDW solution they assume to make it work they will have to spend a lot of time stringing various pieces of technology together (i.e. hardware, database, etl, semantic layer, etc).  The way we’ve built things is a fundamental shift for them. We’ve already tied everything together for them, allowing them to focus on getting data out of their source systems and then working with their end users to find the best uses.  It’s a definite paradigm shift for lots of IT departments. Once they get it though, they appreciate how much of the hard work HCD has already done for them.

We also hear that our price and pricing methodology is more attractive than the competition.  Ultimately we are focused on building a solution that solves a problem in a more efficient manner while delivering enhanced effective care in a cost effective way.

Outside of the CMC Dallas, what is one use of HCD that the company is particularly proud of?

Drummond recently certified us for Meaningful Use.  Because we aren’t an EMR, certification was not an immediate priority for us.  But upon determining it would benefit our clients, we went through the process and achieved our certification in May.  As one of the first Analytics vendors to go this route, we are very excited about achieving this milestone.

What are HCD’s future plans for offerings or plans for growth?

Currently the market for EDW’s and Business Intelligence is focused on Academic Medical Centers, IDN’s, and Children’s healthcare organizations. Because of changes to reimbursement that are occurring, we believe that Business Intelligence will no longer be a luxury, but a required core competency of health systems.  To support mid-sized organizations we have a hosted solution at a lower price point that we are rolling out.

The other area that we are spending a lot of time thinking about is the move from retrospective analytics to real time analytics to predictive analytics.  Most of what you see today is retrospective.  Most organizations still have a lot of work to do in this area.  We are working with a couple groups that are helping us build out more real time and predictive analytic capabilities.

In anticipation for this year’s mHealth Conference, held July 28-29 in our hometown, Boston, MA. MedHealthWorld will be continuing the success of our recent event coverage by interviewing some of the conference’s presenters and attendees. We spoke with Orlando Portale, Chief Innovation Officer at Palomar Pomerado and mHealth Summit presenter. Orlando will be at the conference discussing Palomar Pomerado’s Electronic Health Record implementations.

What is the focus for your presentation at the mHealth Leadership Summit?

Orlando Portale, Palomar Pomerado Chief Innovation Officer

I will describe MIAA (Medical Information Anytime Anywhere), our mobile healthcare computing platform that provides physicians with real time access to electronic health record information and physiological monitoring information that is housed in a variety of systems.

Why do you think this is a particularly timely and important topic for mobile health practitioners and decision makers?

There are a number of policy prescriptions from the federal government that incentivize increased integration of physician and hospital services.  This includes Accountable Care Organizations, that will require that physicians gain immediate access to patient information that is currently housed in disparate information systems.  The most efficient platform to deliver this information is to the smartphone or tablet device.   These devices enable on the go access to all of the information the physicians may need, no matter whether they are outside or inside the hospital setting.

Please give a brief description of Palomar Pomerado, its strengths, initiatives, and its goals. How do you work to showcase these offerings and achieve these goals?

My role as a Chief Innovation Officer is very unique among healthcare organizations; frankly you can count on one hand the number of healthcare organizations that have a dedicated innovation officer.  My primary focus is to drive business and clinical transformation by the investigation and ultimately adoption of new ideas.  Many of these new ideas have a technological component, whether in the area of medical devices, genomics, or mHealth.  Over the last four years we have pioneered a number of new ideas including using Xenon Light Emission technology for reducing hospital infections, development of our own mobile healthcare computing platform, direct to patient genomics testing, neuro-robotic stroke rehabilitation to name a few.

How does Palomar Pomerado address or represent the convergence of mobile technology with healthcare?

We believe that mobility is the next killer app in healthcare.  This includes the next generation of wireless medical devices, as well as new applications that enable real time access to information from smartphones and tablets.

