Top 10 Health IT Trends For 2016

For the past five years, EHR/MU was selected as the top health IT initiative for the coming year. This year, there’s a new top initiative, and what it is should come as no surprise.

Once again, we asked for your help in identifying what is going to be front of mind in the world of health IT in the coming year. As always, you were up to the task, ranking the security of patient health information just ahead of ICD-10 compliance as the top health IT initiative for healthcare providers for 2016.

As 2014 drew to a close, EHR Meaningful Use, PHI Security, and ICD-10 Compliance were all weighing heavily on the collective minds of those working in health IT. Those three initiatives were predicted to have the most impact on health IT in 2015, and for the most part they didn’t disappoint.

Let’s start with EHR Meaningful Use (MU). CMS released a final rule specifying criteria eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) must meet in order to participate in the Medicare and Medicaid EHR Incentive Programs. The final rule’s provisions encompass 2015 through 2017 (Modified Stage 2) as well as Stage 3 in 2018 and beyond.

Among the highlights: All providers are required to attest to a single set of objectives and measures; EPs face 10 objectives, including one consolidated public health reporting objective; and EHs and CAHs face nine objectives, including one consolidated public health reporting objective.

In addition, existing regulations were changed in several ways, including giving providers and state Medicaid agencies until Jan. 1, 2018, to comply with the new requirements and prepare for the next set of system improvements. Developers were also given more time to create the next advancements in technology, and support was pledged to improve the exchange of health information and interoperable infrastructure for data exchange between providers and with patients.

Moving on to PHI Security, and for good reason, as 2015 was also being called “The Year Of The Healthcare Data Breach” even before 2014 had drawn to a close. Unfortunately, that prediction turned out to be true. Numbers are still being compiled, but since the start of the year until early November, 224 breaches of unsecured protected health information affecting 500 or more individuals were reported to the U.S. Department of Health and Human Services as required by the HITECH Act. The top five breaches during this period — Anthem, Premera Blue Cross, Excellus Health Plan, UCLA Health, and Medical Informatics Engineering — saw the PHI of 108,200,000 people compromised.

Finally, ICD-10 Compliance tried to live up to the hype it generated as 2014 drew to a close, but, in the end, it proved to be misplaced worry. One healthcare expert called the angst caused by the October 1 conversion to the more than 68,000 codes “much ado about almost nothing,” comparing it to Y2K. One vendor reported 99 percent of its 6.6 million claims submitted during October were successful, and 87 percent of its customer base had already been paid for at least one submitted claim.

CMS issued a release as October wound down revealing 4.6 million claims were being submitted daily, a number equal to its historical baseline. The rate of Medicare claims rejected due to incomplete or invalid information was 2 percent, also identical to its historical baseline. Finally, the total Medicare claims denial rate for all reasons was 10.1 percent, up ever so slightly from a 10 percent historical baseline.

All said, not bad for a conversion many predicted would cause significant disruption in healthcare. Then again, maybe the conversion went as smoothly as it did for that very same reason.

But enough looking back. Let’s dive into which initiatives our readers predict will carry the most weight with providers in 2016, starting with a look at how we conducted our research.

Research Sample
Health IT Outcomes’ survey respondents were selected at random and are a fair representation of our total circulation of IT decision makers from healthcare providers. Th e majority of respondents (48.6 percent) represented hospitals and IDNs, followed by group practices/clinics/ ambulatory care centers (23.7 percent).

Some consultants, systems integrators, and value-added resellers (13.3 percent) were included in the survey, given their involvement in and influence over the health IT implementations of many healthcare providers.

IT, clinical, and executive titles were well-represented in our sample, with IT leadership (including CIOs and CTOs) accounting for 44.1 percent of respondents, C-level executives (e.g., CEO, COO, CFO, CMO, CMIO, etc.) accounting for 17.1 percent, and clinical leaders accounting for 23.4 percent.

