Executive Insight

ADVANCE for Executive Insight
The interoperability to succeed with accountable care
We offer a platform for Strategic Interoperability. Our technology is essential if you want to become an accountable care organization, and make breakthroughs in strategic initiatives such as coordinating care, managing population health, and engaging with patient and physician communities. Add our HealthShare platform to your EMRs. InterSystems HealthShare will give you the ability to link all your people, processes, and systems and to aggregate, analyze, and share all patient data. With HealthShare, your clinicians and administrators will be able to make decisions based on complete records and insight from real-time analytics.
InterSystems.com/Ability5EIN
2013 InterSystems Corporation. All rights reserved. InterSystems and InterSystems HealthShare are registered trademarks of InterSystems Corporation. 11-13 Ability5EIN
CONTENTS
Features
EXECUTIVE INSIGHT
2013
NOVEMBER
30 5 Strategies for Reshaping the Revenue Cycle

Its a new world with new rules
By Janie Patterson
33 Tools, Technology Improvements for Your Radiology Department

Strategies for creating imaging as the center of excellence are revealed
By Lenny J. Reznik
40 The Business Case for Improved Sepsis Diagnosis
COVER STORY
14

A large percentage of total hospital costs are dedicated to sepsis, so hospital administrators and healthcare providers should identify ways to reduce this massive cost
By Tom Polen
46

46 Use Your Pharmacy to Grow Revenue

Learn from 3 hospitals that experienced a revenue surge
By Robert Scholz, RPh, MS, MBA
Clinical, Peer-reviewed Article
Mobile Health
44 Role of Mobile Health in ACOs

Engaging patients through mobile health is an emerging strategy for ACO success
By Wayne Guerra, MD, and Bruce Henderson
Are you leveraging technologically smart strategies to maximize benets?

By Anand Madhavan and Siva Nandiwada
49 Enterprise Informatics
How to successfully navigate the new big data landscape
By Manish Muzumdar
18 CEO: Competence in m-Health

Health systems must move beyond traditional models of care, increasing access to patients to support them in the day-to-day management of health
By Matt Mattox and Ben Alexander, MD
21 COO: Mobile App Security

Understanding the risks and creating best practice security policies are key steps in protecting your patients data
By Bob Seaman
24 CFO: A Patient-Centered Strategy for Bottom-Line Payoff

Leveraging self-service and mobile technology for improved ROI and patient satisfaction are explored
By Theresa Meadows
28 CIO: Movement on Imaging Mobility

See how far hospitals and imaging departments have come with BYOD and where theyre headed
By Kirk Larson
44
Dont just look beneath the surface. See into the future.
You want a clear picture of whats going on inside your patients. Because you want to provide a clear path to health. With our advanced technology, workflow solutions, and ability to help you implement tough new regulations, youll be able to help your patients achieve their goals. And help your hospital fulfill its mission. Philips Imaging Systems. Transforming care, together.
CONTENTS continued
EXECUTIVE INSIGHT
2013
NOVEMBER
Features
51 RAC Data Analysis
5 critical questions to ask, 3 revenue retention strategies to take
By Dawn Crump, MA, SSBB, CHC
www.advanceweb.com/executiveinsight
Online Content
Features
Managing the Health of Hard-to-Reach Patients
53 Enhanced ED Operations To Boost Bottom Line

How one hospital ED converted to a model of efciency that resulted in nancial improvements
By Karen Barber, RN
Engage hard-to-reach patients through outreach to boost quality metrics and revenue generation
55 Capital Equipment Management

Selecting a vendor that is aligned with core values, mission and goals of your organization is critical
By Dale Hockel Special Advertising Section
Stuck in the Stone Ages

The $8.3 billion impact of outdated technology in healthcare
Meeting Patient Needs in the Affordable Care Act Era

Could innovative automated solutions increase efcienciesand patient satisfaction?
57 Executive Insight Presents Whos Who in

This special section highlights healthcare industry leaders and their strategic directions.
Managing Escalating Employee Benets Costs

A look into the rising costs of employee benets and how organizations can reduce spending
Columns
n ASQs Eye on Quality n CHIMEs Healthcare IT n MGMAs Directions in Group Practice Management n Dollars & Sense, sponsored by Soyring Consulting n Executive Perspectives for the Continuum of Care, sponsored by Status Solutions n Next Level of Leadership sponsored by Caliper n Finance & Investment n m Health, sponsored by AT&T n T he Efcient Emergency Department, sponsored by Wellsoft Corp.
Departments
8 Editorial
Are Paper-Based Strategies Still Critical to Successful HIE?
Blogs
n Politics of Healthcare n Boardroom Buzz
Check back daily for news updates, blog discussions and product information.
10 Healthcare IT
Move Over, BYOD; BYOA on its Way
ON THE WEB
Copyright 2013 by Merion Matters. All rights reserved. Reproduction in any form is forbidden without written permission of publisher. Executive Insight is published quarterly by Merion Matters, 2900 Horizon Drive, Box 61556, King of Prussia, PA 19406-0956. Postmaster: send address changes to: Executive Insight Circulation Department, Merion Publications, Inc., 2900 Horizon Drive, Box 61556, King of Prussia, PA 19406-0956. Executive Insight delivers innovative strategies and solutions by and for healthcare executives to help them lead and succeed. This national print and 24/7 online resource offers our community educational opportunities, information on cutting-edge products and services, multimedia, exclusive webinars and training, enabling these leaders to respond quickly
to industry changes and trends. Produced by Merion Matters, a leading publisher in the healthcare industry, Executive Insight provides forward-thinking analysis to help executives address daily issues and prepare for the challenges ahead. Advertising Policy All advertisements sent to Merion Matters for publication must c omply with all applicable laws and regulations. Recruitment ads that discriminate against applicants based on sex, age, race, religion, marital status or any other protected class will not be accepted for publication. The appearance of advertisements in ADVANCE Newsmagazines is not an endorsement of the advertiser or its products or services. Merion Matters does not investigate the claims made by advertisers and is not responsible for their claims.
Looking for a new job? Now you can get job postings on Facebook and Twitter! Follow us at www.twitter. com/AdvanceHCAJobs and www.facebook.com/ExecutiveInsight to search for healthcare administration jobs.
EDITORIAL
By Lynn Nace
is published by Merion Matters Publishers of leading healthcare magazines since 1985

PRESIDENT Ann Wiest Kielinski W.M. Woody Kielinski GENERAL MANAGER CHIEF INFORMATION OFFICER Bob Mozenter PUBLISHER Lynn Nace Editorial EDITOR MANAGING EDITOR WEB MANAGER Design V.P., DIRECTOR OF CREATIVE SERVICES DESIGN DIRECTOR ASSOCIATE ART DIRECTOR MULTIMEDIA DIRECTOR
Are Paper-Based Strategies Still Critical to Successful HIE?
Lynn Nace Kerri Hatt Jennifer Montone
IMSS Analytics released a new report on the barriers, challenges, and opportunities of healthcare information exchange (HIE). Sponsored by ASG Software Solutions, the report examines the current state of information exchange among U.S. hospitals and the opportunities for improving the collection and exchange of patient data. According to HIMSS Analytics, survey respondents indicated two major challenges in the collection and sharing of patient information despite high levels of HIE participation:
n Healthcare facilities that are participat-
ing in some form of health information exchange organization (HIO) reported difculties in exchanging patient information in robust, meaningful ways. n Respondents indicated sharing information outside of HIOs is constrained by budget limitations and stafng resources.
Over 70 percent of respondents reported that their organization was part of a HIO, meaning that they participate in HIE with other hospitals and health systems. Approximately half of those respondents also reported improved access to patient information. However, the benet did not result in robust data sharing, as 49 percent of the respondents cited this as the primary challenge to sharing patient information. Based on high participation numbers, hospitals clearly understand the value of electronic sharing of health-re-
lated information among organizations and the important role it can play in improving the speed, quality, safety and cost of patient care, said Jennifer Horowitz, senior director of research for HIMSS Analytics in a press release. But meaningful engagement between healthcare organizations and easy ways to share patient information, both in paper and electronic formats, still remain a challenge. We hope this new report will shed light on those issues and help IT professionals integrate their HIE strategies with their output/print environments. Additional data exchange difficulties were reported in the modes by which facilities integrate faxed and scanned documents into EHRs for data exchange, or output/print strategies. To download the full report, go to:http://www.himssanalytics.org/research/AssetDetail.aspx?pubid=82108&tid=127. At this months U.S. News & World Report Hospital of Tomorrow executive forum, issues like this will be shared, examined, probed and investigated, with innovative solutions and strategies revealed. Executive Insight is proud to be a media partner at this event and will relay critical information via interviews, articles, blogs and more.
Susan Basile Walt Saylor Scott Frymoyer Todd Gerber
Advertising DIRECTOR OF MARKETING SERVICES Christina Allmer Chris Wofford ART DIRECTOR Events PUBLIC RELATIONS DIRECTOR JOB FAIR MANAGER EVENTS PRODUCT MANAGER
Maria Senior Laura Smith Mike Connor
Administration V.P., DIRECTOR OF HUMAN RESOURCES Jaci Nicely INFORMATION & BUSINESS Ken Nicely SYSTEMS DIRECTOR Maryann Kurkowski CIRCULATION MANAGER Christine Marvel BILLING MANAGER SUBSCRIBER SERVICES Vikram Khambatta MANAGER Media & Marketing Opportunities CORPORATE SALES MANAGER
Todd Bula
Display Advertising ACCOUNT EXECUTIVES Nicole Anastasi, Clark Celmayster, Hilary Druker, Jackie George, Tom Neely, Andrew Pfeifer Education Opportunities SENIOR ACCOUNT EXECUTIVES
Christine Hudak Brock Bamber
Custom Promotions SALES MANAGER Mike Kerr Noel Lopez SENIOR ACCOUNT EXECUTIVES Sue Borjeson-Romano SALES ASSOCIATES Kristen Erskine, Danielle Lasorda, Gina Willett
Lynn Nace Publisher lnace@advanceweb.com
2900 Horizon Drive, Box 61556 King of Prussia, PA 19406-0956 (610) 278-1400 www.advanceweb.com EDITORS PHONE (800) 355-5627, ext. 1121 lnace@advanceweb.com (800) 355-6504 (800) 355-5627, Ext. 1446 (800) 355-5627
ON THE WEB
EDITORS E-MAIL TO ORDER REPRINTS
Visit our ACO Resource Center at www.advanceweb.com/executiveinsightaco
FOR PRODUCT INFORMATION TO PLACE AN AD, OR TO CONTACT THE E DITORIAL DEPARTMENT
EDITORIAL ADVISORY BOARD
ADVERTISER INDEX
Log on to www.advanceweb.com/executiveinsight
Support the companies that support your profession. The companies listed below support healthcare leaders by placing advertisements in Executive Insight. Their support keeps our publication coming to you free of charge. Please contact these advertisers or visit their Websites to learn more about their products or services.
ADVERTISER WEBSITE PG #
JOSHUA ADLER, MD CMO, UCSF Medical Center San Francisco, CA ALLEN BUTCHER CFO, Camden Clark Memorial Hospital Parkersburg, WV EDMUND E. COLLINS, MBA, CPHIMS Vice President and CIO Martin Memorial Health Systems Stuart, FL FRANK CORVINO President and CEO Greenwich Hospital Greenwich, CT SUSAN L. DAVIS, EDD, RN President and CEO, St. Vincents Medical Center/ St. Vincents Health Services Bridgeport, CT COLE EDMONSON, DNP, RN, FACHE, NEA-BC Vice President, Patient Care Services and CNO Texas Health Presbyterian Hospital Dallas, TX NEAL GANGULY, CHCIO, FHIMSS Vice President and CIO CentraState Healthcare System Freehold, NJ JOHNNY KUO COO, Gracie Square Hospital New York, NY ED MARX Senior Vice President and CIO Texas Health Resources Arlington, TX DAN MORISSETTE CFO, Stanford Hospital & Clinics Palo Alto, CA LYNNE MYERS President and CEO, Agrace HospiceCare Madison, WI LISA ROWEN, DNSC, RN, FAAN CNO and Senior Vice President of Patient Care Services, University of Maryland Medical Center Baltimore, MD AMIR DAN RUBIN President and CEO, Stanford Hospitals and Clinics Stanford, CA SUE SCHADE, FCHIME, FHIMSS CIO, University of Michigan Hospitals and Health Centers Ann Arbor, MI CHRISTINE SCHUSTER, MBA, RN President and CEO, Emerson Health System Concord, MA NANCY TEMPLIN, CPA CFO, All Childrens Hospital, St. Petersburg, FL DEBORAH ZASTOCKI, EDM, DNP, CNAA, NEA-BC, FACHE President and CEO, Chilton Memorial Hospital Pompton Plains, NJ
ADVANCE Custom Promotion Baxter Healthcare BD Diagnostic Systems Care Communications Conifer Revenue Cycle Solutions, Inc Craneware Elsevier Inc Fidelity Investments Hitachi Medical Systems America, Inc. InterSystems Corporation McKesson Information Solutions Nuance Communications Parallon Business Solutions Philips Medical Systems Psyche Systems Corp. ResMed Stanley Healthcare Solutions Stryker Sustainability Solutions Varian Medical Systems Abbott Diagnostics AGFA Healthcare Beckman Coulter Honeywell HomMed Merge Healthcare Optum PhoneTree TriMedx
http://www.advancecustompromotions.com http://www.doseedge.com http://www.bd.com http://www.carecommunications.com/icd10 http://www.coniferhealth.com http://www.craneware.com http://www.clinicalkey.com www.delity.com/nfphealthcare http://www.hitachimed.com http://www.intersystems.com/ability5ein http://www.mynewhis.com http://www.nuance.com http://www.parallon.com/rcs http://www.philips.com http://www.psychesystems.com www.resmed.com http://www.stanleyhealthcare.com www.ascenths.com http://varian.com/oncologysoftware www.abbott.com www.agfa.com/healthcare www.beckmancoulter.com www.hommed.com www.merge.com www.optum.com www.phonetree.com www.trimedx.com
35 11 41 27 31 37 25 38 23 3 13 75 47 5 43 2 76 12 7 58 72 66 60 68 70 64 62
WHOS WHO INDEX - Executive Insight Presents Whos Who in
INDUSTRY ADVISORY BOARD MEMBERS