Are there any newly released or planned products or services that you will be showcasing in the second half of 2011?  If so, please describe the main features:

We are going to add real time collaboration capabilities to our mobile applications that enable video conferencing among our care team from tablet computers.  So, for example, two physicians will be able to consult on a particular case remotely.  Each will have our application and can view the patient’s electronic health record, while they consult with each other over video conference.

More on MIAA can be found here, while information on Palomar Pomerado’s deployment of the Cisco Cius Android tablet is available here. A recent Cisco video interview with Orlando can be watched here.

Registration is still open for this mHealth leadership event, taking place in Boston on July 28 and 29 and discount registration is available for MedHealthWorld readers.  SAVE $200 on your current registration fee when you mention PROMO CODE: PZH857 and PRIORITY CODE: HL11028-60404! (Not valid for government, exhibit hall only rate)  Call 800-767-9499 or visit www.worldcongress.com/mHealth for more information or to register today.

Jim White, VP of Connected Hospital Sales, ALCATEL-Lucent

In anticipation for this year’s mHealth Conference, held July 28-29 in our hometown, Boston, MA. MedHealthWorld will be continuing the success of our recent event coverage by interviewing some of the conference’s presenters and attendees. We start with ALCATEL-Lucent‘s Jim White, VP of Connected Hospital Sales, who will be co-presenting with Lifewatch‘s CTO John Moss.

Please give a brief description of ALCATEL-Lucent and its offerings. What is your position and what is your role in providing these offerings to customers?

JW: I run ALCATEL-Lucent’s connected hospital program, our program name captures the near term focus for hospitals to build infrastructure to improve connectivity within the walls.  The drive for meaningful use of EHRs is a near term driver to ensure caregivers are coordinating around the patient’s record.  But the aspiration is to help the healthcare industry implement connected medicine.  ALCATEL-Lucent is a global service integrator for large carriers like AT&T and Verizon as well as for strategic industries like healthcare.  We provide communication and data infrastructure solutions for large IDNs like UPMC, the VA and advocate and large health payors like CMS and the Blues. We are working across the whole healthcare ecosystem.

What is the focus for your presentation at the mHealth Leadership Summit?

JW: Introduce a service development model that is proven based on mass market services like residential broadband access and mobile phones to address the key problem with m-health today: it is too expensive.

Why do you think this is a particularly timely and important topic for mobile health practitioners and decision makers?

JW: The whole industry recognizes that we need to shift from  expensive encounter or what I call “heroic healthcare” to a new replacement encounter to address chronic disease management.  If we want to address the cost issue, then we need to address the mass market economics required for success.

How does your company’s solution represent the convergence of mobile technology with healthcare?

JW: We help build the mobile ecosystem and we understand the dynamics of that drive that investment from carriers, we understand the power of the technology ecosystem to radicalize costs and we have been help healthcare players use this technology to solve their business issues for years.

Are there any newly released or planned products or services that you will be showcasing in the second half of 2011?  If so, please describe the main features:
JW
: Yes, we are very excited by the rollout of LTE by our large carrier customers and we think this is a key enabler for m-health.  We have some revolutionary wireless access solutions like our light radio innovation from bell labs that can provide A key building block for m-health solutions.  Our Genesys contact center solutions can help solve the hidden cost problem with most m-health solutions. The people who need to see data collected via m-health are expensive, scarce and workflow driven.  We have released our iWD  solution for distributing work to knowledge workers in a manageable and cost effective way. No m-health business model can ever be attained if a medical decision isn’t changed. Providers need to collaborate around the data an m-health system provides.


Registration is still open for this mHealth leadership event, taking place in Boston on July 28 and 29 and discount registration is available for MedHealthWorld readers.  SAVE $200 on your current registration fee when you mention PROMO CODE: PZH857 and PRIORITY CODE: HL11028-60404! (Not valid for government, exhibit hall only rate)  Call 800-767-9499 or visit www.worldcongress.com/mHealth for more information or to register today.