Of the hospitals and IDN contacts that responded to the survey, 35.7 percent were from hospitals with 500 beds or more, 14.3 percent were from hospitals with 300 to 499 beds, 26.8 percent represented hospitals with 100 to 299 beds, and 23.2 percent were from hospitals with fewer than 100 beds. Of the group practices, medical clinics, and ambulatory care centers that responded to the survey, 56.2 percent represented facilities with more than 50 physicians, 11 percent represented facilities with 26 to 49 physicians, 11 percent represented facilities with 10 to 25 physicians, and 21.9 percent represented facilities with nine or fewer physicians.

Survey Methodology
To identify the top trends, Health IT Outcomes asked each of the survey respondents to rank a series of technology initiatives in line with their implementation plans for 2016. For each initiative, respondents were asked to clarify whether the initiative was a “Top Priority,” a “Priority,” “Important,” “Somewhat Important,” or “Not Important At Th is Time.” Each response was then weighted. For example, all “Top Priority” responses were given a rating of one (1), while “Not Important At Th is Time” responses were given a rating of five (5). An average of the total ratings was then calculated for each initiative. Th e lower the cumulative rating, the higher the priority the IT project was to our survey respondents. Th is rating system was used to determine the Top 10 Health IT Trends for 2016. These trends are outlined in the table below.

One Last Look Back
Last year saw a three-way tie for the top health IT trend for 2015 between EHR/ MU, PHI Security, and ICD-10 Compliance with all receiving a cumulative rating of 2.07. Th is forced us to apply a tiebreaker (percentage of survey respondents that ranked an initiative as a “Top Priority”) to determine the final rankings. Nearly 50 percent of our survey respondents (47.43 percent) ranked EHR/MU a “Top Priority” for 2015, making it our top overall health IT trend for the fifth year in a row. Th is initiative was followed by PHI Security, which received “Top Priority” designation by 45.71 percent of respondents. Finally, ICD-10 Compliance ranked third with 38.37 percent of respondents naming this initiative a “Top Priority.”

The King Is Dead, Long Live The King
Th is year marks the end of EHR/MU’s five-year reign as the top health IT initiative with PHI Security taking over the top spot with a weighted average of 2.09. ICD-10 Compliance ranked second at 2.11, though more respondents indicated ICD-10 Compliance was a top priority (47.57 percent) than PHI Security (42.06 percent). HIE/Interoperability (2.31) jumped seven spots from last year, checking in at number three on this year’s list, with Clinical Decision Support/ Evidence-Based Medicine (2.34) and Patient Portals/Patient Engagement (2.39) rounding out the top five.

That’s not to say EHRs are no longer a concern amongst the health IT community. The adoption of them was ranked sixth by our readers, although, interestingly, of the top 10 trends EHR Adoption (2.41) had the highest percentage of “Not Important At This Time” responses at 15.9 percent. Rounding out the top 10 were Population Health Management/Analytics (2.45), Secure/Unified Messaging (2.49), Mobile/Tablet Computing (2.56), and Revenue Cycle Management (2.68).

Contrary to last year, which saw a marked score increase (0.25) separating the top three initiatives from the rest of the field, this year saw a more even distribution. There was no more than a .10 difference from one initiative to another, indicating no one big issue — such as ICD-10 Compliance last year — will be dominating healthcare in 2016.

Our list of 2016 health IT trends is similar to our 2015 installment (seven of our top 10 trends for 2016 were also represented on our 2015 list), but there are some interesting new trends to crack our top 10 this year: Population Health Management/ Analytics, Mobile/Tablet Computing, and Revenue Cycle Management. Dropping out of last year’s top 10 were e-Prescribing, MU Audits, and Meaningful Use.

On With The Show
But enough reviewing the numbers, it’s time to take a deeper dive into the initiatives that made our top 10. To do that, we’ve enlisted the help of several health IT visionaries to provide additional insights and commentary on our top 10 trends.