CASEY CRAM, MA Director of Marketing, Talyst Bellevue, WA www.talyst.com NANCY M. FALLS National Managing Partner Healthcare Managing Partner Nashville Tatum Brentwood, TN www.TatumLLC.com AMY JEFFS Chief Operating Officer, Status Solutions Charlottesville, VA www.statussolutions.com KEN PEREZ Senior Vice President of Marketing and Director of Healthcare Policy MedeAnalytics Emeryville, CA www.medeanalytics.com CHRISTINE RICCI, RN, BSN, MBA Chief Marketing Officer, B. E. Smith, Inc. Lenexa, KS www.besmith.com
HEALTHCARE IT
By Steve Huffman
Move Over, BYOD; BYOA on its Way
YOD, or Bring Your Own Device, is something that technology executives have struggled with over the last few years. Employees, customers, patients, physiciansand suppliers all want to bring in their own personal equipment, and its been a struggle to keep up with this radical change. With advancements in technology and enterprise feature sets continuously added to products, it hasnt gotten any easier, but we do have direction on tackling the problem. As a CIO we are supposed to look ahead way ahead in some casesand anticipate the next challenge. Frankly, I am more concerned about BYOA than BYOD. BYOA, or Bring Your Own Application, is just starting to take o (Im coining the term). This isnt the old days where someone brought you an access database that they created themselves and wanted you to take the beast as its now too complex.What Im referring to is the onset of personalized applications to manage various aspects of your life, including your health.
THE BACKDROP
team up with people around you or challenge friends and family. While the wearable companies make money o of their devices, think of the revenue that they are receiving from advertisements from your data.If you have one of these devices you will notice that the rapid pace of innovation isnt around the device itself; rather, its with what they can do with the data it produces.
YOU WANT YOUR DATA TO GO WHERE?
Thanks to Meaningful Use regulations many healthcare providers around the country will soon be oering, or are already oering, a patient portal. This is a tremendous step in the sharing of important medical information for patients and hopefully will bring the patient into the information fold as it relates to their care. Now join with this the rapid advancement of wearables. FitBit or the Jabber UP, for example, are devices that can track the number of steps you take, how hard you exercise and monitor how well you are sleeping. Along with the wearable, you are given access to an app that helps graphically show how well you are doing. It can also help you track your calorie intake when you log the food you are eating. Some of these have become very comprehensive and allow you to log your runs on a map,
I can only imagine that the day is coming soon when a patient comes to us to ask how they can get their data from their portal into their own preferred health app. No problem, you say? We have CCD and standards now that can help with that. While standards can and do help, these little wearables and health applications are not regulated and may not be interested in standards-based information sharing. The reverse will also be sure. The new health apps are becoming more mature. Do you think our portals will keep pace with small innovative companies who are generally unregulated by the FDA? Do you think that patients wont be asking us to upload their data so the doctor can see it? This BYOA phenomenon can extend beyond the patient as well.From an employee standpoint, could you imagine trying to keep pace with the advancement of productivity apps hitting the market? From email cleansing, le sharing, spreadsheet creation and personal banking, I believe BYOA is almost upon us.
WHY NOW?
Understand consents, FDA guidelines, data privacy and risk limitations. All of your current practices and policies probably arent going to automatically work in a BYOA arena.
Two years ago when I wanted to write an article I would have used my organizations copyof Microsoft Word that they purchased for me. Today, Im typing this article in EverNote (www.evernote. com), a utility that is device agnostic. EverNote happens to be free for basic features and for
Steve Huffman is vice president and CIO, Memorial Health System.
Healthcare IT is sponsored by the College of Health Information Management Executives (CHIME). Contact CHIME at www. cio-chime.com
10
11
HEALTHCARE IT
more advanced features you can pay $50/year, which I do personally. There are two major levers going on in this advancement. Enterprises are nding it hard to justify a tremendous expense for utility software like word processing, note taking and email. At the same time startup companies are making better products and selling them in online stores for little money. Did you ever think 10 years ago that employees would want to bring their own cell phones and laptops to work because they were better than what we purchased? The same will happen with applications. Here are some suggestions when considering your response to BYOA:
n Dont deny that its coming. BYOA will be a reality and starting to
thinking through how great of an opportunity it might be to learn. Once you have experience with a few of them you can be in a position to recommend ones that you can support more deeply. n Troll the latest wearable devices and test them.Dont take the ostrich approach and bury your head in the sand. Buy them, use them, have your team play with them. Move data back and forth. Can you get the wearable data in your Portal?Do you even want to try? Someone is going to ask! n Understand consents, FDA guidelines, data privacy and risk limitations. All of your current practices and policies probably arent going to automatically work in a BYOA arena. When does your risk end when you tie to a patients favorite app? Do they understand that? Will you require a release of information?
talk about it with your team and your executives is important.

n Know which internal policies might need tweaking and what hard
lines you will hold on data sharing. We are all working on Portal access now and the intricacies that brings. Start pondering what this might look like when someone asks to re up a new app on their phone with their data. n Instead of saying No to the rst requests, use them as pilots. Patients are innovative themselves. They are going to push for the latest and greatest app that they believe will help them. Dont make a we cant do that because... response without rst
The benets of personalized medicine can be great; new devices and applications will be a strong component of personalized medicine.
ON THE WEB
How do you feel about BYOD and BYOA? Share your comments with a blog. To read what others have to say, go to www.advanceweb.com/executiveinsightblog
Hospitals spend billions annually purchasing single-use medical devices.

Many of these dollars can be invested in other quality of care initiatives. Reprocessing is becoming a mainstay in healthcare, and its one of the easiest ways hospitals can drastically reduce supply costs. In fact, the majority of Honor Roll hospitals listed by U.S. News & World Report use reprocessing in their cost containment strategies. Over the past 20 years, Stryker Sustainability Solutions has collectively helped hospitals find more than $1 billion in savings.
To reclaim your loss visit sustainability.stryker.com/hpn or call 888.888.3433
12
Enabling better care in hospitals across the US The Paragon HIS

Affordable and easy to use for better clinical and financial decisions Providing superior care in todays healthcare environment requires you to have a hospital information system that is easy to use, maintain and support. The top-of-the-line Paragon system is designed for hospitals and health systems of all sizes and offers your organization: An intuitive, Windows-based system Comprehensive clinical and financial applications in one system that simplifies IT and vendor management A modern, single database Microsoft-based platform that reduces operating costs and enhances patient safety
To find out more and hear directly from Paragon customers, visit www.mynewHIS.com
We chose Paragon because we needed a system that drove staff satisfaction and buy-inand it has exceeded our expectations.
Patti Sulak Senior Director of IT St. Marks Medical Center LaGrange, Texas
2013 McKesson Corporation and/or one of its subsidiaries. All rights reserved. Paragon is a trademark of McKesson Corporation and/or one of its subsidiaries. Microsoft and Windows are trademarks of Microsoft Corporation.
13
Mobile Health
Are you leveraging technologically smart strategies to maximize benets?
By Anand Madhavan and Siva Nandiwada
14
TOM WHALEN
martphone usage is getting fairly pervasive within the U.S. adult population1 and its penetration is on the rise from the current ~35%. Taking cognizance of smartphone usage and the subsequent growth of apps development,2 the U.S. Food and Drug Administration (FDA) is focusing on the regulation of mobile medical apps. The mobility channel is an attractive proposition from a productivity, cost and outreach perspective. A number of industriesretail, banking, and educationhave modied their operations to leverage the mobility channel, along with other channels. Traditionally, the healthcare industryand specically healthcare providershas been a laggard in adopting mobility compared to other industries; they are looking to aggressively catch up. A combination of factors, including challenges in integrating mobility with other existing channels, new technology, and lack of experience to kick-start operations, have been potentially discouraging organizations. Using our experience of working with multiple healthcare organizations, we provide a perspective of how healthcare providers can typically adopt this new channel
and maximize the benets.

OBJECTIVES OF ADOPTING MOBILITY SOLUTIONS
For healthcare providers impacted by mandates under the Accountable Care Act (healthcare delivery and expanded coverage for previously uninsured population), adopting mobility solutions is a critical option to consider. The objectives that the provider aims at achieving using the mobile solutions have to be clearly articulated to measure the return of investment. Some of such objectives/benets across the provider function include:
Operational Objectives
n Improved productivity by leveraging technology at point of care
and more time with the patient

n Reduction in utilization of services (especially ofce visits) using
remote monitoring /email communication

n Improved collaboration within the hospital for improved, cost-ef-
fective and timely care
15
COVER STORY
TABLE 1 - MATURITY MODEL FOR HEALTHCARE MOBILITY; REPRESENTATIVE USE CASES INFORMATIONAL TRANSFORMATIONAL INTERACTIVE ORCHESTRATED
BUSINESS VALUE
Patients are able to use an app to read about different types of conditions based on body part they choose
Allow nurses to monitor patient vital stats on real time basis when they are on their rounds of the wards
Create procurement alerts for Stock Outs, Process Orders, Supply Orders for the OR team
Real-time analysis of EHR records across colleagues enable clinical team to make better decisions to improve care delivery and patient outcomes
COMPLEXITY
Traditionally, the healthcare industry and specifically healthcare providers has been a laggard in adopting mobility compared to other industries; they are looking to aggressively catch up.
Similarly, appreciating the use of mobility solutions in other industries such as banking and retail for day to day function of purchase, productivity (education on the go, engaging with others etc.), customers/patients are looking forward to leveraging similar benets in the healthcare sector. An example is the inclination of patients to leverage and pay for remote monitoring devices to share information related to glucose levels, cardiovascular irregularities, etc. with their healthcare providers.
Patient-Centric Objectives:
n Enabling basic use cases such as scheduling
chronic conditions
n Enabling access to health information and news
from member portal/social media platforms
KEY CONSIDERATIONS FOR DEVELOPING MOBILE STRATEGY
appointments, re-lls, accessing lab results, etc.

n Improving member service by providing options
Anand Madhavan is a senior practice lead with Infosys Public Services responsible for analytics in healthcare. Siva Nandiwada is an associate vice president in Infosys Public Services responsible for client relationships in healthcare.
for self-service as well as tailoring the service options to member needs through telemedicine n Increasing patient loyalty and thus increasing the awareness/utilization of a spectrum of services oriented toward wellness and prevention n Enabling patients to access and own data for improved decision making simple data such as weight, blood sugar to more complex data for
Objectives need to be translated to use cases for development of mobile applications (process by which application software is developed for smartphones). In our example of operational objectives, use cases can be developed depending on the actors/users impacted by the objective. For example, we could have different use cases for the same objective of improved collaboration within the hospital for improved, cost eective and timely care. In our engagements, we stress that use cases and their implementation need to evolve based on a providers current state of infrastructure and the roadmap they seek to chart for themselves. We have dened a basic informational stage use case of using mobility to educate and culminate with the orchestrated stage where mobility can be used to enable and monetize interactions. Using the examples of use cases we provided above, provided below is a logical sequence to their development implementation (Table 1).
CHOICES FOR MOBILE STRATEGY
Healthcare providers have a number of options for mobile application development for embracing the mobility channel:
16
COVER STORY
n Mobilize the web: Making the website
mobile friendly
n Mobile Web: The use of a browser-based
TABLE 2 -BEST PRACTICES IN MOBILITY FOCUS ON MANAGING APPS AS A PORTFOLIO OF USER EXPERIENCES
Internet service from a handheld mobile device n Native Client: A device resident mobile application developed using a native software development kit (SDK) n MEAPS: Mobile enterprise application platform (MEAP) is a comprehensive suite of products and services that enable development of mobile applications. Cross-platform considerations are one big driver behind using MEAPs. n Hybrid Frameworks: A device resident mobile application developed using a hybrid cross-platform mobile application development framework n Customer Container: A device resident mobile application developed using a custom container cross-platform mobile application development framework
USE CASE 1
USE CASE 2
USE CASE 3
Development Approach MOBILE WEB NATIVE MOBILE WEB MOBILE WEB NATIVE
HYBRID
Given the number of options, which one should a provider go for and what are the constraints they may face? From a constraint perspective, providers are faced with multiple trade-offs security, cost, and technology risk. On the other hand, there are a number of capabilities that a provider looks to harness app distribution, with services provided and user experience being the key ones. The strategy to choose the mobile application technology should be one that optimizes between the channel capabilities required and the associated trade-os. These would be specific to the context of each
provider. Relative weights can be assigned to each of the capabilities and trade-offs. The optimization will need to be considered across use cases for development purposes as illustrated below. Once the use cases have been developed, comparing options in mobile technology from a capabilities and trade-o perspective will provide an idea on which option is better suited. A typical example of such a comparison is provided below.
CONCLUSION
egy is imperative. We recommend they build an ecosystem that is robust yet exible, avoiding technology lock-in but poised to ride the wave of changing trends. A comprehensive and continuous evaluation of use cases and trade-os would guide the development of this ecosystem. Reference
Pew Research Center, July 2011
Conversations with providers investing a major percentage of their annual IT budgets on mobility initiatives indicate great strides in early adoption of mobility solutions. Business requirements will continually evolve with changing market conditions. As providers transition development of use cases from informational to orchestrated, a smart technology strat-
With more than 17,000 health and tness apps and 14,000 medical apps being created (mid-2012), FDA had its third and nal congressional hearing regarding usage of apps in March 2013.
ON THE WEB
To learn how texting can promote patient engagement in healthcare, go to: http://healthcare-executive-insight. advanceweb.com/Web-Extras/Online-Extras/Texting-Can-Promote-Patient-Engagement-in-Healthcare.aspx
TABLE 3 - MOBILE TECHNOLOGY STRATEGY; OPTIMIZING BETWEEN CHANNEL CAPABILITIES REQUIRED AND ASSOCIATED TRADEOFFS IN YOUR SPECIFIC CONTEXT CAPABILITIES Security Architecture Background Integration Testing and Validation Dev Tools Peripheral Integration App Distribution Analytics SSO UX Capability Services
MOBILIZE WEB MOBILE WEB NATIVE CLIENT HYBRID FRAMEWORKS CUSTOM CONTAINER MEAPS
TRADEOFFS User Coverage & Experience Cost & Maintainability Security Existing Technology Asset Leverage Time to Market Technology Risk
17
CEO PERSPECTIVE
Competence in m-Health
and Ben Alexander, MD
onsider the following:
Health systems must move beyond traditional models of care, increasing access to patients to support them in the day-to-day management of health By Matt Mattox
n At the end of 2012, 91% of U.S. healthcare professionals had a smartphone.1 n 80% of physicians are using mobile technology to provide patient care.2 n 75 million U.S. adults used their mobile devices to access health information in 2012, up from 61 million in 2011.3
This widespread adoption might lead one to believe that health systems are prioritizing mobile health. But just 13% of health systems are ex-
Matt Mattox is vice president of products at Axial Exchange.
Dr. Ben Alexander is CMIO, WakeMed.
18
pected to launch a branded health app this year.4 Why? The answer could have something to do with Meaningful Use (MU).
MEANINGFUL USE AND WEB PORTALS
The MU standards and the HITECH act encourage and enforce standards for exchange of health information; however, widespread implementation has yet to become a reality. For hospitals, stage 2 MU requires that 50% of patients should be able to access their health information digitally and 5% must actually log-on. MU has been a signicant stimulus for health IT
of U.S. healthcare professionals have a smartphone
91%
of physicians use mobile technology to provide patient care
80%
but has put tremendous pressure on hospital IT departments. Most hospitals are just now coming up for air after spending the last two years replacing or updating their EHR. In addition, most EHR vendors have had all previous development priorities placed on hold while they rushed to become (and stay) certied as well as help their customers qualify for MU incentive payments. For most, the fastest way to meet the access requirement was through a web-based patient portal. MU doesnt specify how a patient must access their health information; as long as 5% log-on, the hospital satisfies the requirement. After such a long and expensive slog, can you blame the hospitals that are relying on their web-based portals to meet stage 2 MU?
TONE DEAF TO THE MARKET
U.S. adults used mobile devices to access health information in 2012
75
million
THINKSTOCK/ISTOCK/CATHERINE YEULET
Anecdotal evidence suggests that many hospitals are struggling with extremely low adoption of their web-based patient portals. If you take a patients perspective, this phenomenon might not be so surprising. Consider this common scenario: You have recently been discharged from the hospital and have made a follow-up appointment to see your primary care physician. You are now in the waiting room of that physicians oce. It occurs to you that your PCP will want to see your care summary and discharge instructions. Youre called into the exam room and your physician not only asks for these items, but also asks for a recent medication list and the results of the tests that were run. If you didnt bring the paper records and you dont have access to the records via your smartphone, then you and your PCP will simply have to wing it. After all, only about 25% of doctors receive discharge summaries by the time patients make their rst post-discharge visit. The rate doesnt rise to above 50% until after
Failing to [use mobile to reimagine patient relationships] will result in nancial consequences that start with MU and ripple out to HCAHPS, accountable care, and other patient-driven quality programs.
19
CEO PERSPECTIVE
The steady march toward population health is not decelerating. Health systems must move beyond traditional models of care, increasing access to patients to support them in the day-to-day management of health.
four weeks, aecting the quality of care in about a quarter of follow-up visits.5 Meanwhile, 41% of patients are discharged with a pending test result and 66% of physicians are unaware of the results of the pending tests.6 As well, at discharge, only 42% of patients are able to state their diagnosis, and 37% are able to state the purpose of all of their medications.7 How many patients carry laptops to the doctors oce? This is a usability problem with serious consequences.
THE STAKES ARE GETTING HIGHER
n to share all of the above with my healthcare
providers and my family members
As a provider, I need:
n a way to measure care plan adherence, including
medication adherence
n a means to easily communicate with the patient n to be alerted of out-of-range weight, glucose,
and blood pressure readings

n to measure the patients relative health literacy n to collaborate with other healthcare providers
and family members
The early recommendations for stage 3 MU focus on accommodating patient-generated data. The idea is for healthcare providers to support patients between encounters. Accepting patient-generated data validates the patients role in their health. Much of health reform is meant to reorient the industry around this patient-centric perspective. This may not be a challenge for some EHR vendors that have supported mobile for years. Most vendors, however, are simply behind the curve and will struggle mightily to catch up. A mobile version of the patient portal may be on the way, but patient-centric healthcare changes the game. Health systems are increasingly launching chronic disease management programs in response to incentives from CMS and private insurers. The programs are meant to keep patients well and out of the hospital and ED. The patients in these programs need help with the day-to-day management of disease. Moreover, providers need an early-warning system to flag patients heading toward a costly care cycle. To illustrate, consider a patient with type II diabetes, hypertension, and congestive heart failure:
As a patient, I need:
n something that helps me regularly and easily
Its hard to imagine that the preferred device for the patient will be anything other than something that is with them at all timesin other words, mobile. When EHR vendors finally roll out a mobile solution focused on appointments, bill pay, and read-only viewing of health records, the game of catch up will begin again.
THE BOTTOM LINE
The steady march toward population health is not decelerating. Health systems must move beyond traditional models of care, increasing access to patients to support them in the dayto-day management of health. This will require competence in mobile health. Hospitals that are using mobile to reimagine their patient relationships will be poised for success. Failing to do so will result in financial consequences that start with MU and ripple out to HCAHPS, accountable care, and other patient-driven quality programs. Hospitals that take a just-in-time approach to meet the letter of MU will likely struggle over the long term. References
1. EPG Health Media, Healthcare Professional Use of Mobile Devices. December 2012 2. 2nd Annual HIMSS Mobile Technology Survey 3. Pew Research Centers Pew Internet & American Life Project, Mobile Health 2012. November 2012 4. 2nd Annual HIMSS Mobile Technology Survey 5. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Decits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA Feb. 28, 2007. 6. Roy CL,Poon EG,Karson AS,et al. Patient safety concerns arising from test results that return after hospital discharge.Annals of Internal Medicine 2005. 7. Mayo Clinic Proceedings, 2005
ON THE WEB
Be sure to read our article on the $8.3 billion impact of outdated technology at http://www. google.com/url?q=http:// healthcare-executive-insight.advanceweb. com/Features/Articles/ Stuck-in-the-Stone-AgesThe-83-billion-impact-ofoutdated-technology-inhealthcare.aspx
capture glucose, blood pressure, and weight and view changes over time n help navigating nutrition decisions that involve sugar and salt n a way to sync data from my wearable device that shows my daily activity and sleep patterns n a complete medication list and push reminders of how much to take at which times n to log pain, mood, and other symptoms
20
COO PERSPECTIVE
Mobile App Security