Hielix, a leader in creating operationally sustainable, open solutions to seamlessly exchange health information, today announced a master U.S. services agreement with the world’s largest technology distributor Ingram Micro Inc. Ingram Micro selected Hielix’s online physician assessment and EHR product evaluation application, as well as the Hielix EHR Roadmap to provide assessment services to its growing community of healthcare-focused IT resellers.

Under the new master services agreement, Ingram Micro now provides IT resellers access to the Hielix EHR Roadmap, a first-of-its-kind interactive web application enabling technology resellers to more efficiently support their ambulatory physician practice customers in practice assessment and electronic health record (EHR) vendor selection. In addition to the Hielix EHR Roadmap, Hielix will work with Ingram Micro to provide education and training services to IT resellers in the U.S.

The Hielix EHR Roadmap streamlines this first stage of adoption and helps resellers work with physicians to identify the unique EHR needs of the practice and speed adoption of specific technology. Hielix CEO Patti Dodgen says there is no other solution available today with the scale to meet the demand for relevant EHR selection and the ability to address the unique needs of individual practices.

The application will be offered to Ingram Micro resellers as part of a host of tools, training and other support services designed to help enhance credibility for the physician, accelerate time to revenue and protect the EHR investment made by both physician and reseller.

“We are proud to team with Ingram Micro and equip their healthcare reseller community with the tools, education and training they need to speed EHR adoption among their ambulatory physician practice customers,” said Dodgen. “Physician assessment, combined with relevant training and support services, will assist the Ingram Micro reseller community in selling EHR solutions while also strengthening their relationships within the physician practice market space.”

Beginning immediately, Ingram Micro healthcare resellers will have access to the Hielix EHR Roadmap. In addition, Hielix and Ingram Micro will work together to roll out a series of value added tools and services to support the reseller community in the sale and implementation of EHRs and other healthcare IT services. This will include live and on-demand webinars, qualification tools and regional events.

“The need for EHR solutions is unquestionable, but hospitals and private practice physicians don’t know where to start or what technologies will help them achieve greater efficiency and offer predictive healthcare,” says Michael Humke, senior director, vertical markets, Ingram Micro U.S. “Hielix’s online assessment, product evaluation and EHR roadmap will simplify the sale by helping our reseller partners to demonstrate what’s needed and why, as well as show the benefits EHR solutions deliver in the short- and long-term. We’re pleased to offer Hielix’s innovative healthcare tools and EHR Roadmap to our reseller partners throughout the U.S.”

With the Hielix EHR Roadmap, Ingram Micro resellers are able to identify features and functionality of specific concern to their customer practices and quickly make the most relevant product recommendations to aid physicians in their decision-making process. Armed with this information, the reseller is able to more easily identify opportunities for incremental revenue including managed services, IT consulting, hardware and software, privacy and security, meaningful use and healthcare IT consulting.

“I’m excited to work closer with Ingram Micro to build our healthcare practice and offer Hielix’s tools to physicians in order to help them better understand where they are in the process of EHR adoption and give them the assurance needed to know they are on the right path,” says Nancy Gretzinger, president, Imagex, Inc., a small business solutions provider based in Reston, Va. “Physicians are often overwhelmed with the technical aspects of EHR adoption and the Hielix EHR Roadmap eliminates any confusion by providing them with a customized and easy-to-understand report specific to their practice.”

Additional information on the Hielix EHR Roadmap can be accessed at http://www.HielixEHR.com/ingrammicro.

Follow Ingram Micro Inc. on Facebook at http://www.facebook.com/IngramMicro and Twitter at http://www.twitter.com/IngramMicroInc.