Trend 10: Revenue Cycle Management
Reducing Costs? Prepare For And Embrace Change

By Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy, Revenue Cycle MAP, Healthcare Financial Management Association

Twitter: @hfmaorg, Website: www.hfma.org

As healthcare continues to look for ways to drive down costs, revenue cycle operations in the healthcare arena continue to focus on strategies supporting the following trends:

• provider integration and consolidation
• patient engagement
• workforce management
• revenue integrity
• technology tools

Integration and consolidation are taking new forms. Originally focused on the development of larger hospital systems, healthcare organizations today are not only consolidating hospital and physician revenue cycles under one platform and one leadership structure, but expanding their reach into post-acute care services. For revenue cycle leaders, this leads to further integration of processes involving major segments of scheduling, pre-service, and post service operations.

Patient engagement is becoming a critical metric for providers for many reasons. For example, research has demonstrated a positive relationship between top quartile HCAHPS scores and better clinical outcomes for surgery cases. Medicare now ties patient satisfaction scores to reimbursement. Also, with the growing prevalence of high-deductible health plans, patients are taking on increased direct financial responsibility for their healthcare bills. HFMA’s Patient Financial Communications Best Practices offers providers clear guidance on how to appropriately and effectively communicate with patients about billing and payment. Because revenue cycle operations touch every patient, they influence not only HCAHPS scores but also patient satisfaction overall.

Revenue cycle leaders are faced with the challenge of structuring the work environment to meet the changing needs of their organizations and their employees. Work-from-home programs, once limited to a few services, i.e., transcription, are being implemented for significant portions of the scheduling, pre-registration, coding, billing, and follow-up workforce. Extended hours, including weekends, are a necessity for pre-service activities and provide opportunities for greater personal interaction with patients. A focus on accountability and employee scorecards, supported by a robust communications program, supports employees in these new models.

Any time there is a major change in how providers are paid, there is a clear need to validate the integrity of the new payment processes. With ICD-10 now in place, revenue cycle leaders will be challenged to monitor and prevent denials, as well as confirm that payments received based on ICD-10 coding are correct. Failure to monitor and validate these payments, and review clinical documentation when expected payment levels are not achieved, could well mean the difference between a positive and negative bottom line.

Finally, embracing new technology tools will potentially reduce costs and improve patient satisfaction for several key revenue cycle operations. First, mobile applications may become as important, or even more important, than web-based tools. Scheduling, payment portals, and the ability to conduct secure e-mail exchanges with providers are high on the priority list. Second, enhancements to existing patient portal applications, such as a program to establish online payment plans, have yielded positive results for providers. Even basic patient-focused activities, such as appointment reminders, can be automated and handled via secure communications with patients.

The bottom line for revenue cycle 2016 is this: prepare and embrace continued change — in processes, in patient expectations, and in the challenge to reduce costs associated with the administrative and financial side of healthcare.

Trend 9: Mobile Computing
mHealth: Bringing Value To The Healthcare Equation

By David Collins, Senior Director, Connected Health, HIMSS - Personal Connected Health Alliance

Twitter:  @collinsdavid, Website:  www.himss.org/connectedhealth

Value is often defined as the balance between cost and quality, or the best quality that can be achieved at the lowest cost. In healthcare, what is the answer to this cost/quality conundrum? Can mHealth simultaneously increase value, and decrease costs?

Let’s explore a few ways mobile technology is transforming healthcare and changing the delivery of care, creating efficiencies, decreasing costs, and improving outcomes.

mHealth, such as remote patient monitoring, and of course telehealth, is taking a leading role in the development of new care models in achieving cost/quality goals aligned with value of care over volume. mHealth offers efficiency, convenience, and access to care through wireless infrastructure, personal connected health devices, telehealth, remote monitoring, and apps.

Discharge toolkits, which include tablets, weight scales, pulse oximeters, and blood pressure cuffs to engage patients in their own care, are becoming more common and help communicate chronic care management trends to providers and mitigate the need for as many onsite nursing visits. The costs of these toolkits are minimal, especially when considering they help reduce readmissions — extremely draining on healthcare system as they must absorb the cost of a readmission — and, of course, better for the patient as the focus of care becomes one of prevention and wellness rather than sick and acute care.