Understanding the risks and creating best practice security policies are key steps in protecting your patients data By Bob Seaman
ability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information. To meet this requirement, HHS published what are commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. The Privacy Rule The Privacy Rule establishes national standards for the protection of certain health information. This rule refers to individually identiable health information that can be linked to a particular person such as a persons health and the provisioning of health care to an individual. The Security Rule The HIPAA Security Rule applies to individual identifiable health information in electronic form, typically known as electronic protected health information (ePHI). The Security Rule established a national set of security standards for protecting ePHI, specifically how it is
U
Bob Seaman is director of technology, Ancero.
nderstanding best practices for mobile device security in todays healthcare environment can be a challenge for many organizations. As mobile devices such as tablets and smartphones become more powerful, they become more useful to your health organization. This usefulness also can translate into more risk for your organization. Understanding the risks and creating best practice security policies are key steps in protecting your patients data.
HIPAA BASICS
The Health Insurance Portability and Account-
JEFFREY LEESER
21
COO PERSPECTIVE
Proper planning, policy creation, implementation of controls and, most importantly, training for your users will help ensure your datas protection and eliminate the risks typically associated with mobile devices.
stored, maintained, or transmitted.
THE FIVE-STEP PROCESS
3. 4.
Install and activate remote wiping and/ or remote disabling. Remote device wipe allows you to remove all data from the device in the event it is lost or stolen. Some mobile device management software (MDM) allows for greater control and selective removal of only corporate data. Disable and do not install or use le-sharing applications. Use of file sharing in software should be carefully examined. These types of software often allow you to copy information from applications like email directly to the software cloud provider. This could mean that ePHI is moved o the mobile device and out of the control of your organization. To prevent these data leaks, disable this type of software or utilize MDM software that can containerize the ePHI and prevent data copy. Keep your software up to date. When you regularly update your software, you are protecting your device from known security holes.
The Office of the National Coordinator for Health Information Technology (ONC) has outlined the ve basic steps organizations can take to manage mobile devices used by healthcare providers and professionals. Healthcare organizations can use the ve steps to help develop and implement mobile device policies and procedures to safeguard patient health information. The five steps are outlined on their website (HealthIT.gov) as follows: Decide Decide whether mobile devices will be used to access, receive, transmit or store patients health information or used as part of your organizations internal networks or systems. Assess Consider how mobile devices affect the risks to the health information your organization holds. Identify Identify your organizations mobile device risk management strategy, including privacy and security safeguards. Develop, Document and Implement Develop, document and implement the organizations mobile device policies and procedures to safeguard health information. Train Conduct mobile device privacy and security awareness and training for providers and professionals.
SIMPLE BEST PRACTICES
5. 6. 7.
Research mobile applications (apps) before downloading. Using only the ocial application stores such as iTunes or Google Play help protect your mobile device as these apps are put through a more careful screening process to help avoid malware. As a rule, devices that are jailbroken or rooted should not be allowed in your policy. These devices have circumvented some of the manufacturers controls, which allow them to install software from unprotected sources.
So youve made it through your ve step process and decided to allow mobile devices on your organizations network, and perhaps even have a bring your own device policy (BYOD) to allow employees to use their personal mobile devices to access your corporate network. Here are some basic tips for securing mobile devices that help meet HIPAA compliance requirements.
1. 2.
22
Use a device key, password or other user authentication. Authentication is the most important rst step to protecting the contents of a mobile device.
Use adequate security to send or receive health information over public Wi-Fi networks. Public Wi-Fi networks can be an easy way for a hacker to compromise information from your mobile device. Implementing a Virtual Private Network (VPN) only policy for corporate data encrypts the data to protect it from hackers using sniers and other equipment that can intercept the data. Implementing mobile devices in your organization can add a lot of value for your team when the proper balance between security and usability is achieved. Proper planning, policy creation, implementation of controls and, most importantly, training for your users will help ensure your datas protection and eliminate the risks typically associated with mobile devices.
Install and/or enable device encryption. Encryption protects the data should a hacker gain access to the physical device and try to copy the data o. It is also important to require any backups of the devices to be encrypted as well.
ON THE WEB
Be sure to visit our ICD-10 Resource Center at www.advanceweb.com/executiveinsighticd10
VISIT US AT RSNA BOOTH 2511 | SOUTH HALL
Embracing life through innovation

Hitachi recognizes the significance of healthcare in our society today and in our shared future. Utilizing our innovative technologies, Hitachi is committed to improving the diagnosis and treatment of disease while enhancing the patient experience and delivering diagnostic confidence.
Discover the competitive advantages of Hitachi.
23
CFO PERSPECTIVE
Organizations must remember that the point-of-service experience is essential to patient satisfaction.
revenue stream benets to healthcare organizations that embrace the opportunity. As one of many trends unfolding in healthcare, the patient-centered movement is backed by a competitive landscape comprised of Hospital Consumer Assessment of Healthcare Providers and Systems scores and performance-based reimbursement models that heighten the need for an exceptional patient experience. Simply put, patient satisfaction now directly impacts the bottom line. Equally challenging is the increasing prevalence of payment models that place greater healthcare cost burdens on patients. This trend requires healthcare organizations to more efficiently capture self-pays and co-paysa percentage of total revenue nearing 30% for most organizations. As such, a precarious balance now exists where payments must be requested upfront without alienating patients who could easily choose to take their business elsewhere. Because of these challenges, busy healthcare organizations need an ecient point-of-service strategy that addresses multiple revenue cycle and customer service objectives. One Fort Worth, Texas-based health system has done just that. For Cook Childrens Health Care System (CCHCS), finding an effective solution started with an effort to empower patients families. It has grown into an expanded technology strategy that encompasses self-service and mobile technology to improve workows, maximize patient collections and completely transform the patient experience.
SELF-SERVICE TECHNOLOGY
A Patient-Centered Strategy for Bottom-Line Payoff

Leveraging self-service and mobile technology for improved ROI and patient satisfaction are explored
By Theresa Meadows
Theresa Meadows is senior vice president and CIO of Cook Childrens Health Care System in Fort Worth, Texas.
atient-centered care is an evolving concept defined by rapid movement toward more active engagement of patients and families in healthcare delivery. While this foundational shift is a positive step in improving care quality, it also has the potential to deliver workow and
CCHCS is a not-for-profit, nationally-recognized pediatric health system that sees between 700-800 children daily in the specialty clinic setting. In early 2012, the health system recognized it needed to further enhance its patient engagement strategies when its advocacy group, the Family Advisory Council, expressed the
24
THINKSTOCK/ISTOCK/CATHERINE YEULET
Accelerate your hospital to the speed of care
Elsevier ClinicalKey: Improved patient care and reduced clinical errors

Comprehensive: The largest collection of clinical resources, covering every medical and surgical specialtyeliminating physicians reliance on less accurate sources Trusted: Authoritative medical and surgical content from Elsevier that you and your physicians can trust to reduce clinical errors Speed to Answer: Unique search technology, ensuring physicians see the most clinically relevant answers, giving them more time to care for their patients
Learn more at ClinicalKey.com

Find us on:
TM
Smarter search. Faster answers.

2012 Elsevier B.V. All rights reserved. Printed in USA. 2ELKY018
25
CFO PERSPECTIVE
The patient-centered movement is backed by a competitive landscape comprised of Hospital Consumer Assessment of Healthcare Providers and Systems scores and performance-based reimbursement models that heighten the need for an exceptional patient experience.
need for a more efficient, less repetitive registration process that was easier for busy parents with children. As Council members pointed out, a working parent with a sick child is already under duress before arrival; the last thing the parent wants to do is wait in long lines and ll out forms. At about the same time, CCHCS began working to streamline workflows and improve bill collection via a centralized check-in point for its specialist oces. After researching available options, CCHCS executives decided to adopt a self-service strategy and deployed 10 kiosks to enhance both the registration and bill collection experiences. Almost immediately, patients began to benet from registration wait times that narrowed from 10-15 minutes during busy times to less than four minutes. This enabled staff to greet patients and caregivers at a central registration point and efficiently guide them through the electronic self-service process. The strategy has also allowed sta to focus on more complex registrations that require additional services outside the scope of self-service technology. Currently, about 70% of patients are eligible to use the self-service technology at registration, which also allows them to:
n Check in for an appointment using a drivers
at registration is interfaced directly into hospital accounting systems for accurate payment posting in real-time. This neutral method for collecting patient payments has proven eective. Recently, for example, three patients paid o sizable bills of $4,000, $5,000 and $8,000 at the kiosk. This has helped CCHCS annually capture $1 million more on the day of treatment, rather than 30 days later after dropping a statement.
EMPOWERING PATIENTS ON THE GO
Building off this success, the next phase of CCHCS patient engagement strategy extends to mobile access and patient portal offerings. Currently, mobile technology interfaces are being rolled out to address check-in, bill pay and patient record updates via handheld devices. When this implementation is finalized, all paperwork can be completed from home or from a smartphone, and patients will be able to print a barcoded schedule prior to an appointment. The next step for patients simply will be to enter CCHCS doors, scan the bar code, and follow a map to the correct location. Mobile interactions also will allow CCHCS to enhance communication and customer service via text alerting. For example, CCHCS could notify patients of appointment delays in advance, and provide a coupon for refreshments at the onsite restaurants during the wait. The possibilities are wide-ranging.
TIPS FOR A PATIENT-FOCUSED APPROACH TO SELF-SERVICE
ON THE WEB
Employing mobile health strategies to improve outcomes and reduce costs in diabetic patient populations was a topic of discussion recently posted at http:// healthcare-executive-insight.advanceweb. com/Features/Articles/ mHealth-and-Management-of-the-Diabetes-Population.aspx
license or insurance card

n Verify and update registration information n Review, complete and/or electronically sign
HIPAA consent forms and medical history questionnaires
Furthermore, the kiosks, which look and operate much like those at airport check-in counters, also accept credit cards for co-payments and outstanding account balances. The data entered
1.
Before implementing its current strategy, CCHCS executives previously attempted a self-service technology project that never came to fruition due to poor timing and lack of vendor expertise. Thus, the organizations past experience oers some valuable lessons for others considering a self-service strategy to enhance patient satisfaction: Choose a partner knowledgeable about regulatory requirements. The laws governing the Payment Card Industry, for example, are incredibly complex. Not all self-service solutions meet compliance standards, so hospitals and health system executives should do their homework before selecting a partner.
26
CFO PERSPECTIVE
2.
THINKSTOCK/ISTOCK/PRESSURE UA
Map out the registration process before installing IT. It pays to ask the following questions when developing a strategy: Where do patients come in? How do they interact with the sta? What back-end payment mechanisms do you need? These step-by-step details are critical for creating a solution that will actually work in real life.
3.
Pay attention to the little things. CCHCS has found the smallest conveniences have had the largest impact on patient satisfaction. For example, parents coming in with their children appreciate the counter
Finally, organizations must remember that the point-of-service experience is essential to patient satisfaction. CCHCS is an example of an organization that has learned how self-service solutions can contribute to more ecient, patient-centered care. By simultaneously improving registration procedures, easing payment processes and rolling out mobile solutions to patients, both patient satisfaction and collections have increased. The business case for self-service technology has beenand continues to bean easy one for CCHCS.
4.
space installed on the kiosks giving them a place for purses, briefcases or diaper bags.
Jump Start Your ICD-10 Readiness: Prepare with CARE!

Care Communications experienced ICD-10 team can quickly get you on the road to readiness with our comprehensive services, including: Staff Inventory and Knowledge Gap Analysis Clinical Documentation and DRG Revenue Risk Assessment Comprehensive Staff Education (remote or on-site) ICD-10 Project Manager or Coach ICD-9/ICD-10 Production Coding Support Systems-based Leadership and Change ManagementSM For more information, contact Roberta Peters at 800-458-3544, ext. 153 or rpeters@care-communications.com.
800.458.3544 www.carecommunications.com/icd10
27
CIO PERSPECTIVE
Movement on Imaging Mobility

BYOD will continue to rapidly gain acceptance, as physicians, imaging departments and other clinical users expect to have access to the same state-of-theart technology they use outside of work.
See how far hospitals and imaging departments have come with BYOD and where theyre headed By Kirk Larson
nly a few years ago the concept of Bring Your Own Device (BYOD) was downright impractical. However, technology has been able to keep pace with user expectations, and many healthcare facilities actively support BYOD for a variety of clinical and workow functions, including in hospital imaging departments. Results from a 2012 study of 130 hospitals by Aruba Networks, Inc. revealed that 85 percent of facilities support their physicians and stas use of personal devices at work. The most commonly allowed application was accessing the EMR (60%), but other top uses included viewing radiology images on PACS (37.9%), CPOE (37.1%), and dictation / transcription (23.5%) all playing into progress on the imaging mobility front.
PROGRAM ROOTS
concerns around mobile devices, and resource (client and server) eectiveness. We ultimately landed on leveraging VMWares virtual desktop infrastructure (VDI) to accommodate these considerations. Although we did not fully realize it at the time, we were putting into motion the infrastructure to make BYOD a reality. To use BYOD, an end user simply needs to install the VMWare client on their device. Any device that can download this very small le can then access the VDI environment. It does not matter what operating system a user has on his or her device (we run a Windows platform). For example, a user can bring an iPad from home and then run a virtualized Windows environment on the device at work.
Kirk Larson is vice president and chief information ofcer, Childrens Hospital Central California.
VIRTUAL DESKTOP INFRASTRUCTURE
We faced a triad of issues: the sheer increase in the number of clinical end users, security
28
THINKSTOCK/ISTOCK/MONKEY BUSINESS IMAGES LTD
At Childrens, BYOD originated more than two years ago from a grassroots eort. Our physician community, led by Chief Medical Information Ocer Dr. Joel Brownell, expressed early interest and support for BYOD. It allows people to choose their own device whether PC-based, Apple-based, or whatever their preferred device is, and we can support it. Thats an easy win and it did not seem to be an overly arduous task, said Dr. Brownell. Also in 2011, Childrens experienced a transformational year, having gone live with our advanced clinical system. This included converting to CPOE, electronic nursing documentation, and more. The experience required IT to reconsider our strategy on content delivery and end user device support.
SECURITY
ON THE WEB
Mobility in healthcare has dramatically advanced in the last 10 years, and has the power to enhance patient care outside of acute care facilities and doctors ofces, where the most expensive care is provided. Go to www. advanceweb.com/executiveinsight and search Mobility in Healthcare to nd out the three major areas of mHealth.
This virtual presentation of the environment also ensures security. At no time is data physically present on the device. So, if the device is lost or stolen, or for that matter, simply disconnected from the network, there is no data on the device.
USER EXPERIENCE
of VDI are particularly evident in our imaging department. We have more radiologic technologists on shift than available workstations, so use of VDI allows them to share devices without logging out and closing applications. This provides a better workow and improves their productivity.
NEW IT ROLE
The user experience was also an important factor when designing the BYOD infrastructure. VDI allows the end user to access their familiar work environment, which virtually eliminated training expenses. Utilizing VDI on both organizationally owned devices as well as the BYOD environment allows the end user to work seamlessly, regardless of the device type. The benets
We went live with a pilot program in April of 2012 by working with Dr. Brownell and a small group of physicians. The concept was embraced enthusiastically, and we rolled it out house-wide in June of 2012. Although the program was designed with physicians in mind, any clinical employee could utilize BYOD. With the success of BYOD, IT no longer has complete control over which devices access the hospital network. Consequently, it has been important to set ground rules as to what IT does and does not support. We have defined the boundaries of our support to be connectivity to the device, and not the device itself. For example, we will assist a user to connect his/her iPad to the network; however, we will not help with nding family photos on the iPad, connecting to personal apps, etc. These boundaries are identied in written standards on acceptable usage and support provided to the end user. It is also important to consider the scalability of a BYOD program. Inevitably, there will be an increase in the number of VDI sessions, and the network team will need to provision for this. To offset the investment, organizations should be able to procure fewer devices over time.
BYOD TREND
My sense is that BYOD will continue to rapidly gain acceptance, as physicians, imaging departments and other clinical users expect to have access to the same state-of-the-art technology they use outside of work. Dr. Brownell notes, A variety of devices need to be available to suit the preferences of physicians. I think it will be interesting to see where standardization and eciency is balanced with the expectation of meeting individual workow preferences. And why should physicians have a better device at home for viewing family pictures? BYOD is an answer to the question, but it will likely not be the nal answer.
29
REVENUE CYCLE MANAGEMENT
5 Strategies for Reshaping the Revenue Cycle