As a vital link in the technology value chain, Ingram Micro creates sales and profitability opportunities for vendors and resellers through unique marketing programs, outsourced logistics, technical and financial support, managed and cloud-based services, and product aggregation and distribution. The company is the only global broad-based IT distributor, serving more than 150 countries on six continents with the world’s most comprehensive portfolio of IT products and services. For more on Ingram Micro, visit http://www.ingrammicro.com.
Hielix creates operationally sustainable, open solutions for seamlessly exchanging healthcare information. Hielix works with healthcare providers, including physician practices, hospitals and regional/state healthcare organizations to seamlessly integrate health IT (HIT) solutions with minimal disruptions to operational and clinical workflows. Services include HIT readiness planning, meaningful use planning and reporting, EHR vendor selection, implementation and more. To learn more about Hielix visit http://www.hielix.com and follow them on Twitter at http://www.twitter.com/hielix.

As hospitals and health IT professionals face up to a growing list of electronic record requirements, HITECH and ICD-10 implementation deadlines, aligning multiple HIT systems becomes more of a challenge.  At the same time, administrators must consider the impact of new systems on physicians and other care providers.  The plodding pace of e-prescribing, EMR and CPOE (Computerized Physician Order Entry) adoption over the past decade shows that unless physicians see clear benefits in using a new electronic process, care provider adoption will be an uphill battle.  To hear more about how HIT vendors help to motivate these key medical stakeholders to try new systems, and the potential for mobile CPOE, MedHealth World spoke with Peter Henderson, VP of Marketing at PatientKeeper which claims to have “the highest physician adoption rates in the industry.”

MedHealthWorld: How many physicians are actively using CPOE in the U.S. today? What can hospitals do to improve their rate of adoption?

Peter Henderson,VP of Marketing, Patient Keeper

Peter Henderson: The adoption numbers are still surprisingly low.  A 2010 KLAS survey reported that less than 1/6 of U.S. hospitals have implemented even nominal CPOE into their workflow and less than 6% of hospitals had all their physicians regularly using CPOE systems.  So even though the federal government is creating meaningful use mandates for electronic health records and offering financial incentives for adoption, there is still a huge challenge ahead to get the majority of physicians to adopt this technology.

One problem with adoption is that many systems are designed around the hospital or practice group workflow rather than on how individual doctors actually practice medicine.  That means that many HIS systems today are not that helpful for the doctor –the system may be seen as counter-productive by the physician who is asked to use it.  Plus many of the existing CPOE system’s on the market today require extensive physician training time and have a fairly steep learning curve before the doctor becomes comfortable with the new processes.  That means it takes the doctor extra time to accomplish routine tasks, while reducing productivity and creating frustration – all huge negatives for adoption of a system with no visible benefits to the care provider.

I believe that demonstrating a value proposition for the physician is essential. With that in mind, PatientKeeper is really focused on improving the end user experience for the physician by facilitating the doctor’s current routine with a flexible user interface.  It’s fundamental to our solution to work with the doctor’s current processes and design each step with an interface that actually reflects the physician workflow and makes it easier to accomplish tasks such as order entry, physician documentation, charge entry, e-prescribing and other records related tasks.  That way, the physician can spend more time actually caring for patients.

MHW: How does that work in practice?  Is there anything unique about the PatientKeeper approach?

PH: One distinctive strategy is that we start our product design process with user interface experts and panels of physician who test and critique and improve all our apps before we bring them to market.  And even after we launch a new product, we are constantly working with the physicians to get their feedback about how each new app integrates with and improves their daily workflow.  For our CPOE app, PatientKeeper spent over a year in development with regular physician feedback on usability and functionality before doing a beta release for customer implementation.  That investment in ease of use and physician productivity dramatically improves the acceptance and adoption rate among care providers when our customers roll out a PatientKeeper solution.