Mobile technology is introducing both new ways of delivering care and new business models. GW Medical Faculty Associates’ ConnectER Program is leveraging telehealth to conduct follow-up visits after care in the ER, allowing patients easy access to physicians via patients’ personal tablets. UPMCAnywhereCare supports the goal of providing more efficient, high quality care, at a lower cost. On average, the AnywhereCare virtual visits are $86.64 — less costly when compared to an ED, Urgent Care, Retail or PCP office visit. These are just two examples of many case studies demonstrating how the cool new tools of mobile technology continue to pop on a daily basis, with unlimited potential for mHealth and “mValue”.

Mobile technology in healthcare is becoming the great equalizer, increasing access to care, decreasing costs, improving quality, and engaging the patient as part of the overall solution. ONC’s Federal Health IT five year strategic plan recognizes how mobile computing and connected health are no longer disruptive and unique, but a ubiquitous platform, strategy, and solution becoming part of the integrated solution of healthcare delivery. Integration of patient generated health data into the EHR, an enhanced focus on the availability of chronic code management codes for reimbursement of telehealth and remote patient monitoring, and the use of APIs to promote interoperability and patient engagement are all changing the status quo.

Trend 8: Secure/Unified Messaging
Trending Towards Tablets: Optimizing Patient Care And Service

By Cameron Roche, Research Analyst, VDC’s Enterprise Mobility and Connected Devices

Twitter: @Cam_Roche

The innate nature of the healthcare system is such that its workforce is highly mobile and heavily reliant on real time information. In a high pressure hospital environment, where a medical team’s response time often directly affects patient outcomes, having the most up-to-date and accurate information on-hand is critical. As such, it is only fitting mobile technology is making its mark on the healthcare landscape.

While mobile solutions are not new to the healthcare field, advancements in mobility are leading to significant shifts in how mobile technology is implemented and how HIS (hospital information systems) are being designed. A perfect example of this is the shift away from bulky COWs (computers on wheels) towards more portable technology such as tablets. According to a 2015 VDC survey, tablets are now the primary mobile solution to support healthcare applications and workflows. In fact, when looking at both rugged and consumer-grade form factors, 50 percent of respondents reported relying on tablets compared to just 22 percent of respondents using notebooks and a like amount using smartphones.

Healthcare is a field which places particularly high demand requirements on its mobile devices and must ultimately lead to increased accuracy, efficiency, and patient safety. The ability to quickly reference medical information and collaborate with treatment team members means a mobile device would have to have a large screen to view information, the ability for signature capture (often via touchscreen), access to a keyboard (either built-in or as an attachable accessory), and an intuitive interface. Furthermore, long shifts have driven demand for increased battery life and the built-in capability for constant Wi-Fi connection. Given these considerations, the tablet form factor is well suited to support healthcare requirements.

With the adoption of new mobile technologies, many forward-thinking healthcare organizations are leveraging mobile solutions to provide patients with better customer service and more effective engagement opportunities with treatment team members. Now, patients can easily access lab results, make appointments, refill prescriptions, and communicate directly with their entire healthcare management team conveniently from their home or mobile device. While these advances clearly position patients and healthcare organizations alike with added benefits, there are also some barriers which still must be addressed before mobile technology becomes fully embedded within the healthcare system.

VDC’s 2015 Healthcare Survey revealed 64 percent of participants pinpoint app security and 53 percent cite privacy concerns as major obstacles in the way of full deployment of mobile healthcare solutions. With complex HIPPA regulations as well as increasingly strict PCI DSS requirements looming in the wake of recent data breaches, healthcare organizations are actively seeking solutions to make their mobile interfacing more secure. While clearly an issue, security also presents an opportunity for technology and security firms. Those able to provide enhanced security measures for communication, data access, and information storage could find their services in high demand.

Even with these concerns in mind, the trend towards tablet use is strong. Following increased demand, survey respondents indicated 70 percent of healthcare institutions are providing some level of increase to their mobility budgets. Furthermore, 34 percent of respondents indicate they are increasing their budgets by more than 10 percent. This increased funding should allow healthcare providers to overcome some of their barriers and more effectively incorporate mobile devices into their everyday workflow.