Its a new world with new rules
By Janie Patterson
unsustainable fee-for-service model, where consumers are increasingly involved in their healthcare decisions and are expected to pay for a greater portion of their healthcare services. During this period of volume-based healthcare (e.g., do more, bill more fee-for-service system), the paradigm will shift to value-based healthcare (e.g., no outcome, no income fee-for-value era) methodology. This new world of successful revenue cycle management rests on foundational pillars:
n Enhancing the patient experience n Increasing yield n Improving health outcomes
Visionary providers are already on the path to adapting these foundational pillars and embracing the below ve strategies.
1.
Manage the economic continuum of care to enhance the patient experience and increase yield from the providers perspective Enhancing the patient experience must augment the existing comprehensive method utilized to identify and address the needs of the patient while providing better communication. Revenue cycle management services will need to provide a more holistic, patient-centric approach across the patients economic continuum of care. This type of program will require a large commitment from the provider and their agents, but the program is critical for the provider to remain economically viable and to meet the needs of the patient in the future.
B
Janie Patterson is senior vice president, Revenue Cycle Solutions, Conifer Health Solutions.
ased on the high interest in the healthcare market and as health systems prepare for the paradigm shift from volume-based care to value-based care, hospitals and medical centers must ready themselves. Patient outcomes, eective population health management and renement of revenue cycle functions will change in profound ways as reimbursements decline and there is a corresponding shift to value based care. Navigating this new world requires new rules in revenue cycle. Much of this evolution is being driven by an
30
ADVANCE
Much of this evolution is being driven by an unsustainable fee-for-service model, where consumers are increasingly involved in their healthcare decisions and are expected to pay for a greater portion of their healthcare services.
2013 Conifer Health Solutions, LLC.
To reach a new frontier in financial performance, hospitals are leaving the status quo behind to partner with Conifer Health Solutions. With revenue cycle management services built for hospital operators by hospital operators, Conifer Health harnesses 30 years of business process management experience to help hospitals of every size improve yield and drive cash flow while enhancing the patient experience.
discover new territory in

revenue cycle performance
* HFMA staff and volunteers determined that Conifer Healths Business Ofce Management Solutions met specic criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.
CONIFERHEALTH.COM | 877.CONIFER
Full Revenue Cycle Management Patient Access Health Information Management Revenue Integrity Case Management Business Office Management* 31
REVENUE CYCLE MANAGEMENT
In light of the Affordable Care Act, providers will need to have aggressive programs that pursue the patients eligibility for a funding source and determine categories of patients who may qualify for the providers economic programs.
2.
Sacrice speed for increased yield Conventional revenue cycle management focuses on selected key indicators that are typically based on speed of results. But due to this age of declining reimbursements and cost shifting to the patient, the mantra has become increasing yield. With this enhanced emphasis on yield, the utilization of state-of-the-art technology, and the emergence of a clinically driven/consumer driven retail model, the various programs utilized to increase yield would be treated as a strategic asset. This strategic asset would contain positive implications for improvements that would impact the patient, the patients family members, and the internal health system. The shift in emphasis to yield is needed due to the perfect storm or convergence of events within local healthcare markets consisting of capital and cost constraints, workforce planning and scalability issues. Enhance the patient experience while providing programs or mechanisms to enable the patient to meet their healthcare nancial obligations In the new world, patient dissatisfaction may cause reductions in reimbursement. Providers should seize this opportunity to elevate and implement programs to ensure a positive, dierentiated patient experience. Providers must embrace capabilities successfully employed by consumer businesses that will cultivate a positive customer experience. For example, smartphone applications can be used for scheduling services, getting lab results, connecting with their providers, and paying their bills, similar to other industry applications. This type of positive patient experience will result in long-term, sustainable revenue streams and a positive return-on-investment.
as insurance verication, obtaining authorization, and determination of the patients nancial responsibility (including notication to the patient) associated with scheduled appointments prior to the patients arrival for services provides for the horizontal integration of functionality across the revenue cycle workow. This will improve efciencies, reduce the number of errors, and streamline the back-end process while enhancing the patient experience.
Clinical Advisory Services
n Completeness of documentation and coding
3.
will support appropriateness of care and assist in the determination of the correct clinical pathway. These functions will drive improved revenue cycle performance by reducing denials and serve as a basis for integration with value-based care/population health and desired patient outcomes.
5.
4.
ON THE WEB
Want to learn more about allocating your organizations resources with revenue cycle management best practices? Read Using the Revenue Cycle to Contain Costs at www.advanceweb.com/ executiveinsight
Place increased emphasis on pre-service clearance and clinical advisory services functionality as a means of facilitating the adoption of population health and value-based care methodology while protecting the providers revenue As we move toward population health and value-based care programs, the emphasis of revenue management needs to shift toward the rst two stages in the cycle: Pre-Service Clearance
n Performing all administrative functions such
Target specic groups of patients who are eligible for new funding sources or who qualify the providers for economic programs In light of the Aordable Care Act, providers will need to have aggressive programs that pursue the patients eligibility for a funding source and determine categories of patients who may qualify for the providers economic programs. These programs will oer potential increased sustainability for the provider. Fast growing patient segments include Dual Eligibles and Hierarchical Condition Categories. This paradigm shift from volume-based healthcare to value-based healthcare will reshape healthcare and revenue cycle functions in profound ways. The shift is driving a fundamental reorganization of the healthcare system around quality, cost eectiveness and the patient experience. These combined factors will have a direct impact on all revenue cycle programs, the patient experience and the ability to economically manage the patient population within this era of cost containment. In that rare instance that allows a series of comprehensive strategies to go beyond merely satisfying selected constituencies, the establishment of these ve strategies has the opportunity to delight the patients, not only through their clinical care, but also through their corresponding revenue cycle experience.
32
IMAGING EXCELLENCE
The modern hospital enterprise is a dynamic and complex environment that moves beyond just traditional radiology images.
Tools, Technology Improvements for Your Radiology Department

Strategies for creating imaging as the center of excellence are revealed
JEFFREY LEESER/ CAPITAL HEALTH REGIONAL MEDICAL CENTER
By Lenny J. Reznik
A
Lenny J. Reznik is the director, Enterprise Image and Information Systems, Agfa HealthCare.
major focal point and real struggle for the radiology community for the last few years has been the balancing act of the continued pursuit of patient care, while facing mounting reimbursement cuts and cost constraints. Radiology professionals are beginning to regain condence in the future success of the industry and are seeing that radiology will continue to be the center of excellence in value-based patient care. Recently, the American College of Radiology (ACR) challenged its members, staff, and all medical imaging
stakeholders to work together to help transform medical imaging into a more durable and valuable enterprise. From this we see the launch of Imaging 3.0. What ACR is referring to as a cultural transformation change is truly a multi-year change initiative for the profession of radiology that includes a set of technology tools that equip radiologists to ensure their key role in the continued evolution of healthcare delivery. Imaging 3.0 is a call to action to all radiologists to take a leadership role in shaping Americas future healthcare system.
33
IMAGING EXCELLENCE
ENHANCING THE EHR: ENTERPRISE IMAGING
Radiology as we know it today is more than just a department it is a critical component in contributing to the overall health of patients, and technology continues to be an enabling factor for this shift. With 40-60% EHR adoption in the market, we are quickly moving into a post-EHR era where the value of patient data is no longer locked into silos. However, there seems to still exist one significant roadblock to ultimate clinical productivity: Most of the EHRs available today do not complement the textual data with relevant clinical images in context. The modern hospital enterprise is a dynamic and complex environment that moves beyond just traditional radiology images. Radiology is no longer the only specialty that produces diagnostic images. Today, cardiology, gastroenterology, pathology, and a number of other departments rely on imaging to provide proper patient care, so facilities must have a streamlined
RAD ONC EXCELLENCE
Accreditation veries practices commitment to safety and quality care By Kelly Graham Bocich
trategies and advice abound for improving the quality of care in radiation oncology practices. But for practices eager to prove a deep commitment to providing excellent quality patient care, accreditation is widely considered the gold standard. As part of an accredited facility, we feel condent that our team is a collective group of hard-working individuals who want the best for the patient population and the institution as a whole, said Stacy Joy, administrative manager, Memorial Sloan-Kettering Cancer Center. Their practice was rst accredited by the American College of Radiology (ACR) in 1999, with continuous re-accreditation every three years since then. The American College of Radiology is the nations oldest and most widely accepted accrediting body in radiation oncology, said Brian T. Monzon, MBA, RT(R)(T), program manager for radiation oncology accreditation in the Department of Quality and Safety at the ACR. ACR Radiation Oncology Practice Accreditation [ROPA] is a voluntary process. The majority of practices seek accreditation to provide quality and safety for their patients. Although a voluntary process, accreditation is mandated by some states and payers as well as the Department of Veterans Affairs for radiation oncology departments in their hospitals. There are nearly 500 facilities in the U.S. that have
received accreditation through ROPA approximately 20% of radiation oncology facilities. In addition to the ACR ROPA program, the American Society for Radiation Oncology (ASTRO) is developing its own accreditation program. A workgroup is developing standards that will be used in the program, which will be organized around ve pillars:
n Patient-centered care n The process of care n The radiation oncology team n Safety n Quality management and assurance
The American College of Radiation Oncology (ACRO) also offers accreditation to deserving practices. The program was implemented in 1995, and the process involves professional peers identifying standards indicative of a quality practice and conducting an audit to assure that these standards are followed. All of these accreditation programs exist to ensure patients are receiving the safest, most effective radiation therapy. Accreditation Preparations ROPA provides a third-party, impartial peer review and evaluation of patient care. Personnel, equipment, treatment planning and treatment records as well as patient safety policies and quality control/quality assessment activities are assessed as part of the accreditation pro-
34
JEFFREY LEESER/ CAPITAL HEALTH REGIONAL MEDICAL CENTER
of average consumers will remember your name if you send them a branded promotional product.*
Promotional products deliver repeat impressions, increased familiarity and long-lasting brand identification all at a better cost per impression than most other advertising media. Let the experts at ADVANCE Custom Promotions unleash the power of promotional products for your facility. Whether you need to build brand awareness, energize recruitment & retention efforts or support product launches and initiatives, our promotional solutions will keep your brand top of mind.
*Research provided by the Advertising Specialty Institute, 2012, All Rights Reserved.
% 87
1. 877. 776.6680 advancecustompromotions.com

ADVANCE for Executive Insight 35
IMAGING EXCELLENCE
No longer just a radiology and IT endeavor, we have begun to see a culture change where visionary CIOs recognize cloud as a business strategy and a tool for change.
way to distribute these scans and medical images throughout the health system. For the post-EHR market, the use of enterprise imaging solutions with radiology type workow to capture and access patient images and metadata to help enable better clinical outcomes and research outcomes will be key to optimizing the EHR.
THE EVOLUTION OF MEDICAL IT SOLUTIONS
New IT solutions can help clinicians improve patient outcomes, while also improving productivity and lowering costs. PACS , the traditional image-management systems utilized in
radiology departments for nearly two decades, are evolving into broad imaging and clinical information systems and expanding beyond their radiology and typical imaging roles. Growing departmental and imaging capabilities of new systems will allow a better ROI of the solutions through better use of IT infrastructure and less administrative overhead. The expansion of these imaging information systems also allows for better focus on productivity for imaging professionals. Productivity is being increased by a truly integrated and seamless user experience that encompasses all aspects of interpreting diagnostic images (HIS/ RIS, PACS, 3D, reporting, specialized clinical applications and more). There will be no more fumbling between diering applications while having access to richer clinical data and diagnostic tools.
FOCUS ON THE CLOUD AND MANAGED SERVICES
With better access and management of
cess. The process starts with submission of a detailed online application. After all of the application information is gathered, there is an on-site visit by ROPA surveyors. During the visit, 10 cases of denitively treated patients who recently completed treatment at the facility and have had at least one follow-up visit are reviewed. The accreditation process requires time, energy and preparation from the entire staff. Everybody has to be 100% behind the process, Monzon said. To understand the process, the practices have to be familiar with ACR and ASTRO guidelines and technical standards, ACR Appropriateness Criteria and the American Association of Physics in Medicine Task Group Reports. To prepare, Bonnie Bresnahan, RT(R)(T), director of Radiation Oncology and Cancer Registry, Anne Arundel Medical Center, said her team formed a working committee to review the standards. Then, we pulled our documentation from that three-year period to show the work we were doing and to show compliance with those standards. I thought the process was very straightforward, she said, adding that the ACR was helpful whenever questions arose. Joy said her facility started by carefully studying the online application to understand the requirements. There is a lot of data collection involved; all documents were scanned and saved in a centralized location. We spoke with our ACR contacts, when needed, making sure their expectations and our information were aligned, she added. The advice from these two facilities reects the advice from Monzon about overcoming challenges in the accreditation process:
n Take your time. n Create an Accreditation Committee or Team n The radiation oncologist should be your champion and leader n Review your policies, procedures, manuals and other documents
to make sure they are up-to-date and readily available for submission with your application or review during the survey n Contact ACR staff members, who are happy to help guide facilities through the process Honor and Satisfaction Joy and Bresnahan agree that accreditation is a great source of pride for their facilities. We take pride in saying our institution practices within the guidelines of the ACR. The accreditation is a validation that we are following the rules and regulations set for our eld. It allows us to be accountable to a larger society, not just our institution, Joy explained. Accreditation shows we strive to give the best care possible to our patients and community, Bresnahan added. She said she would encourage any radiation oncology practice to apply for accreditation. Its a deep dive into your program and it is a way of validating your program. Its an expert review allowing the opportunity for improvement. Accreditation is a validated way to demonstrate a facilitys commitment to excellence. It is a source of pride for personnel, and ultimately contributes to the most important goal of any practice: safe, superior patient care. Kelly Graham Bocich is a former associate editor.
36
C R A N E W A R E . C O M
On the journey to revenue integrity, you need an expert guide.
ptimizing reimbursement. Minimizing compliance risk. Increasing operational efficiency. How is your hospital reaching revenue integrity? One in four U.S. hospitals chooses Craneware Revenue Integrity Solutions to help them on their journey. We pioneered automated chargemaster maintenance in 1999 with Chargemaster Toolkit, and its been rated 1st in its category by KLAS* for seven consecutive years. Now spanning a broad range of software backed by unsurpassed supporting services, we can help you reach your revenue integrity goals. Our free Revenue Integrity Survival Guide can help your hospital wherever you are on your journey to revenue integrity, whether a CAH or part of a large network. Just scan the code to get your copy and forge your own journey.
CRANEWARE REVENUE INTEGRITY SOLUTIONS FOCUSED ON INTEGRITY

