Engineering the Healthcare Technology Transition

Engineering the Healthcare Technology Transition

According to a report issued by Deloitte in the summer of 2009, the market will find health care organizations fall into one of three camps when it comes to adopting new technology required for health care mandates: Pragmatists, Collaborators & Innovators.

• Sixty percent of the industry will fall into the“Pragmatist” category, and will do their very best to achieve the minimum required for compliance.

• This includes basic coding, EDI transactions, CMS or government reporting, all to facilitate only the core administrative and revenue cycle management processes.

Pragmatists

• The risk of aiming for average is potential failure to integrate these changes withother workflows required for new legislative requirements such as Meaningful Use and a resulting loss of revenue opportunity and negative return on investment in technology.

Pragmatists

• Between 20-25 percent of the industry is predicted to fall into the “Collaborator” category.

• They strive to achieve successful compliance by using mandates as an opportunity to review and improve internal reporting and possibly adopting advanced analytic and payment monitoring tools, such as digital dashboards.

Collaborators

• These Collaborators will break even, at a minimum, and will likely experience an actual value in return for the costs of using these mandates as an opportunity.

Collaborators

• The remaining 15-20 percent will win the day in these transformative times.

• These “Innovators” will use 5010/ICD-10 and other ongoing legislative mandates as a change agent to renovate overall health care management.

Innovators

• This includes contracting processes, advanced training, outcomes management, physician report cards and possible business acquisitions, arriving on the other side with a competitive advantage and strategic positioning for success.

Innovators

• From an engineering perspective, the workflows in an ambulatory setting consist of three components: Financial, Operational & Clinical.

Ambulatory Workflows

• Financial• A/R, Billing, Statements, Eligibility

• Operational• Scheduling, Calls, Record Release, Referrals

• Clinical• Notes, Vitals, Orders, Results, CCD, PMH, Rx

Ambulatory Workflows

• All three must work seamlessly to ensure success. In the ambulatory vendor community, there are two methods to automate these three components: dual or single database.

Ambulatory Workflows

• Dual Database/Systems Solution – A separate practice management database/system for scheduling, billing, ARmanagement, etc. that “integrates” through an interface to an electronic health record (EHR) database/system.

Dual vs. Single Database

• While the dual database can work, providers should be cautioned that their workflows can be impacted by having workflows in separate systems.

Dual vs. Single Database

• Single Database/Systems Solution – This means all three components reside on a single database. If using a relational database, such as Oracle or SQL Server, end-users will be accessing the same data field from a different workflow.

Dual vs. Single Database

Dual Solution Example

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

Two sides of the practice divided by an interface.

INTERFACE

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

INTERFACE

Telemedicine call received by Operational staff

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

INTERFACE

Call documented in PM database. In order for call to be seen by clinical staff, the EHR Database must be

updated separately.

Practice Mgmt Database

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

User logs into EHR database to document call with same information used in the Practice Mgmt Database.

EHRDatabase

Practice Mgmt Database

INTERFACE

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

Clinical staff answers telemedicine call and updates EHR Database with billing information.

EHRDatabase

Practice Mgmt Database

INTERFACE

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

The user now logs into the Practice Mgmt Database to document the same information so the Financial staff can bill.

EHRDatabase

Practice Mgmt Database

INTERFACE

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

After the Practice Mgmt Database has been updated with the EHR Database’s info, the Financial staff can now look at billing the patient.

EHRDatabase

Practice Mgmt Database

INTERFACE

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

In order for all staff to see the same information, both systems must be manually and separately updated.

EHRDatabase

Practice Mgmt Database

INTERFACE

OPERATIONAL

OPERATIONAL CLINICAL

FINANCIAL

Scheduling, Calls

Record Release, Referrals

A/R, Billing, Statements, Eligibility

Notes, Vitals, Orders, Results, CCD, PMH, Rx

Single Solution Example

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EHR Side

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Practice shares a single database that updates in real time. This is called a Point-of-Care Total Solution.

Shared, Single Database

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(Will handle HIPAA 5010)

EHR Side

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Po

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Telemedicine call received by Operational staff

Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

OPERATIONAL

Po

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Shared, Single Database

Call documented in database. This information is now accessible to operational, financial and clinical staff.

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Practice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

OPERATIONAL

CLINICAL

Po

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Shared, Single Database

Clinical staff completes telemedicine request and updates information on database. An alert is sent to the financial staff to bill patient. An alert is sent to the operational staff to correspond with patient.

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Sin

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Sys

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luti

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Exa

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lePractice Mgmt Side

(Will handle HIPAA 5010)

EHR Side

(Will handle ICD-10)

OPERATIONAL

CLINICAL

FINANCIAL

Scheduling, Calls, Record Release, Referrals

A/R, Billing, Statements, Eligibility

Notes, Vitals, Orders, Results, CCD, PMH, Rx

Po

int-o

f-Care T

otal S

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tion

Shared, Single Database

Same data fields seen by all staff, regardless of the end user’s place in the practice workflow.

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