Trend 7: Population Health Management/Analytics
Population Health

By Linda Stotsky, Healthcare Consultant

Twitter: EMRAnswers

Population Health has been defined as the health outcomes of a distributed group of individuals within a specific patient population. The Affordable Care Act boosted our understanding of three healthcare goals — improving the individual experience of care, reducing the cost of care, and improving the health of populations.

We are seeing models of care shift to support new design (Patient Centered Medical Homes), as well as improved communication across practice settings and locations of care offering patients tools to improve communication, education, and manage chronic disease.

In 2015 CMS added three programs to improve the health of Medicare patients: Medicare Annual Wellness Visits, Transitional Care Management Reimbursement, and Chronic Care Management (CCM) Payments. Healthcare organizations are promoting a more active role for patients, to better manage the health of patient populations. As we enter 2016, expect to see the following.

• New Patient Engagement Models

Healthcare organizations are becoming proactive in patient engagement, including patients in care management through text, email, and voice reminders for medication adherence, daily device readings, and additional daily living concerns. Primary care physicians are developing care teams to better educate patient populations in the areas they live, on the devices they use, via the cultural and linguistic manner they find most helpful.

• Integrated Care Models

We will continue to see a push for more states to support whole patient care in which a continuum of comprehensive services is provided through one delivery system that includes behavioral health, substance abuse, and population health management. This integrated system will prevent gaps in the care model and incorporate a stronger community infrastructure to secure and support collaborative effort between primary care and public health initiatives. Connecting patients outside the four walls of a facility with vital social services reduces the cost of care and improves the health of patient populations by addressing social determinants, the wider set of forces that shape the conditions of daily living.

• Healthy Aging

The population of Americans age 65 and older is expected to double in the next 25 years due to increased life expectancy of baby boomers. Research shows the health of the aging population can be preserved by broadening the use of preventive services, encouraging healthy lifestyles, and supporting the efforts of older Americans to age in place. Livable communities — those that promote pedestrian safety, walking, and transportation availability — help facilitate healthy aging. Community-based resources promote a transition from institutional settings to a more collaborative, community based setting which includes exercise, education, and services to aid patients with disease management, mental health support, and palliative care.

Trend 6: EHR Adoption
EHR Adoption: A Demise Greatly Exaggerated

By Jim Tate, President, EMR Advocate

Twitter: @jimtate, Website: www.EMRAdvocate.com

Mark Twain put it best when he said, “The reports of my death have been greatly exaggerated.” The same can be said about the adoption of EHRs.

The CMS EHR Incentive Programs are beginning to look a bit long in the tooth and we know most of the incentives have been paid out. Quite a few providers, many of them specialists, opted to wait out the program, not worry about EHRs, and accept the perceived relatively small Medicare adjustments.

Better hold your horses. While the CMS EHR incentives that drove adoption are on the wane, Federal legislation enacted in 2015 will continue to motivate EHR adoption for the foreseeable future.

Medicare Part B reimbursement is shifting quickly from pay-for-performance to a system based on pay-for-quality. On April 16, 2015 Public Law No: 114-10 was signed into law. The bill’s title, SGR Repeal and Medicare Provider Payment, scarcely provided a hint as to the importance of the legislation.

Many Medicare Part B providers will be directly impacted by portions of this bill and have Part B reimbursement affected in 2019 based on their 2017 performance. That performance will be calculated by a composite score that will range from 0 — 100 points. Twenty-five of those points will be earned by achieving the Meaningful Use (MU) of Certified Technology. Decide to ignore MU and your score will immediately drop to a maximum of 75.

For those Medicare Part B providers who fall under the new Merit-Based Incentive Payment System (MIPS), the swing of received Part B payments in 2019 (based on a 2017 generated composite score) could be as much as 12 percent. That is looking to go to 15 percent in in 2020, 21 percent in 2022, and 27 percent in 2022. If you are a Medicare Part B provider, and choose to avoid the MU of CEHRT you will experience significant fee adjustments.