Revenue Cycle
Chargemaster Toolkit Physician Revenue Toolkit Bill Analyzer
Supply Management
Pharmacy ChargeLink Supplies ChargeLink
Audit & Revenue Recovery
InSight Denials InSight Audit InSight Payment Variance Analyzer
Access Management & Strategic Pricing

Patient Charge Estimator Pricing Analyzer InSight Medical Necessity
Download valuable resources and join the movement to prevent revenue leakage
stoptheleakage.com
*Chargemaster Toolkit is ranked No. 1 in the Revenue Cycle Chargemaster Management market category for the seventh year in a row (2006 2012), and Bill Analyzer is ranked No. 1 in the Revenue Cycle Other market category the second year in a row (2011 2012). 2012 Best in KLAS Awards: Software & Services report, published December 2012. Data 2012 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
SCAN FOR YOUR FREE DOWNLOAD
craneware.com stoptheleakage.com
Healthcare Financial Management Association staff and volunteers determined that Cranewares Chargemaster Toolkit, Chargemaster Corporate Toolkit, Bill Analyzer, Online Reference Toolkit, and Interface Scripting Module have met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of these products.
37
SPONSORED CONTENT BY FIDELITY INVESTMENTS
Mergers and Acquisitions in Healthcare: A Guide for Retirement Plan Sponsors

Key considerations and best practices for effective retirement plan design and integration
erger and acquisition (M&A) activity has been on the rise as more healthcare organizations aim to strengthen their competitive positions. Often overlooked, an important factor for a successful merger or acquisition is optimizing the design and implementation of retirement benets to support the organizations overall strategy.
ALIGNING BUSINESS AND BENEFITS STRATEGIES
Fidelity Investments, the leading provider of retirement plans to the not-for-prot healthcare market, can help acquiring, acquired, newly-formed, and aliated organizations develop and implement benets and retirement plan strategies that support their missions and business strategies. Fidelity has found that the following retirement benets considerations are most relevant for organizations completing a merger or acquisition:
n Developing a strategy to account for qualied and non-qualied plans n Understanding merger or asset purchase impacts on plan integration n Updating plan administration policies and processes n Communicating the change(s) to employees
roadmap to help administration and Human Resources partner to eectively manage the change and take advantage of the opportunity a merger or acquisition presents. Develop a governing strategy for mergers and acquisitions Organizations should have an over-arching strategy for M&As that details the overall retirement benefits goals and provides a framework to drive integration. When organizations address M&As inconsistently, there is a greater possibility that employees will experience confusion, and the retirement plan will include multiple providers, duciaries, payrolls and legal lings - and higher administrative costs. Establish a repeatable integration model To enable successful retirement benets integration, organizations should create an M&A integration template, outlining key activities and dening a task force of experts who can collaborate as needs arise. Suggested members include: due diligence specialists; benets technical experts to focus on plan design; human resources specialists to explore potential cultural issues; and information technology specialists to address data integration. Identify integration leaders Forming an eective leadership team is critical. The representation should include administration and functional leaders as well as influential advocates who will visibly support the changes. These leaders can ensure inclusive decisions occur, and should include the chief medical ocer, chief nursing officer, human resources, finance, legal, labor relations, and leadership of the acquired organization. Begin integration early Key internal stakeholders, including board members, business line managers, information technology leaders and clinicians, and external stakeholders, including outside legal counsel and local political and community leaders, should be aware of a pending deal as early as possible. Prompt notication can help generate trust and cooperation.
LOOKING FORWARD
Successfully addressing these considerations can improve the competitive position of the post-transaction organization. A merger or acquisition presents an opportunity to improve the overall cost and competitiveness of the organizations benefits, says Rick Mitchell, executive vice president, Fidelity Investments Tax-Exempt Retirement Services. Fidelity has found that implementing a benets strategy that supports the business strategy and talent management needs of the post-M&A organization can optimize the return on the retirement investment.
IMPLEMENTATION BEST PRACTICES
Fidelity can partner with healthcare organizations to help navigate the most complex transactions and implement a strategy that positions them for long-term success. Fidelity understands the challenges and opportunities in the ever-changing healthcare market, states Mitchell. We do not react; we lead with solutions that help ensure organizations retirement programs remain competitive despite the many changes ahead. For more information on how Fidelity can help, please call 877259-8560.
Based on LIMRA (Life Insurance and Market Research Association) not-for-profit market survey Q2 2013 results For plan sponsor use only. Fidelity Brokerage Services LLC, Member NYSE, SIPC, 900 Salem Street, Smitheld, RI 02917. 666106.1.0
Fidelity has compiled a list of best practices to help guide leadership in engaging stakeholders and implementing a forward-looking retirement benets strategy. Tim Ruggles, vice president and healthcare practice lead for Fidelity states, I encourage leadership to follow Fidelitys recommended best practices, which provide a
38
IMAGING EXCELLENCE
medical images, the industry also needs to focus on ecient management and storage. A continuing industry trend and keeping in line with focus of streamlining operations, cloud-based solutions and managed services will continue to be core to the discussion. Enterprise Strategy Group reported in December of 2010 that the total North American healthcare providers data will grow at a 35.3% CAGR between 2010 and 2015. Also, large hospitals will go from managing an average of 500 terabytes of data in 2010 to more than 1.7 petabytes in 2015. We will see hospital CIOs on the forefront of imaging cloud discussions. No longer just a radiology and IT endeavor, we have begun to see a culture change where visionary CIOs recognize cloud as a business strategy and a tool for change. CIOs further recognize the cloud as a secure medical imaging solution that provides a platform for viewing and sharing medical images across the hospital enterprise. They realize that they can help physicians and other members of a patients care team to easily collaborate and offer second opinions, regardless of their physical location. Since such a medical imaging solution offers the ability to automate workows while increasing the speed and volume of medical imaging studies handled, CIOs and other hospital administration are putting cloud and managed services on the forefront of their agendas. Marching forward, we will continue to see radiology and medical imaging being core to patient care, as high tech tools and new innovative solutions provide a much-needed evolution for healthcare, specically with a renewed knowledge on how modern technology can assist us with lowering budget costs. Several of these key items will be how optimization of the EHR with a multi-media patient record may help improve clinical outcomes, how new IT platforms are expanding beyond radiology and typical imaging roles, and how cloud and managed services have moved to the forefront of the CIOs attention and are not just an IT strategy any longer.
Marching forward, we will continue to see radiology and medical imaging being core to patient care, as high tech tools and new innovative solutions provide a much-needed evolution for healthcare.
Get More Online!

The Executive Insight website is your 24/7 online resource for the tools, business strategies and in-depth analysis you need to make crucial decisions for your hospital and healthcare network.
Visit www.advanceweb.com/executiveinsight to nd: Exclusive online content Solution-based multimedia videos and podcasts, including Executive Answers Educational webinars Digital editions of Executive Insight with enhanced, interactive features not found in print Late-breaking news updates Expert blogs and columns And much more!
Check out Executive Insight online at www.advanceweb.com/executiveinsight
ON THE WEB
For more imaging and oncology content, go to the Imaging Solutions section at www.advanceweb.com/executiveinsight
39
SEPSIS
The Business Case for Improved Sepsis Diagnosis

With a complex syndrome such as sepsis, which lacks a single, cure-all solution, the key will be to look for smaller, scalable solutions that yield meaningful downstream effects.
A large percentage of total hospital costs are dedicated to sepsis, so hospital administrators and healthcare providers should identify ways to reduce this massive cost By Tom Polen
epsis is a leading cause of morbidity and mortality in the United States, ahead of prostate cancer, breast cancer and HIV/
AIDS combined.1 There are an estimated 1 million cases of severe sepsis in the U.S. annually,2 which ultimately lead to over 215,000 deaths each year;3 sepsis is the number one cause of death in non-coronary intensive care units (ICUs).4 The incidence of sepsis is estimated to be growing at a rate of 8.7 percent per year,5 and is disproportionately increased in elderly adults.6 As the baby boomer generation ages, the healthcare implications become even more alarming. Of equal concern is the economic impact that sepsis and its treatment have on healthcare providers. With an average price tag of $20,000 to $25,000 per case (in 1995), the cost of sepsis treatment was estimated at $16.7 billion annually.3 In 2009, not only was sepsis ranked as the most expensive reason for hospitalization, but also costs for this condition grew at almost three times the rate of costs for hospital stays overall (average annual growth of 11.9 percent versus average annual growth of 4.4 percent).7 Moreover, a large
Tom Polen is the president of BD Diagnostics Diagnostic Systems.
40
JEFFREY LEESER/ MATTHEW TARRABORELLI
BD MAX - The Freedom of Choice