From the hospital and medical practice group perspective, an important differentiator is that we do the heavy lifting of integration with their existing HIT systems.  Our solution basically serves as an overlay on the customer’s existing HIT infrastructure with PatientKeeper managing integration of the various vendor technologies that are already in place.  That integration work reduces the cost and complexity of installing our solution. As a company, we have built up a core competence in integrating with wide variety of HIS systems and have developed our own integration technology.  We collaborate actively with IT vendors to ensure that upgrades and new releases remain compatible.  Some vendors welcome this effort and others are less willing to deploy through standardized interfaces.  Even where interoperability options are not readily available, we go the extra step to making integration work as a service to our customers.  Our position is that if there is a current system in place we will integrate with it.

"PatientKeeper is focused on improving the end user experience for the physician by facilitating the doctor’s current routine with a flexible user interface."

MHW: Do you think mobile CPOE is going to be more readily accepted by physicians or does going mobile just add a new layer of adoption complexity?

PH: Personally, I think that Mobile CPOE adds a major new benefit, because bringing mobile functionality to physicians has a very powerful positive impact on patient care and care provider effectiveness.  One of the most fascinating things about physician response to mobile applications is that there has been a long standing perception that doctors just don’t like new technology.  However, the rate of physician adoption of apps for smartphones and new tablet devices is showing that to be a fallacy.  In fact, we are experiencing a huge demand for mobile PatientKeeper apps by the physician population and our customers are seeing a rapid rate of adoption.  Both Android and iPhone device adoption are tracking way ahead of our expectations, and the physicians are the ones who are actually driving and leading this adoption.

PatientKeeper has been providing mobile solutions for many years – since the Palm and the Treo were the hot new mobile devices.  Two years ago, we reengineered our mobile architecture to leverage advanced device capabilities and to make it easier to implement across a wide variety of devices. So we are in a strong position to support multiple mobile environments to keep up with the demand for PatientKeeper on mobile.

At the same time, I believe that any stand alone mobile solution will be at a disadvantage over the long term. To really transform health care, vendors need to integrate mobile apps with all the multiple points of access that are typical in every hospital and health care system.  Transformation will really take off when mobile devices can seamlessly access exactly the same data and services across all the different systems that are in use.  As with CPOE, HIT integration and interoperability are key capabilities that will ensure the delivery of the best value for hospitals and physicians.

“The power of TITAN is the ability to finally give doctors the real transparency into what’s going on. To know what the RAC auditors know, know what the payers know, know what regulators already know. Now, physicians and practice groups can know and do something about it to compete at the same level and be part of the discussion in healthcare.”

RemitDATA’s President Michael Sanderson spoke to MedHealthWorld about TITAN, a solution to the lack of transparency available to the outpatient provider market.  By parsing and analyzing available ANSI835 data, TITAN provides metrics and benchmarking that empowers users with instant transparency and enables them to reduce hours, accelerate cash and cut costs.

RemitDATA’s President Michael Sanderson

RemitDATA was founded in Memphis in 2000 and from its inception has focused on providing solutions to the outpatient provider market. The crux of RemitDATA’s patented process is taking ANSI835 data and focusing on the information that is subsequently relayed by payers in the adjudication process. The premise is to work with remittance information to create and share provider focused data. With a 94% renewal rate, the company works with companies like McKesson, Barnes-Jewish, Johns Hopkins, NextGen, AllScripts, and numerous private labels to build and expand its growing database. Sanderson explains, “The universe of those files is around 1.5 billion per annum. We’ve got greater than a quarter of that database coming through direct from practices and from these larger partners of ours, whether they’re practice management or EMR or clearing house vendors. We have a huge, honking database – a technical term I like to use. And that’s given us the largest footprint for provider focused data.”

TITAN is an acronym for Transparent Insights To Act Now and is directly aimed at minimizing what RemitDATA calls disproportion transparency. Sanderson and his colleagues identify a tremendous disparity in the availability of actionable information to doctors and physicians. They feel that evolving industry trends like EMRs, meaningful use, and compliance, the risk of audits, and the emergence of new payment methodologies are all overwhelming to doctors and that they are essentially flying blind. TITAN is being introduced to reduce this problem. Sanderson asks, “How does it make sense that the doctors, who control 80% of the spend, have the least information of the whole mix? The OIG has it, the government has it, payers have it, pharma-companies can buy it, doctors don’t have it, and TITAN’s going to fix that.”