Over the next few years the MU of certified EHRs will be decoupled from the CMS EHR Incentive Program and incorporated into a reimbursement plan based on pay-for-quality. The avoidance of MU will become more and more painful. The rules and regulations are being worked out now and much has yet to be determined but the timeline has been set. Those that decide not to participate will pay dearly. The continued adoption of EHRs is certain. Those who choose to avoid the inevitable will find themselves paying a high price.

Trend 5: Patient Portals/Patient Engagement
Portals Operational, Users Not So Much

By Linda M. Girgis, MD, FAAFP, Girgis Family Practice

Twitter: @DrLindaMD

The year 2015 saw more widespread implementation of patient portals in hospitals and practices across the U.S., much of which was done to keep aligned with MU requirements and avoid financial penalties. However, the fact remains that patient portals show great potential as a tool to allow users immediate access to their clinical records. Likewise, practices’ workflows should be eased by a reduction in the number of phone calls received as much of the information patients most inquire about is now available on the patient portal.

That said, user engagement lags behind expectations. Numerous studies report patient portal use at anywhere from 35 percent to 50 percent, a disappointing number that doesn’t seem to vary much between large and small practices. So, why are patients not using patient portals?

1. Many simply do not know they exist as a great number of doctors rolled out their portals just to stay within MU requirements without investing effort into patient education.
2. The IT learning curve left many portals lacking functionality. While this has been largely repaired, patients may be reluctant to retry a portal they had a prior bad experience with.
3. Some patients simply aren’t computer savvy, and many elderly patients are reluctant to adapt this new communication platform. Admittedly, while studies show age is not always a factor, something is leaving patients reluctant to use this technology.
4. The learning curve of medical practices is still in play with many still learning how to fit the portal into their everyday workflow, and it’s going to take time before it becomes main stream.
5. No value can be placed on the human factor. Many patients just prefer talking to a real, live human being, something no portal can replace.

While we now have these portals in place, user engagement is now our goal. Practices need to make patients aware of their portals and what they are capable of doing, as well as make part of their everyday workflow. Additionally, the IT industry needs to be responsive to the users of their products and continue to implement needed changes. Widespread patient use of portals will only happen when all members of the team step up and do their part.

Trend 4: Clinical Decision Support (CDS)/Evidence-Based Medicine
Medical Evidence With CDS Is Closer To Reality

By Shahid Shah, The Healthcare IT Guy

Twitter: @ShahidNShah, www.healthcareguy.com

Last year I wrote evidence-based medicine (EBM) requires computable guidelines, an area Clinical Decision Support (CDS) tools have lacked. While we’re not closer to my suggested computable care maps or machine-readable guidelines, significant advances in analytics, artificial intelligence (AI), and machine learning (ML) will help move the ball in 2016.

This year I was invited by IBM to its Insight 2015 event where product engineers and solutions managers walked me through what they were working on — starting with IBM Watson Health specifically but also touching broadly on their AI, ML, and analytics work. I walked away more impressed than ever and felt the time was right for healthcare institutions to choose horizontal tools for analytics and hire vertical expertise to help with content curation, data integration, and preparing for innovation and evidence that will be generated through new analytics capabilities.

We’re already generating clinical evidence using traditional analytics tools from the usual suspects such Microsoft, IBM, Oracle, Dell, and HP. But the next generation AI and ML techniques being employed by developer-friendly ML tools such as Google’s TensorFlow, Microsoft’s Oxford, IBM’s BlueMix (Watson Health), and Amazon’s AWS ML Service will kick this capability into high gear in 2016.

Health insurance companies looking to use clinical evidence to drive care management across members, healthcare providers wondering whether care gaps are being filled, and pharma companies wanting to understand drug safety with multi-omic personalized biological accuracy can now focus their energy on the difficult medical aspects of data and analytics instead of building the infrastructure tools. I’m hoping that 2016 will usher in an era where solution providers and vendors that have healthcare and medical evidence curation chops will hire developers and start building on these next-generation cloud offerings instead of continuing to build their own proprietary solutions that can’t easily be extended.