Introducing BD MAX Cdiff - The Most Efcient, Cost Effective Way to Get Accurate Results
ARE YOU LOCKED INTO PERFORMING INEFFICIENT, UNPRODUCTIVE AND MONOTONOUS MOLECULAR TESTING?
BD MAX Frees You to Reduce the Time, Complexity and Cost of Molecular Testing - Load and Go Freedom.
Load and run 1 to 24 discrete assays and walk away Mixed assay runs and broad menu* Fully integrated and automated lysis, extraction, amplication, and detection Unit dose reagents stored at room temperature The freedom to break the chains of single assay molecular testing by choosing the BD MAX System Introducing BD MAX Cdiff Assay BD is proud to introduce the BD MAX Cdiff assay to the extensive BD MAX amplied testing (NAAT) assay product line. The BD MAX Cdiff assay rapidly identies the toxin B gene (tcdB) found in toxigenic Clostridium difcile from patient specimens, with the high accuracy of molecular testing. Best of all, C. difcile testing can be performed in the same run as your MRSA testing, consolidating HAI assays on one system and one run.
*The BD MAX System is cleared or approved by the FDA only when used with BD MAX IVD assays which have been cleared (e.g, BD MAX Cdiff assay) or approved by the FDA. IVD assays and userdened protocols cannot be performed in the same worklist or run. BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company. 2013 BD
BD Diagnostics 7 Loveton Circle Sparks, MD 21152 www.bd.com/ds
41
SEPSIS
The multi-faceted process of sepsis treatment offers several potential areas to address cost inefciencies.
percentage of total hospital costs are dedicated to sepsis; within hospital ICUs, sepsis and sepsis-related events contribute to 40 percent of total ICU spending.8 Clearly, this places a large burden on our healthcare infrastructure, so it would seem to be in the best interest of hospital administrators and healthcare providers to identify and evaluate all potential ways to reduce this massive cost outlay. Although sepsis represents a challenge for our healthcare systems, it does not need to cost as much as it does. Of note, not all sepsis cases are improved with greater spending, as patient outcomes and financial spending are not directly correlated. In a study of 309 hospitals, researchers found that hospitals that spend more on treating sepsis do not necessarily have improved mortality rates.9 More than 10 percent of hospitals had both higher-than-expected costs and mortality, whereas a handful of hospitals (7 percent) were able to achieve lower mortality with lower-than-expected spending.9 Additionally, the 63,833 study patients treated at the 105 hospitals with higher costs represented a potential $332 million in excess expenditures.9 This study highlights the fact that there must be opportunities to reduce cost inefficiencies without compromising patient care. With a complex syndrome such as sepsis, which lacks a single, cure-all solution, the key will be to look for smaller, scalable solutions that yield meaningful down-
The Yale School of Managements MBA for Executives offers a focused program of study created to prepare the next generation of healthcare leaders. Join entrepreneurs, health practitioners, executives and others from across healthcare sectors. Develop critical leadership and management skills through a rigorous MBA curriculum with an emphasis on the rising complexities of an industry in transition. Learn more at mbae.som.yale.edu
E D U C AT I N G L E A D E R S F O R B U S I N E S S A N D S O C I E T Y
stream eects. In this vein, the multi-faceted process of sepsis treatment offers several potential areas to address cost inefficiencies. Sepsis is characterized by a systemic inflammatory response to an infection, so it follows that treatment of infection is the cornerstone of anti-sepsis therapy;2 this treatment is largely determined by the laboratorys ability to rapidly and accurately identify the causative organism, and thus select appropriate antimicrobial therapy. It is therefore relevant to explore technological and procedural improvements in the initial detection process that can lead to increased use of targeted therapies and reduced time in the ICU. Both of these outcomes will inevitably reduce spending. To this end, diagnostic companies are using innovative product design and cutting edge technologies to improve the detection process. Blood culture media with proprietary formulations of antibiotic-binding resins have allowed for earlier pathogen recovery, even in the presence of antimicrobials.10,11 Use of these media increase the likelihood that the pathogen is recovered, and that appropriate antibiotic treatment is quickly determined and administered, regardless of whether initial antimicrobials were prescribed.12 This is particularly relevant, as up to 82 percent of patients in the medical ICU may already be on antibiotics when the initial blood culture is drawn.11 The impact of using a blood culture medium that contains resins versus using a medium that does not can be up to a 2.4-fold increase in recovery rates (i.e., 91 percent vs. 38 percent recovery in the presence of antibiotics).11 This is a critical point, as without recovery of the sepsis-causing pathogen, determining the appropriate antibiotic treatment is not possible. In fact, a recent study has shown that the selection of the diagnostic used in a hospital can directly impact antibiotic prescribing practices; organism isolation from blood culture media can result in a 3-fold increase in antibiotic prescribing changes to a more appropriate and targeted therapy.12 In addition to the clear, positive impact on patient health outcomes that
42
SEPSIS
such targeted therapy supports, it also can have a dual impact on spending minimizing the costs of inappropriate, and often expensive broad spectrum antibiotics, and reducing length of stay in the ICU. Another opportunity for cost reduction in the treatment of sepsis is to streamline the diagnostic process itself. It is important to ensure that specimens are processed promptly, and that clinically relevant results are generated as quickly as possible. Prolonged time in getting specimens onto appropriate instrumentation can delay time to results, which in turn can translate into prolonged use of costly and potentially unnecessary antimicrobials,13 and also negatively impact patient outcomes.14 It has been reported that for every hour delay in getting septic patients onto appropriate antibiotic therapy, mortality rates increase by 7.6 percent.14 Alarmingly, these same researchers found that only 50 percent of septic shock patients received eective antimicrobial therapy within 6 hours of diagnosis.14 To help address this, newer blood culture systems have been designed for remote placement in high-volume areas of hospitals, such as the emergency room or ICU, to address and eliminate transportation delays once blood is drawn. Specialized alert systems are available to signal results in real-time to both laboratory technicians and clinical decision makers. By reducing these specimen processing delays, not only are improvements in patient outcomes more likely, but also concomitant decreases in antibiotic usage and length of stay can be realized, with signicant impact to the bottom line. Of course, drawing on recent technological advancements in diagnostics is only one part of the equation to increase eciencies and reduce sepsis-related costs. Prevention, compliance, and continuing education initiatives also hold tremendous potential to lessen the nancial burden of sepsis. It is unlikely that a single panacea will x the sepsis crisis, but it is worthwhile to explore smaller interventions such as those described here, which may still have a big impact. By incorporating technological advancements and promoting process adjustments favoring integration and communication, hospital administrators can feel condent they are modifying sepsis diagnosis and management to both improve patient outcomes and decrease spending. References
1. Global Sepsis Alliance. International Organizations Declare Sepsis a Medical Emergency: issued by an expert panel representing 20 adult and pediatric intensive care societies, 2010. 2. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012 June ; 10(6): 701706. 3. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001, 29: 1303-1310. 4. LaRosa SP. Sepsis. Cleveland Clinic Disease Management Project. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/sepsis/. Accessed 7 October 2013. 5. Martin GS, Mannino DM, Eaton S, Moss M. The Epidemiology of Sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348:1546-1554 6. Martin GS, Mannino DM, Moss M. The eect of age on the development and outcome of adult sepsis. Crit Care Med. 2006 Jan; 34(1):15-21. 7. Elixhauser A, Friedman B, Stranges E. Septicemia in U.S. hospitals, 2009. Health care and utilization project statistical brief 122. Agency for Healthcare Research and Quality, 2011. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/ sb122.pdf . Accessed 28 January 2013. 8. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009; 302(21):2323-2329. 9. Lagu T, Rothberg MG, Nathanson BH, et al. The relationship between hospital spending and mortality in patients with sepsis. Arch Intern Med 2011; 171: 292-299. 10. Flayhart D, Borek AP, Wakeeld T, Dick J, Carroll KC. Comparison of BACTEC PLUS blood culture media to BacT/Alert FA blood culture media for detection of bacterial pathogens in samples containing therapeutic levels of antibiotics. J Clin Micro 2007; 45(3): 816-821. 11. Zadroga R, Williams DN, Gottschall R, et al. Comparison of 2 blood culture media shows signicant dierences in bacterial recovery for patients on antimicrobial therapy. Clin Infect Dis 2013; 56(6):790-7. 12. Zadroga R, Williams DN, Hansen GT. Selection of blood culture media matters BACTEC use in the critically ill facilitates earlier organism detection and antibiotic decision making. Poster presented at the Critical Care 2013 Congress, hosted by the World Federation of Societies of Intensive and Critical Care Medicine in Durban. Aug. 30, 2013. 13. Kerremans JJ, van der Bij AK, Goessens W, Verbrugh HA, Vos MC. Immediate incubation of blood cultures outside routine laboratory hours of operation accelerates antibiotic switching. J Clin Micro 2009; 47(11): 3520-3523. 14. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of eective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34:15891596.
Award Winning LIS and Easy, Affordable Outreach and EMR Connectivity
Your la ab b can can n st stre rea ea e amli mli ine ne e ef ef fc ci ie enc en nc ncies ies sa an nd enha enha nh n hance nce nc ec cu usto sto omer satisfact tio on a on at taf fr fra ract ra cti cti tion t on on o of ft the th he h ec co os st t and and t an ti im imeme-to tot oo -m mar m ar rke ket ket et of of other Out Ou O ut u tr rea re ea each ch pro progra gram gram gra ms sw wit it ith th Ps syc sy yche yc h sO Outr utrea ut utr eac e ch and nd EMR Co Connec nn nn ne ec cti tv vit i it ty solu o ti t ons tio ns. s. Win ndoP do d oP o Pat ath th, our ur aw awa ward wa rd w win in nnin nin ng, full-f fe eat ature ure ur ed LI IS S wa was was sd de esig ig gn ne ned ed e d with the e fe feat atu a tu t ure re res es, , fun un unc nc ct tio ti io onal na i ity y, and y, an nd d workflow wp pat pa at tho ho hol ologi ogi og ists pr pre efe fe er. r. Ps Psy yc ch hes sol ol lu uti ut ti to ons ns s ar are desi are esigne gned gne ned to ma ake ak k laborato or rie ie es of all ll siz sizes zes sm mo ore effi fficie cie c ie ent. n Don Do D on nt t j jus us st keep st ep u ep up p with innovati ion stay io stay st a on o to top op p of of it t.
www.psychesystems.com
Call 800.345.1514
43
mHEALTH IN ACO
Role of Mobile Health in ACOs
Engaging patients through mobile health is an emerging strategy for ACO success By Wayne Guerra, MD, and Bruce Henderson
any organizations are now pursuing accountable care models designed to serve a variety of patient populations. Like the early Medicare ACOs, these models are working to achieve the triple aim of healthcare reform improved care, reduced costs and better patient satisfaction. To meet these objectives, many organizations are now looking to design innovative approaches that engage and empower individuals with valuable support and resources. Todays mobile health technology is quickly becoming the enabler of many of these new approaches. Mobile health can support patient engagement when part of a comprehensive, patient-centered strategy. While there are thousands of dierent mobile health devices and applications available today, there are a select few that ideally align with an ACO model. Consider the following examples which illustrate how mobile health technology can be applied to an ACOs eorts to achieve the triple aim.
THE RIGHT CARE AT THE RIGHT PLACE AND TIME
44
JEFFREY LEESER
Wayne Guerra, MD, is co-founder and chief medical ofcer, iTriage, and Bruce Henderson is head of Integrated Solutions, Accountable Care Solutions from Aetna.
As ACOs take on greater responsibility for the cost and quality of care within their populations, driving patients to the most appropriate venue to receive treatment will be a key strategy. For example, many emergency room visits made by patients are avoidable and are due to non-emergency issues. The important question is why patients choose such a costly and time-consuming avenue for care. The answer is often that patients lack support, information and guidance at the exact time they are making this decision. New mobile applications that incorporate symptom checkers are a good place to start addressing this issue. Patients input their symptoms and receive guidance around potential causes and appropriate care. For example, an individual who has sprained an ankle can use
a mobile application to identify that an urgent care center should be appropriate to treat the injury. Then, advanced features could search a provider directory and nd the nearest urgent care location. The applications may even allow the individual to pre-register and avoid wait times. All of this guidance can occur in a matter of minutes whether the user is at home, at work or on the go. Other mobile health approaches ideally suited to an ACO can promote in-network utilization, a key strategy for these models. To incent patients to stay in-network, individuals should have access to innovative features available through these select providers. These could include appointment scheduling, access to patient health records and provider communication capabilities.
INCREASING PATIENT SATISFACTION
In todays incredibly busy world, the new paradigm is that convenience is the new quality. Consumers demand immediate access to personalized information and resources that can help them make better healthcare decisions. As a result, many of the features that can drive
mHEALTH IN ACO
understanding of patient health. For example, if data reveals that someone is at risk for diabetes, a symptom checker application could consider this factor if the patient enters certain disease-specic symptoms.
IMPROVING CARE DELIVERY ACROSS THE CONTINUUM
While there are thousands of different mobile health devices and applications available today, there are a select few that ideally align with an ACO model.
cost-savings with an ACO model have the potential to dramatically improve patient satisfaction. Going a step further, mobile health strategies can also serve as a platform to strengthen the relationship between providers and patients. For example, new mobile health applications are being developed that emulate todays instant message capabilities. These applications use secure, HIPPA-compliant technology and allow patients to quickly and easily communicate with their doctors office. Through this open window of communication, patients can use applications that allow them to securely message physicians from their smartphone or tablet and be instantly alerted when a reply is received. There are also signicant opportunities to improve patient satisfaction by using mobile strategies to integrate wellness eorts and traditional patient care. As ACOs are designed to address the fragmentation of our healthcare system, mobile health itself should not be an island of its own. Data to and from mobile devices should be combined with electronic medical records, HRAs and other wellness data. Information pushed to the mobile device can then be highly customizable based on an advanced
An integrated approach also has potential to dramatically improve care delivery with an ACO. Mobile solutions can quickly and easily connect with patient insight from a variety of sources. For example, if a patient elects to share the information, providers could monitor an individuals progress in their exercise and nutrition efforts through a mobile wellness application. Or a mobile health application that automates rells could provide information to providers about medication compliance. Many new mobile health monitoring devices are coming on the market to automatically track and store validated biometric data. This real-time data and reporting can help providers within an ACO stay informed about the health of patients with chronic conditions such as diabetes and high blood pressure. As a result of this knowledge, providers can target their eorts to patients most in need of support. This is true even if these patients havent stepped foot into the doctors oce.
NEXT GENERATION OF PATIENT ENGAGEMENT
The implications of this cost-effective and impactful approach to patient engagement are clear. Just as the intent of ACOs is to transform care delivery, mobile health has similar potential in changing the way we empower and engage individuals through better and more convenient access to relevant, timely and personalized healthcare information. As more organizations pursue both public and private ACO models, they need to consider mobile health technology as a key strategy to support these eorts.
What is an ACO under the MSSP? Who can participate in an ACO? How is quality measured? How are savings measured and accomplished? And are there other important legal issues? Visit www.advanceweb. com/executiveinsight and search 5 Things to Know About ACOs to learn more.
ON THE WEB
45
PHARMACY OPTIMIZATION
ty, they can produce signicant income by capturing even a portion of the thousands of prescriptions generated in and around the facility every day. The activity related to patient discharge is a natural t for an onsite hospital pharmacy. For example, in 2010 Hennepin County Medical Center in Minneapolis was faced with $16 million in state-mandated healthcare cuts. Hennepin sought more revenues by expanding its ambulatory pharmacy eorts. They added three new sites and enlarged the one serving its emergency department, resulting in a total of eight for the health system. The outcome: Their ambulatory strategies resulted in a revenue surge of $35 million annually. These funds helped close the budget gap and allowed Hennepin to strengthen ambulatory practice in ways that benefit both patients and the nancial strength of the hospital. Hennepin provides more medication therapy management, has more pharmacy residency programs, and now has the resources to send a pharmacist to a nearby nursing home to help with the care transition. This wouldnt be possible if we didnt have some revenues from community pharmacy operations, said pharmacy services director Bruce Thompson, RPh, MS. Supporting outpatient needs is another source of revenue, including urgent or emergency care, same-day surgery, and other types of specialty care. To capture scripts, hospitals typically differentiate themselves from chain retailers by building awareness with patients and clinicians. Areas of distinction might include:
n Carrying drugs not commonly available in retail
Use Your Pharmacy to Grow Revenue

By Robert Scholz, RPh, MS, MBA
Learn from 3 hospitals that experienced a revenue surge
peer s value-based purchasing reviewed is changing healthcare business models today, health system leaders are also changing the way resources are being utilized to offset eroding margins. To go beyond just maintaining solvency, they are looking in two directions: shore up costs and seek new sources of revenue. Recently, many hospital leaders have begun to take a serious look at the value found within their pharmacy. Theyre nding it can help not only have a signicant impact on clinical outcomes and accountable care, but also contribute to the bottom line.
PR
settings
n Offering medication therapy management
programs for patients with chronic conditions

n Delivering services like vaccinations, immuniza-
tions, and simple preventive screenings

n Tailoring front-end offerings appropriate
to the outpatient setting, such as overthe-counter medications, durable medical equipment, and more
DRIVING REVENUE GROWTH
Robert Scholz is vice president, McKesson Pharmacy Optimization.
Despite their small physical footprint, ambulatory pharmacies can present a signicant economic opportunity. Whether located in hospitals, near treatment clinics, or around the communi-
Some pharmacies are now realizing the opportunities to deliver specialty drugs in an ambulatory setting to patients with chronic, complex diseases. Specialty medicines typically require unique handling and administration such as injection or infusion. Adding this expertise
46
JEFFREY LEESER
INCREASING NET REVENUE A STRATEGIC ADVANTAGE
BETWEEN 1%-6%.
FOR ANY BOTTOM LINE.
THATS THE VALUE OF COLLABORATION
For over a decade, our revenue cycle experts have been increasing net revenue 1%-6% and reducing cost-to-collect by 10%-20% for hundreds of hospitals, including those within one of Americas largest healthcare systems. In fact, today we stand at over $35 billion in annual cash collections. Learn how you can leverage our scale to achieve strategic advantages throughout your organization. Read Revenue Cycle as a Strategic Advantage at parallon.com/RCS
Revenue Cycle Purchasing Supply Chain Consulting Services Information Technology Workforce Solutions
2013 Parallon Business Solutions, LLC. All rights reserved
47
PHARMACY OPTIMIZATION
High-performing pharmacies may expect capture rates up to 70% or more if they offer incentives such as reduced co-pays, 90-day supply for maintenance drugs, or discounts to convert to generic drugs.
supports clinics that handle transplants, infectious diseases, rheumatology, oncology, or hemophilia, to name a few. In addition to more traditional sources of revenue, we are identifying opportunities to work in concert with our medical providers to better care for our patients, and as an ancillary eect, generate prescription volume,. said Scott Graham, assistant vice president, outpatient pharmacy services, at Carolinas HealthCare System. Weve embedded more than 30 pharmacists in physicians practices or outpatient clinics to work in areas such as HIV, cardiac, anti-coagulation, diabetes and asthma management to optimize patient outcomes. Our providers denitely see the value of having a pharmacist on sta at their site. Its also important to note that it takes a dierent set of skills to maximize the revenue potential of hospital-owned retail pharmacies. We teach pharmacists to be better stewards. They are not taught business or nancial prociency in pharmacy school we give them tools to run a protable operation, said Conley McCoy, Carolinas outpatient pharmacy director. Our pharmacists also have perfected their interpersonal and customer service skills to create a boutique experience that builds loyalty. A patients experience with us reects on the entire health system.
SUPPORTING COST SAVINGS
ON THE WEB
Are you aware of the latest information regarding 340B? Go to www. advanceweb.com/executiveinsight and enter 340B in the keyword search box.
In the past year, more than 2,200 hospitals have been penalized $280 million for excessive readmission rates under CMS Readmissions Reduction Program. And, as of Oct. 1, 2013, the penalties become more severe as the maximum penalty rises from 1% of Medicare payments to 2%, then 3% the following year.1 So why are there so many preventable readmissions? Not surprisingly, medication mis-
adventures can play a major role. These issues include unfilled prescriptions, poor patient knowledge, lack of medication reconciliation, and adverse drug events. According to the Agency for Healthcare and Research Quality, patients who understand post-discharge instructions on how to properly take their medications are 30% less likely to be readmitted or visit the emergency department.2 Managing medications at a hospital-owned pharmacy provides direct visibility and hands-on management with patients on critical medication issues. The University of Wisconsin Hospital & Clinics ambulatory pharmacies begin their continuum of care with post-discharge medications and extend it with a range of robust clinical services such as disease management, long-term drug adherence, and wellness counseling. One example of their outreach program is an antibiotic callback eort. Within three days after discharge, we call patients to assess how antibiotics are working for them, if they are able to tolerate them, and if there are any side eects, noted Carrie Boeckelman, manager of ambulatory pharmacy services. Activities like these bond patients to University of Wisconsin, said director of pharmacy Steve Rough, MS, RPh. The hospital reinvests earnings into new technology, expanding sta, and the capital infrastructure of the hospital to continue to improve patient care. And lastly, hospitals are leveraging their pharmacy to support cost savings through employee pharmacy benets. High-performing pharmacies may expect capture rates up to 70% or more if they oer incentives such as reduced co-pays, 90-day supply for maintenance drugs, or discounts to convert to generic drugs. Opportunities for leveraging the value of pharmacy are rapidly growing. There has never been a better time than now to strategize on the impact pharmacy can have on health system objectives to not only better serve patients but also improve the bottom line. References
1. Medicare Revises Readmissions Penalties Again. Kaiser Health News. March 14, 2013 http://www.kaiserhealthnews. org/Stories/2013/March/14/revised-readmissions-statistics-hospitals-medicare.aspx 2. Internet Citation: Re-Engineered Discharge (RED) Toolkit. Agency for Healthcare Research and Quality, Rockville, MD. March 2013. http://www.ahrq.gov/professionals/systems/hospital/toolkit/index.html
48
BIG DATA
Enterprise Informatics
How to successfully navigate the new big data landscape
By Manish Muzumdar
gling is the projected growth rate for healthcare data: By 2020 that number is expected to grow by a factor of 50 to 25,000 petabytes, an estimate that may well prove conservative. The truth is, the influx of data the healthcare industry has experienced thus far is but a trickle compared to whats coming once the proverbial dam bursts. But its important to note that the deluge of big datawhich will pose a substantial challenge to all organizationsis overshadowed by how signicantly most organizations today still struggle to manage and make sense of the millions of bytes of small data now at their disposal.
SINK OR SWIM?
Its safe to say the industry is on the verge of a watershed moment, and, to use one more water metaphor, its sink or swim time for healthcare organizations around the worldeither to their benet, and the benet of their patients, or to the undoing of those organizations unable to efficiently and effectively manage the exabytes of data coming down the pike. The challenge of navigating this new, uncharted landscape falls to a range of stake-
The inux of data the healthcare industry has experienced thus far is but a trickle compared to whats coming once the proverbial dam bursts.
Manish Muzumdar is senior vice president of products at Remedy Informatics.
m not making any grand revelations when I say advances in information technology and computing have yielded numerous valuable, lifesaving improvements for healthcare. But well-informed industry insiders and observers will tell you weve only scratched the surface, and that healthcare IT yet holds great promise for further innovation and advancement in clinical research and the delivery of patient care. A byproduct of these advancements, for better or worse, is the exponential increase in data available to and collected by healthcare organizations around the world. Recent studies1 suggest the healthcare industry has already amassed close to 500 petabytes of data across a multitude of information systems, applications, and medical les. Even more mind-bog-
holders that includes executive management, IT professionals, researchers, and clinicians. When it comes to managing big data, getting it right from the beginning is critical. Recent polls of healthcare executives show that many believe they arent handling current small data challenges adequately, and that the advent of big data is something that keeps them up at night. To make matters worse, some alleged experts would have you believe that handling big data requires superhuman expertise. But enough similarities exist between small data and big data to reassure those who are managing their small data wellwhich is to say, extracting value from itthat the solid foundation theyve established will also enable them to effectively manage and leverage the big data yet to come.
SCOTT FRYMOYER
49
BIG DATA
EFFECTIVE DATA MANAGEMENT
FIGURE - HOW BIG IS BIG?
The realization that you are not effectively managing your small data now, however, should be cause for concern, because mismanagement will only be amplied as the amount of data increases. What were once small errors will, because of the snowball effect, become big impediments. Big data will expose poorly designed or inflexible software system architectures. Scalability is a key to business success, and its no dierent when it comes to data management. Getting it right from the beginning should be your mantra as you prepare for the growing volume of data in your organization. Doing so will, in addition to conferring other benets, lead to greater competitive advantage for your organization, and probably result in fewer sleepless nights. Additional best practice-based suggestions to prepare for the era of big data include: Think beyond the problem(s) du jour. Lack of foresight is the likely cause of a lot of your current technology problems. While the old saying the squeaky wheel gets the grease often proves true, sometimes what you really need is a new wheel or wagon. Reactive decision-making typically results in a patchwork of technologies that prove inexible and of limited capability in operation, in contrast to the robust, truly integrated system that can be produced by taking a more proactive approach. Such inadequately planned information systems typically require inordinate IT resources to manage and often produce data silos that inhibit collaboration and slow discovery. To be fair, no one can predict every future development with 100 percent accuracy, but scalability and vision are keys to successfully navigating challengeseven the unforeseen ones. Look to outside of healthcare for answers to your problems. Just as no man is an island, no institution or industry is, either. While healthcare has its own inherent challenges and eccentricities, the role of technology has proven to bend to meet what might at one time have been considered unique needs. Its worth noting that healthcare and education have been the two slowest industries to adopt technology to make productivity gains. Thats in part a good thing, since new therapies need to be tested and proven before going to market, but its also left a lot of consumers scratching their heads at the perceived slow pace of discovery, innovation and ultimately personalized medicine. In contrast,
Average Blu-ray movie (25GB)
1 Petabyte of storage is equivalent to roughly 42,000 Blu-ray movies, each 2 hours in length.
A single Blu-ray movie made up of 1 Petabyte of data would take 9.5 years to watch from beginning to end.
nance and retail are leaders in eectively managing big data. Because its clear theyve found some of the right answers to these problems, why not take a page out of their playbooks? Your data is one of your most valuable assetsstart treating it that way. You might believe your organization is already in sync with this best practice, and it may be. But according to research from Oracle, 43 percent of healthcare decision makers are concerned they are not capturing enough data or the right data. Data is inherently valuable, and when its capture, storage, and overall management are strategically thought out, its worth both inside and outside your organization will increase exponentially. Clearly, your approach to data calls for everyone within your organization to be on the same page, from top to bottom. What you collect and how you manage and share it should demand as much attention as the development of new treatments. Dont settle. Second and third-rate solutions are not viable long-term solutions, and usually end up as tomorrows problems du jour. As noted above, too many of todays technology problemsthe things keeping your IT departments hoppingexist because previous attempts at solutions werent fully thought out. The square peg doesnt t into the round hole, despite what the crew of Apollo 13 has shown us, and even if it does, like the improvised repair to the crippled spacecraft, its only a temporary x; it cannot be the long-term solution. The answers to your data problems exist; dont give up until you nd the right lasting solution for each of your specic needs. Healthcare isnt covering new ground. Big data challenges, while novel for our industry, have been confronted and overcome by other industries. But the consequences for not getting a handle on big data will be far greater for healthcare than for any other industry. After all, lives depend on it. Reference
http://www.healthcareitnews.com/news/clouds-roll-handle-stratospheric-capacity-needs
ON THE WEB
Talk of the power of big data in healthcare and its potential benets for quality and efciency is everywhere, and while data derived from EHRs, lab systems, HIEs and other sources does offer a great opportunity to improve outcomes and reduce costs, healthcare big data has a real last-mile problem. Read Why Big Data Needs the Right EHR at www.advanceweb.com/executiveinsight
50
DATA ANALYSIS
RAC Data Analysis
FIVE QUESTIONS
The goal of RAC data analytics is to answer the following ve questions:

n How much money is at risk? n What are your reasons for denial? n How many audits are held in appeals? n How are audits impacting cash ow? n How much is the program costing us?
5 critical questions to ask, 3 revenue retention strategies to take By Dawn Crump, MA, SSBB, CHC
Dawn Crump is vice president, Audit Management Solutions, HealthPort.
ecovery Audit Contractors (RACs) escort revenue dollars out your hospital doors every day. Since inception of the RAC program, contractors have reviewed over 1 million medical records and recouped $2.2 billion in denials.1 Data produced by ve years of recovery audits must be continually reviewed and analyzed. Auditors use complex data mining tools to identify hospital vulnerabilities and improper payments. Hospitals should do the same. Historical RAC data in combination with AHAs RACTrac reports oer hospital executives important insights into new revenue retention tactics and strategies. However, the rst step is to ask the right questions. This article describes ve new questions to ask regarding RAC data and explains how hospital executives and revenue cycle directors can implement analytics and business intelligence to uncover audit insights, suggest new conclusions, and open the door to stronger decision-making.
According to the AHAs Second Quarter 2013 RACTrac Survey, 44 percent of hospitals use a claim management tool and should be able to analyze their data. Those without audit management software should review AHA RACTrac data to make correlations based on their facility demographics and reported RAC regional activity. Specics on the above ve questions include: Dollars at Risk Includes any case requested by the RAC. If a medical record was requested, the associated revenue is at risk for take back. Data should be sorted by pending, dispute, RAC discussion, rebuttal as well as the ve levels of appeal. The good news is that during the rst quarter of 2013, according to the AHA, only 34 percent of records requested were ultimately denied. Know Your Denials For example, know which specic DRGs are being denied for your organization and use this intelligence to
TOM WHALEN
51
DATA ANALYSIS
Centralization of the audit management function for multi-location organizations is the best way to curb costs and reduce administrative burdens associated with all types of audit, including RAC.
focus clinical documentation improvement (CDI) efforts, coder training and physician outreach. From a general perspective, identify which diagnosis, procedures or types of cases your RAC/ RACs are targeting and plan future improvement eorts within these areas. Audits in Appeals Youve made the decision to appeal these cases and, therefore, must closely monitor progress and associated costs. Hospitals should know the exact amount of dollars held in appeals, including the interest charged by CMS. Best practice is to separate out automated versus complex appeals, whether an internal or external appeal partner is used, and the cost of appeal versus the dollars at risk. Compare your appeals percentage to national norms for stronger benchmarking and insight. Measure dollars in appeal to historical overturn and appeal success rates, then subtract dollars predicted to be won back from overall dollars-at-risk estimates. The entire appeals process typically takes 18 months to two years. In 2013, many cases that were previously remanded at the Administrative Law Judge (ALJ) level were sent to lower levels for a second review, adding another layer of administrative burden. Cash Flow Impact CMS recoups dollars directly from each months Medicare reimbursement check. Take a close look at RAC reporting against Medicare reimbursement to identify cash ow trends and how many dollars your hospital has lost over the years. With this information in hand, determine and set aside an appropriate cash reserve. Program Costs While program management costs vary by region, 63% of hospitals spend more than $10,000 quarterly to manage the RAC process, according to the AHAs Second Quarter 2013 RACTrac Survey. Forty-ve percent of hospitals spend over $25,000 and 11% fork out over $100,000 quarterly according to the same survey. Increased administrative costs are the biggest culprit alongside the use of outside consultants, software and services. Hospital executives must know program expenses, including how many FTEs are involved, then benchmark their investment against other facilities within their RAC region.
THREE REVENUE-SAVING STEPS TO TAKE
sician relationships. Focus staff Case managers, CDI specialists and physician advisors are in huge demandand short supply. Focusing them on areas prone to auditor take backs ensures eectiveness, reduces costs and mitigates future audit risk. Centralize programs Centralization of the audit management function for multi-location organizations is the best way to curb costs and reduce administrative burdens associated with all types of audit, including RAC. Second, a centralized program more easily identies and shuts down duplicate audit activity, while supporting trend analysis across multiple facilities. These capabilities will be particularly important as RAC regions change and contractors shift later this year. Its painful to lose revenue once; its even harder to lose dollars for the same case twice. Share knowledge - Finally, keep everyone on the audit management team (including executives, case managers, coders, CDI specialists, compliance, revenue cycle, nance and physician advisors) informed on historical patterns, current trends and hot RAC targets. Let them know what types of cases are at risk and the associated nancial impact. RAC analytics empower the entire team to eectively discover new ways to shore up processes and mitigate RAC revenue risk.
KEEP AUDIT DATA CLEAN
Analysis of RAC data can only be done with historical data that is available, analyzable and clean. The old adage garbage in results in garbage out is still true. If your review of RAC information uncovered multiple denitions, categorizations and documentation issues, now is the time to begin cleaning up audit data.
n Standardize audit denitions and protocols n Minimize number of staff assigned to document audits n Validate staff understanding of the process and the auditors
language on denials
Your audit data tells a story over time. It instructs hospital executives on operational costs, future revenue risk, and documentation and coding initiative outcomes. What is your data telling you? Reference
AHA Second Quarter 2013 RACTrac Survey. American Hospital Association. Aug. 27, 2013. Available at: http://www.aha.org/content/13/13q2ractracresults.pdf
ON THE WEB
Armed with answers, cost projections and revenue assessments, hospital executives are now ready to work with their audit management teams to make stronger decisions regarding case management, coder education, documentation improvement and phy-
In todays healthcare environment, one thing is certain: government audits are continuing to increase. In 2012, over $6.1 billion in Medicare payments were targeted for audits. Understanding how audits are affecting your revenue is more important than ever. View an archived webinar, Where Are Your Dollars When It Comes To Audits? at http://healthcare-executive-insight.advanceweb.com/Web-Extras/Webinar-Archives/ Where-Are-Your-Dollars-When-It-Comes-To-Audits.aspx
52
EMERGENCY DEPARTMENT
Enhanced ED Operations to Boost Bottom Line

Karen Barber, RN, is CEO of Yoakum Community Hospital in Yoakum, Texas.
How one hospital ED converted to a model of efciency that resulted in nancial improvements By Karen Barber, RN
JEFFREY LEESER/ RIDDLE HOSPITAL MEDIA PA
mergency departments (EDs) are often seen as an area of the hospital that runs up costs. However, by moving away from paper-based processes and enhancing how patient care is documented in our Yoakum Community Hospital ED, we converted this area into a model of efficiency, and from that, saw a positive impact to clinical care and patient satisfaction, as well as to our bottom line. Our hospital has a legacy of providing high-quality care, so our No. 1 objective for transitioning to an emergency department information system (EDIS) was to provide our clinicians with powerful tools to help them further enhance patient care, safety and the patient experience. We also recognized that technological advancements opened the door for nancial improvements. Not many facilities can say that they manage their ED as a prot center, but we can, and its an accomplishment that were proud of. It means sustainability for our hospital, more opportunity for growth, and a world of possibilities for enhancing patient care and increasing patient satisfaction. Our parent organization, Community Hospital Corp (CHC), is truly committed to adopting electronic systems and improving care coordination and outcomes across all of its facilities. In fact, our sister hospital, Baptist Beaumont, has had phenomenal success utilizing electronic health records, so we were eager to replicate their results. Most of our admissions come
Technology solutions can only deliver results if end users actually adopt them. It is especially important to consider clinician usability and workows prior to any technology purchases.
53
EMERGENCY DEPARTMENT
FIGURE -FINANCIAL IMPROVEMENT WITH AN EDIS 60% 50% 40% 30% 20% 10% 0% charge capture before going live with HMS EDIS charge capture 6 months after going live with HMS EDIS
through the ED, and after seeing Baptist Beaumonts EDIS in action and the numerous positive eects it had on patient care, safety, satisfaction and the hospitals bottom line, we decided the ED was the best place to start our shift to electronic records.
ONE VISION FOR SUCCESS
CHC shared our view of what would make a system valuable: Technology solutions can only deliver results if end users actually adopt them. It is especially important to consider clinician usability and workows prior to any technology purchases. Simply put, systems that interrupt how clinicians provide care will often fail. With that in mind, we were keen on involving ED clinicians in the vendor search and selection process because they could more thoroughly assess solutions to ensure they aligned with the unique needs of the ED while supporting clinical workow. From a leadership perspective, we carefully evaluated each systems track record for helping hospitals comply with regulatory, patient safety and other requirements, and we considered whether they would help us improve operations, nancial performance and streamline processes. For example, with paper-based documentation, our nursing stas duties included manual coding and deciphering evaluation and management (E&M) levels. This was quite time consuming and opened the door for missed charges. We wanted to automate coding and charge capture, among other things, to free up our nursing sta to focus on patient-facing initiatives.
SHARED COMMITMENT, MEANINGFUL TRANSFORMATION
people to change how they have worked for years, in many cases, is nothing to take lightly. We proactively communicated goals and set expectations, and subsequently, sta members were quite receptive. All of this advance communication and planning really contributed to a awless go-live. Soon after the EDIS was up and running, we began to see documentation and nancial improvements. The system was widely adopted by our clinical team because it aligned with their workow and didnt inhibit care eorts, and as a result, charting was much more comprehensive. This not only created a more complete patient record, but it also brought about more thorough and accurate charge capture. By eliminating manual charge capture processes and improving documentation, our E&M levels now more accurately reect the level of care we provide. For example, we saw the average charge per patient increase from $739 to $955, illustrating the gap in our charges due to manual and incomplete documentation and coding practices. Consequently, we experienced signicant revenue improvements within six months of implementing the EDIS, and this is even after we reduced the overall dollar amount charged for Level 4 and Level 5 ED visits. The comparison graph (Figure) illustrates our E&M level charges for the six months before and after going live with the EDIS. In addition to improving nancial performance, we wanted to ensure that we were enhancing the quality of care that we provided and were streamlining workows, sta communication and care coordination. With the EDIS in place, weve reduced the opportunity for human errors, common with manual documentation, and we eliminated other issues, including illegible handwritten charts. Further, clinicians can now access pertinent patient information from any location, enabling physicians to more eciently prescribe corresponding treatments. Additionally, because patient data ows from the EDIS to our inpatient electronic health record, inpatient clinicians now have visibility of the care provided in the ED, which helps improve clinical outcomes and enhances patient experiences.
ED AS FRONT DOOR
A large part of our successful EDIS implementation can be credited to the acceptance we received across the enterprise and the support from both CHC and our vendor (HMS). We had a very structured implementation and communications plan, which facilitated the entire process and contributed to our ED sta and administrative team openly embracing this very signicant transition. Asking
Being a healthcare provider has never been a more dynamic business. While the overall healthcare industry changes in new and sometimes unexpected ways, we face increasing demand for services amid declining budgets and reimbursements and an increasingly complex regulatory climate. As the front door to the hospital, the cycle of care starts in the ED more often than not. The revenue potential in this department is substantial, but the EDs hectic nature often overshadows the possibilities for nancial improvement. With the help of CHC, we changed that scenario at Yoakum Community Hospital, and the results speak for themselves.
ON THE WEB
For more nancial strategies, be sure to read our Dollars & Sense column at www.advanceweb.com/executiveinsight
54
CAPITAL EQUIPMENT MANAGEMENT
Capital Equipment Management