TITAN uses their database of remittances to push customizable information to users. Users can choose to see information on reimbursement issues and trends they are most interested in and can use the information for comparative analytics. Sanderson emphasizes the importance of comparative analytics as a driver for doctors to see if they are performing better or worse than peers. “We’re the only ones out there showing you, the cardiologist for example, how you compare to others in your state…as a cardiologist, things that I can infer from an 835 might be number one: reimbursement issues. What’s Cigna doing to me in this market? Or, I’m in Boston, I’m an orthopedic surgeon, what’s Aetna doing, and what’s Medicare doing?  How does that compare to my peers? Am I being paid faster or am I being paid slower? Am I being paid less or more? Am I being denied for different reasons? What’s going on with the payers?

TITAN users can choose to see information on reimbursement issues and trends they are most interested in and can use the information for comparative analytics.

How about productivity? How does my staff compare? Am I getting paid in the same time frame; is my staff as productive as my peers in this market? Am I coding differently than my peers? Am I an outlier and doing something that’s going to make me stick out like a sore thumb to these auditors?”

TITAN users define their requested insights, and TITAN designs their reports to match user needs. Information is emailed to physicians and users via a summary score card. The score card contains the customized information chosen and comprehensively explains findings. For instance, an orthopedic surgeon can be alerted via a weekly insight that the top ten orthopedic codes have differed from peers by greater than a delta that was permissible. An alert can be set if you are  getting paid less than 5% of peers or are at a 5% discount to them. If that is the case, obviously, there is an issue and users can click review to find out which payers are doing this and why it happened.

TITAN data is also accessible via iPhone and iPad

Other features include payment deviations and RAC audit triggers where users can track behaviors, rank top payers, and isolate mistakes such as the over usage of certain potentially incorrect billing codes. Tracking can be viewed by month or billing period and can be set by various increments and variables that measure relevant data. Data can also be dragged and dropped to organize hierarchies and priorities, and one-touch buttons provide instant reviewing and comparing capabilities..

Sanderson sees the focus TITAN provides as a crucial output. He views obtuse, irrelevant information as commonplace that can oftentimes be misleading. TITAN weeds through the extraneous information and enables clarity. You need to know what’s going on in your region with the codes that you care about. Without that information, you’re not going to change any behavior. You’ve got to know exactly what you’re doing. For example, let’s say you find that you have a spike in Blue Cross denials or a problem with Blue Cross. You look in TITAN and you realize that it’s the same for everybody in your state. There’s a problem with the company – it’s systemic.  There’s nothing you as a doc can do, and it’s going to have to get fixed by Blue Cross. Focus your time elsewhere.”

While Sanderson readily admits that the payer community is less than receptive of TITAN, he maintains that the information will help the healthcare industry. RemitDATA has worked carefully to ensure that their process is HIPAA compliant and maintains the absolute privacy of its users. “I’m not ever going to expose data to you that will get either of us in trouble. You aren’t able to look at your competitors or patients that aren’t yours. You only look at aggregated data.” TITAN’s transparent information, he says, will facilitate reduced denials, higher payments, minimize audit fears, and help doctors and physicians identify if they are outliers or if their firms or offices have problems that need immediate solutions.

TITAN went live at HIMSS 2011 and has been steadily growing since. Armed with case studies (featuring TITAN’s role at Boice Willis and ERS) extolling its benefits and a recent announcement of increased funding, RemitDATA is building TITAN’s breadth and scope and garnering interest. “We’ve literally been overwhelmed with the opportunity from the response by the market. This additional capital is just helping us hit the accelerator and take it to the market quicker. We had more partners sign up than we thought. We didn’t have any idea that we would have such big partners sign up immediately. We knew it was enticing. We knew that transparency’s a big issue and that it would resonate with providers because they’re sick and tired of being in the dark.”