CDS has stagnated for years because we’re depending on incumbent EHR solutions, which were designed more for documentation of episodic care than for EBM. If we’re going to see an acceleration of EBM initiatives leading to better CDS, we’re going to have to jettison the idea that healthcare infrastructure software will come from the healthcare industry. Instead, we must embrace the idea that the horizontal platform players and the significant offering of cloud and open source frameworks will get us closer to the towards the EBM promised land in 2016.

Trend 3: HIE/Interoperability
The Evolution Of Health IT: Solving Interoperability Through Business Model Innovation

By Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University

Twitter: @Donald_M_Voltz

Provider frustrations stemming from a lack of interoperability have been relegated to hospital system techies, even as it impacts patient care and leads to unintended clinical consequences. Despite pressure from the AMA and AAFP, little resolution has been obtained. The future of interoperability will not be solved with new policies neither in Washington nor within the EHR market. There is simply not enough incentive to do so.

However, pressure is being applied to physicians and hospitals by patients and organizations such as GetMyHealthData.org. Recently, a lawsuit was filed against two hospitals in Washington, D.C. alleging excessive charges imposed to obtain copies of their health data, something EHR implementation was suppose to make easier while reducing costs. The real test of interoperability is not expanded access to health data, but instead a sophisticated flow of information.

Authorized, secure, and monitored access to patient health data does not bring value. The conversion from paper to electronic medical records expanded access, but did not improve the delivery of care. While algorithms can improve the delivery and communication of the data collected, a human touch is still needed to gain new insights and value from the creation of health data applications.

Curation, new meaning arising from the combination of new and existing information is the sweet spot for health IT, but unobtainable until we change our perspectives of EHRs. Hospitals and physicians who are able to create and harness the concept of curation will be rewarded with decreased care costs.

CMS’ commitment to pay for the administrative side of coordinating medicine for patients with chronic medical conditions (CPT 99490) and transitions of care (CPT 99495 & 99496) has established a means for increased revenue, provided physicians and health systems can harness the power of aggregating patient health data from a variety of sources supporting patient care documentation flow between diverse sources.

Despite the lack of interoperability, we are making some headway in this area, without requiring standardization or EHR vendors to revamp their systems. The addition of a layer of software between the application healthcare professionals interact with and databases storing patient and operational health data finally brings a solution to a problem that was unlikely to be solved. Zoeticx, a Healthcare 2.0 EHR integrator, has developed a solution to meet the numerous requirements to bill for CPT 99490.

Under the bundled payment system that has begun to affect hospitals, the financial pressures require us to think outside of the box. Waiting for EHR vendors is no longer an option. Understanding and implementing new health IT business models will drive change in the health IT industry. However, addressing the claims of EHR proprietary clauses, information blocking, and standards will take time. Partnerships to develop innovative solutions to the health technology challenges will bring new opportunity to healthcare and empower the currently frustrated and apathetic.

Trend 2: ICD-10 Compliance
What’s Next For ICD-10?

By Steve Sisko, Health IT Consultant and Blogger

Twitter: @ShimCode, Website: www.shimcode.com

To paraphrase Chief O’Hara of the old Batman TV series, “ICD-10 finally went in! Saints be praised!”

Now that professional providers and hospital facilities have started collecting ICD-10 coded data, healthcare should begin seeing ICD-10’s added precision start to bear fruit in 2016. Sophisticated data analytics will combine ICD-10 coded data with unstructured data collected from EHR’s and social media streams. In turn, more complete, insightful information, accurate risk assignment models, and patient profiles will become available to help support emerging healthcare quality and value-based reimbursement programs. Following are trends involving ICD-10 I think will establish a strong footing in 2016.

Leveraging The Unstructured
Over the past few years, while the ICD-10 implementation date was being pushed back time and again, providers were implementing EHR systems and starting to collect clinical and administrative patient data. Though a lot EHR data is unstructured and hard to extract, advances in integration tools and unstructured text processing technologies are finally opening up easier access to data stored in EHR’s. Reading and writing simple HL7 documents like CCD and CCDA are leading the way; and the FHIR standard is almost ready for prime time.

The opportunities integration tools and text processing technologies offer are expanded by companies providing easy access to social media streams such as Twitter and Facebook. Combining these non-traditional data sources identifying social determinants, economic, and environmental factors impacting one’s health with structured data like ICD-10 maintained in EHR’s offers significant opportunities for healthcare organizations to advance patient care and improve overall patient engagement.

Sophisticated Data Analytics
Advancements in technologies and mathematical analytic techniques have made great strides in the past few years and are finally within reach of most organizations. Vendors package these technologies and techniques in ways that mask underlying complexity and are bundling powerful data visualization techniques and tools to simplify the ability of less technologically-adept people to generate valuable insight from available data. These “Big Data” technologies not only consume structured data like ICD-10, but also various forms of unstructured data to provide a whole new level of information to support new healthcare quality and payment programs.

Risk Identification, Assignment, And Management
Historically, healthcare has employed coding schemes like Hierarchical Condition Categories (HCC’s) and Diagnosis Related Groups (DRG’s) to classify, measure, reimburse, and manage risk. While diagnosis codes are the primary attribute used in these coding schemes, risk assignment models incorporating the social determinants, economic measures, and environmental factors referenced above are rapidly being developed and made available on a cost-effective, data-as-a-service basis.

Bring It All Together
The last several years have brought dramatic changes and advancements within the healthcare industry. Providers have EHR’s loaded with patient clinical and administrative data needed for quality measures and patient satisfaction scores. Reimbursement is shifting from FFS to payment for value and quality. Finally, tools and technologies are getting more sophisticated as they drop in price. Will 2016 be the year when the treasure trove of healthcare data start to pay off big time?

I’m sure Chief O’Hara would say: “Begorrah! Sure’n that’s the truth!”

Trend 1: PHI Security
PHI And The Cloud

By Mark Kadrich, Chief Information Security And Privacy Officer, San Diego Health Connect

Twitter: @starwizz, markkadrich.com

As CISO for three organizations, I’m witness to some pretty interesting trends around PHI and PHI security, as well as how the data is being generated, managed, and shared.

Social service organizations that have been built by local governments to assist their distressed, homeless, or otherwise disadvantaged citizens find solutions for their most pressing problems popping up across the country. They are offering services that connect people in need with social services intended to help their citizens and improve population health. Unfortunately, many of these people have health issues that are used to qualify them for some of these programs. Drug abuse, AIDs, diabetes, heart disease, or mental health issues are the core set of conditions used to qualify these people for the funds, time, and resources that local governments are offering.

Sounds pretty much like PHI to me.

Unfortunately, since these organizations are evolving from government programs, they are doing so on shoestring budgets. Additionally, not for profit organizations are being created to support these very serious and extremely helpful efforts but, again, budgets are limited.

As these services begin to collect data, they are beginning to realize centralizing and correlating this data into Community Information Exchanges (CIEs) will create a solution that has the potential to offer higher quality services to their citizens. The down side of this is that few, if any, of these organizations are equipped to capture, correlate, and protect the PHI that they will invariably collect or create. For example, the simple act of associating different call-center encounters will create very sensitive PHI that will need to be protected.

PHI laws have been around for a while now and healthcare organizations are used to complying with them in order to protect PHI. However, an argument can be made that says that social services programs are neither equipped nor even aware of the requirements.

What’s the bottom line here?

I think it’s rather obvious these organizations are going to have to turn to the cloud to provide at least part of their data correlation and thus part of their PHI solution. They will recognize that, by adopting a cloud-based architecture, they will be better equipped to provide solutions focused on their local populations without having to spend a ton of money. Once that happens, it’s a simple step to look at HIEs and how they could help improve the service and therefor the public health. It’s also a short step for HIEs to look to these CIEs in order for clinicians to ensure their patient communities are benefiting from the quality services that local communities are offering.

Wouldn’t it be great if a doctor could see his patients have taken advantage of a service that helped them live a better life? Or perhaps he or she could simply make a recommendation on a computer screen that kicks off the process?

Yes it would! We just need to make sure they can do it in a secure and trustworthy way. We just need to create architectures that incorporate cloud services, address compliance obligations, and reduce the initial startup and continuing maintenance costs.