Sanderson says that ultimately, TITAN’s power comes from its role as a third party independent solution and that as the information becomes more transparent, dialogue will spur industry changes. “It’s time for transparency. RemitDATA is about enlightening healthcare. We’ve got a unique opportunity because we’ve got a big database and cool technology. We’re not bound to the payers or the government or to anyone’s system. As a 3rd Party independent company, we’ve got a unique situation where we can really help bring this transparency to the docs. And I’m excited by it…I think this is going to be one of those David and Goliath fights that says, ‘hey Docs, you already control 80% of the spend in healthcare, don’t you think you should have this information?’ And that’s the piece I’m most excited about: watching this unfold over the next year.”

The CAQH® Universal Provider Datasource® (UPD®) has registered its 900,000th provider firmly establishing it as the go-to resource for complete and reliable self-reported data from physicians and other healthcare professionals. Three out of five licensed and practicing physicians in the country have signed up with the service. About 7,000 additional providers are registering each month. CAQH estimates that UPD reduces provider administrative costs by $105 million a year.

“At a time when the electronic exchange of health information has created new and expanded requirements for verifying provider data, UPD is a key resource for accurate data to populate provider directories for regional, state, and federal health information exchanges,” said CAQH Executive Director Robin Thomashauer.

As adoption of electronic health records and health information exchanges intensifies, it is important to eliminate administrative redundancy and simplify data sharing. Broader use of UPD supports those goals, particularly in relation to development of provider directories, a focal point of an HIT Policy Committee workgroup within the Office of the National Coordinator for Health Information Technology. Last fall Sorin Davis, managing director of UPD, provided testimony to the Committee’s Information Exchange Workgroup, Provider Directory Task Force. Based on CAQH experience, Davis emphasized that technical requirements for provider directories should:

  • Integrate data from sources that directly engage providers in the collection process.
  • Enable direct communication with providers regarding data maintenance.
  • Offer providers access that is free, simple and secure.
  • Assure that data sources function with full transparency and permit provider access and control of their information.

“While the role of provider directories in facilitating health information exchange is still under discussion, the CAQH experience offers policy-makers valuable insight on the importance of addressing physicians’ core concerns: trust, reliability, privacy, and the use of information regarding their identity and professional profile,” said Steven Waldren, MD, director of the Center for Health Information Technology at the American Academy of Family Physicians.

UPD eliminates the need for providers to fill out multiple forms with various healthcare organizations whenever information is needed for credentialing and other purposes, saving time and administrative costs for both the provider and the authorized database user.

UPD boasts 93.9% accuracy, according to a recent independent study. The data source is created through direct input from providers, who are automatically reminded to update and re-attest to their information every 120 days. An add-on feature, SanctionsTrack™, delivers timely information from 480 different state licensing boards, Medicare and Medicaid sources, and other relevant sources on physicians and other healthcare professionals whose licenses were revoked or had restrictions put on their practice.

Used by more than 600 authorized healthcare delivery organizations to check information on individual providers, UPD is a single, uniform electronic utility that streamlines and improves the ability of physicians and other healthcare professionals in all 50 states to easily and securely submit, and control access to – at no charge – their online information for credentialing, claims administration, quality assurance and other purposes. UPD is endorsed by leading national provider and health plan associations, meets data collection requirements of healthcare quality accreditation agencies and has been adopted as a standard form for provider credentialing in 12 states and the District of Columbia. Additional details are available at http://caqh.org/ucd.php.

CAQH, a nonprofit alliance of health plans and associations, is a catalyst for simplifying and streamlining healthcare administration. CAQH solutions, including UPD and CORE, reduce costs and frustrations associated with healthcare administration, facilitate healthcare information exchange, and encourage administrative and clinical data integration. Visit http://www.caqh.org for more information.

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