By Dale Hockel
Selecting a vendor that is aligned with core values, mission and goals of your organization is critical
select a partner that is aligned with your organizations core values, mission and goals. In this article, well share some important considerations when selecting the right partner for your organization, including understanding how best in class healthcare technology management can impact your capital equipment plan, the nancial benets to evaluating vendors with similar goals of your organization, and how to assess your equipments total cost of ownership.
ROLE OF HEALTHCARE TECHNOLOGY MANAGEMENT
Dale Hockel is the senior vice president of Operations at TriMedx.
s hospitals are tasked with doing more with less, every opportunity to save money and increase patient throughput is being sought. In many cases, the quickest way to save money starts with a comprehensive plan for acquisition, usage and disposition of medical equipment. Although its possible for a hospital to achieve best in class practices on its own, the time value of money plays a factor, considering it could take up to five years to reach goals, all while costing the hospital thousands each yearand thats if the initiative isnt abandoned along the way. Selecting the right partner for comprehensive medical equipment management can bring significant and sustainable savings as well as improved healthcare to your facility in a relatively quick and cost-eective manner. Choosing a partnership doesnt require a hefty investment of time and money over several years. In fact, those who partner with an in-sourced resource (healthcare technology management services) receive increased uptime, shared accountability system-wide best in class practices, regulatory compliance, improved sta satisfaction, higher patient throughput, cost savings and even generated revenue and improved healthcare...all within the rst year. But settling on a partner based on cost or convenience is dangerous and can end up costing you more over time. Its important to
The first and most important consideration is understanding the importance healthcare technology plays in capital equipment management and within your facility overall. Long gone are the days when clinical engineering was easily dened as equipment repair and maintenance. To achieve optimal savings and uptime today, the healthcare technology department must be fully integrated into the capital planning and technology assessment of a hospital and be considered a vital asset to a hospitals comprehensive equipment management and purchasing program. A well-functioning healthcare technology management department is more than just the repair and maintenance management of medical equipment. It should be viewed as comprehensive medical equipment management. To be regarded as such, clinical engineers should be data driven and able to provide valuable information regarding inventory, downtime, productivity needs and regulatory issues all which help the management team make informed decisions and accurately forecast equipment needs. Through a computerized maintenance management system (CMMS), clinical engineers are able to help determine the total cost of ownership by eectively monitoring equipment performance and program effectiveness. Such a system can provide detailed device information such as age and value, maintenance service cost histories, preventative maintenance schedules, work order views, device reports and inventories. A best-in-class healthcare technology team provides a holistic approach to medical equipment capital equipment planning, purchasing, implementation, service and repair, and endof-life management. The department knows which service contracts to retain, what to bring in-house, what to x, when to x it and when to replace equipment without relying on out-
TOM WHALEN
55
CAPITAL EQUIPMENT MANAGEMENT
To achieve optimal savings and uptime today, the healthcare technology department must be fully integrated into the capital planning and technology assessment of a hospital and be considered a vital asset to a hospitals comprehensive equipment management and purchasing program.
side service providers, which can drive up costs and delay uptime. One simple way to begin realizing cost savings from your clinical engineering team is to ensure them a seat at the capital equipment planning decision-making table in your organization. The hospital should look to clinical engineering for knowledge and expertise of managing their medical equipment and recommendations based on what will save the hospital the most money in the long run not bells and whistles or extra features. Clinical engineering can help a hospital avoid short-term decisions, or decisions that make sense in the moment, but dont align with the hospitals long-term goals. Short-term decisions can cost a hospital thousands maybe even millions of dollars.
SHOPPING FOR THE RIGHT PARTNER
ON THE WEB
To learn how to achieve best-in-class clinical engineering and navigate the 7 stages of clinical engineering, go to www. advanceweb.com/executiveinsight and enter Clinical Engineering in the keyword search box for articles and an archived webinar.
Now that you have a good understanding of the role clinical engineering can and should play in your organization, its time to shop for a partner that is aligned with your organizations values, goals and mission. To begin shopping, its important to understand the true cost of clinical engineering so that you are comparing apples to apples. If you are shopping on price tag only, remember there is ne print in every transaction; therefore ,you can get yourself into some costly situations very quickly. The true cost of healthcare technology management involves more than just the repair and maintenance of medical equipment. It includes equipment downtime, preventative maintenance and repair costs, training, and much more. An eective department will consistently save money; however, an inecient department can be very costly in both time and money. The best way to unveil the true cost of your clinical engineering department is by conducting a current state of assessment that examines all areas of expenses, including those that are possibly miscoded or not coded as clinical engineering (i.e., handling and vendor fees, inbound freight, and equipment rental/lease, etc.) Once youve determined the true cost for clinical engineering for your facility, here are a few questions you should be asking to ensure the vendor aligns with your organization:
n Will there be added costs later? Make sure
Added costs can come from exclusions, service calls outside of normal business hours, out-ofscope service and much more. For instance, limited coverage for medical equipment can cost the hospital up to 10 percent in additional fees annually. n What is the structure for the vendor to make money? Its important to know if the vendor can help drive continued savings over time and help you progress along the way bringing new ideas to the table. If the vendor is an OEM, for example, this may not be a benet they can offer, as the main goal is to sell more equipment or extended contracts. If the vendor is not an OEM, do they have buying power and ability to negotiate long term savings with a diverse group of OEMs across a variety of modalities? n Can the vendor help you create and stick to a comprehensive medical equipment plan that is aligned with your facilitys overall goals? Every hospital has a long term plan for the entire facility (not just for CE and capital equipment). Therefore, its critical you feel comfortable sharing those with a partner so they can align a comprehensive plan to your long term facility goals. For example, if your goal is to be the top hospital for cancer treatment in the next ve years, be sure your capital equipment plan is in line to help you prepare and achieve it. n And nally, what is your upfront investment to reduce costs and improve the quality of services? By selecting the right partner, you can receive an upfront savings, without making an investment, on your current healthcare technology program that will carry through the entire length of the agreement. One health system with over 1,500 beds was able to save nearly $1 million instantly with a continued savings over time when they aligned with a partner to insource their healthcare technology department.
ALIGNING VALUES, GOALS AND MISSION
everything that is included in the program is listed in the contract with a cost associated.
As healthcare reform legislation pushes the entire system to reduce costs and improve patient outcomes, theres also a new tax on medical equipment and devices for manufacturers that will likely mean an increase in equipment costs for healthcare providers. And lets not forget the predicted $155 billion Medicaid/Medicare reimbursement shortfall for hospitals over the next 10 years. Being able to quickly save significant amounts of money may mean the difference between life and death of a hospital.
56
Special Advertising Section
58
This special section highlights healthcare industry leaders and their strategic directions.
60
62
64
66
68
70
72
57
Optimization, Standardization and Consolidation in the Laboratory
Enhancing Your Performance Through Diagnostic Optimization

Abbott is continuing to make a difference for your lab through its introduction of POInt (Partner. Optimize. Impact.), a proprietary, partnership-driven solution.
s global healthcare continues to evolve, healthcare organizations face increasing nancial, economic and regulatory pressures. While demand for healthcare services is steadily increasing, an organizations ability to invest in new capacity and capabilities is often static or decreasing. Simply put, systems must do more with lessmore services with fewer resources, more volume at lower costswithout sacricing their high standards of patient care. Often, healthcare systems spend large amounts of time, resources and eort looking at the larger budget items to reduce cost or provide an even greater nancial impact. Regularly missed in these eorts are the small budgetary items that make an extremely large impact on both patient health as well as system performance/eciency. As an example, the value of the systems lab impact is exceptional relative to its nancial cost. It is estimated that diagnostics accounts for less than 5% of hospital costs and about 1.6% of Medicare costs but inuences as much as 70% of all healthcare decisions.1 Labs are less than 5% of hospital costs but aect up to 70% of clinical decisions. Labs influence critical outcomes in nearly every department and facility. Evidence-based guidelines designate diagnostics as the standard of care for 12 of the 15 most clinically and economically burdensome disease/condition categories in the United States.2 With the advent of readmission penalties for various disease states, it is critical that the right diagnosis, fueled by the right data, be placed at the right time to ensure patient stability upon release. To help maximize efficiency and value, Abbott introduces POInt (Partner. Optimize. Impact.), a propriety approach that converts your lab into an engine of growth, financial performance, efficiency and clinical quality. The POInt process is unique to Abbott among diagnostic solution providers. It draws
upon our 40-year history of diagnostic innovation, having been developed exclusively through countless customer engagements and has been tested successfully through a wide variety of global, real-world diagnostic environments. Through the POInt approach, Partnership, Optimization and Impact occur via a progression of reinforcing steps, each playing a critical role in producing system-wide performance enhancements. Discover: Our Abbott account team works with your organization to understand not only your lab goals, criteria and gaps, but also the goals and key initiatives of the larger system to ensure a long-term t with organizational vision. Dene: Once objectives have been discovered, the team presents a customized solution approach that denes the objectives, applicability and t within your system. Propose: After collaborating with you on the solution, a formal proposal is given, outlining the approach, where it impacts and the process to reach successful implementation. Implement: As soon as the proposal is accepted, Abbotts proven implementation team works with you to ensure implementation is done on time and within budget to ensure minimal disruption to system service. Measure: After implementation, your Abbott team continues to monitor and measure system performance to ensure we meet the objectives defined throughout the process. Metrics also evolve to ensure the solution meets your current and future goals. Rene: As your system grows, so does the Abbott solution. Rather than wait for the next system purchase cycle, your Abbott team will continue to ensure that your system remains at optimal performance. In the end, POInt is more than a checklist. Its a progressive, on-going process designed to closely collaborate with you and continually enhance results. Visit abbottdiagnostics.com, or contact your local Abbott representative to learn more about the POInt process, and hear how Abbott can partner with you to provide impactful, optimized solutions.
1. Forsman, Rodney W. Why is the laboratory an afterthought for managed care organizations? Clinical Chemistry. 42(5), 1996. 813-816. 2. The Value of Diagnostics: Innovation, Adoption and Diusion into Health Care. The Lewin Group, Inc.: Report prepared for AdvaMed. July 2005.
58 SPONSORED CONTENT BY ABBOTT
58
1,4 4 0 NE W YORK MINUTES:
Establishing a high-volume, 24/7 lab to support a trauma center. And a pediatric ICU.
Abbott Diagnostics worked around the clock to make it happen for one institution. See what, together, we can do for yours.
Trauma centers and pediatric ICUs move fast at all hours. For one New Yorkarea hospital, having a laboratory that can quickly and accurately turn a test around at any time of dayor nightis absolutely vital. Lives depend on it. Thats why it was important to not just install multiple systems, but to have a team of engineers, medical technologists and IT consultants on call to ensure the assays were up, running and responsive to our customers rigorous demands. At Abbott Diagnostics, we go beyond tests and instruments. Well partner with you to develop a solution that ts the needs of your laboratory. VISIT ABBOTTDIAGNOSTICS.COM.
Put science on your side. is a trademark of Abbott Laboratories in various jurisdictions. 2013 Abbott Laboratories ADD-00001707v2.
Put science on your side.
59
Enterprise and Regional Imaging
The New World of Visual Healthcare

Lenny Reznik, director of marketing - Enterprise Imaging, North America, Agfa HealthCare
Agfa HealthCares ICIS imaging platform does not cure disease, repair broken bones or perform surgical procedures. However, what it oers to patient-centric healthcare is a breakthrough that compares with the latest advances in medical information technology. ICIS is an enterprise and regional imaging platform that allows any medical professional within a health system to create, collaborate, exchange and manage a patients visual medical history using the clinical context of the electronic health record (EHR). ICIS integrates with most any image-generating device, providing specialized workows to a wide variety of disciplines to capture, index and store visual health information. As a result, ICIS enables clinicians to have a greater comprehension of the patient condition, supporting fast, condent diagnoses and helps increase operational eciencies. To understand the signicance of ICIS enterprise imaging, one must rst appreciate a key challenge that many clinicians face, in spite of the mandated, growing use of EHRs. The modern hospital enterprise is a dynamic and complex environment where patient care is often managed by an array of healthcare specialists from numerous departments. Observational and diagnostic data, such as blood pressure and medical history, are standard shared information and are the foundation of the traditional EHR. However, in many healthcare settings, medical images, such as funduscopy, X-rays, and digital images taken during wound or dermatology care, and perioperative surgical photographs, are only viewable by the doctor or department that acquired them. Besides the lost opportunity for clinical collaboration, images stored outside the enterprise infrastructure may represent a compliance risk. Digital images taken with an untethered camera may or may not be documented as a billable activity within the EHR, which may cause lost potential revenue for the facility. Siloed images may lead other care providers to order more or redundant studies. The existing imaging environment is inefficient and costly. More importantly, lack of a centralized imaging platform potentially delays the diagnosis and treatment plan by preventing clinicians from having a comprehensive view of the patients medical condition along the entire continuum of care. Without access, a care providers ability to understand a patients full story can be compromised.
60 SPONSORED CONTENT BY AGFA HEALTHCARE
How is ICIS changing the patient care landscape?

The increasing adoption of EHRs and health information exchanges (HIEs) presents hospitals and health systems with the opportunity to adopt an ICIS strategy to oer the same accessibility of images as other patient information, supporting physician-to-physician collaboration and strengthening evidential support for decision making. ICIS was designed to help organizations turn patient imaging into an enterprise-wide strategic asset. ICIS provides a scalable platform for accessing medical images and imaging information throughout the health system with the click of a button. ICIS unifies patient records by integrating and linking multi-facility, multi-departmental and multi-specialty imaging data. The benets are massive. By providing a comprehensive view of a patients medical history, ICIS simultaneously supports the care a medical institution can provide while signicantly advancing the eciency and cost eectiveness of how that care is administered. In doing so, Agfa HealthCare is empowering health systems with the means to re-imagine the value of medical images, both in the near term as a treatment tool and as a long-range opportunity to create eciencies and save expenses.
Visual Healthcare for good

Revenue pressures from reimbursement reform are driving consolidation of images into archives, known as vendor-neutral archives (VNA). Healthcare reform incentives are pushing providers to utilize EHR technology to make patient records accessible to help decrease costs and improve care. Although not yet mandated, the inclusion of imaging as a component of Meaningful Use criteria is making an enterprise imaging strategy increasingly unavoidable. Yet not all imaging strategies deliver the same results. The ICIS platform provides a comprehensive set of services. Whether beginning with ICIS departmental point-of-care image acquisition, VNA or EHR universal viewing services, having the right infrastructure provides present and future operational eciencies to support quality clinical care. Informed care, ecient workows, cross-enterprise cost reduction Agfa HealthCares ICIS opens up a whole new world of visual healthcare. To learn more, contact AgfaHealthCareAmericas@agfa.com.
60
With all of Captain Warrens images in one view, you can see the big picture.
ICIS opens up a whole new world of visual healthcare. When Captain Warren presented with a severely injured hand, his orthopedic surgeon was able to quickly access images within his EHR to visualize the hand, using digital photography taken in the Emergency Department, side-by-side with CT and MRI scans all in one view, at the click of a button. ICIS is an enterprise imaging platform that encompasses all image-generating modalities and departments, giving healthcare providers a comprehensive view of their patients. This makes for fast, condent diagnoses and treatment, and helps increase operational efciencies across the enterprise.
Learn how Agfa HealthCares VNA and Enterprise Imaging solutions can advance your EHR strategy now and for the future. See us at RSNA 2013, South Hall, #4737 agfahealthcare.com
Agfa HealthCare Corporation 2013
61
Clinical Diagnostics
Understanding the Importance of the Laboratory

Diagnostic testing is an integral part of a patients health.
Danaher is helping to improve the world we live in by enabling health systems to push the limits in their filed and address the complex analytical challenges they face. Committed to improving healthcare, Danaher oers a breadth of companies who are leaders in clinical diagnostics. Danahers diagnostics businesses oer a broad range of analytical instruments, reagents, consumables, software and services used to diagnose disease and make treatment decisions in hospital labs and other critical care settings. Among those businesses is Beckman Coulter Diagnostics. Beckman Coulter Diagnostics develops clinical diagnostic products that help advance and optimize the clinical laboratory. The companys instruments, systems and tests help streamline processes to enhance eciency, reduce costs and speed the delivery of results particularly important in todays integrated health delivery system. For more than 75 years, Beckman Coulter has been a global leader devoted to providing scalable solutions to laboratories of all sizes oering a broad portfolio of chemistry, immunoassay, hematology, urinalysis, automation and information systems. As it becomes increasingly more pertinent for laboratories to position its services for inclusion in an accountable care organization (ACO) or coordinated-care model, laboratories are tasked with streamlining every process in their workow to eliminate waste, minimize variation and reduce costs. For years, Beckman Coulter has worked with its customers to simplify very complex laboratory processes standardizing processes and results. Well-executed standardization programs greatly improve the quality of laboratory measurements and also ensure that laboratories across the healthcare network are producing credible and comparable data, thereby reducing ineciencies, errors, duplications and delays that contribute to unnecessary expenditures. Integrated health delivery systems benet from our continuous investment in technologies that automate, consolidate and accelerate the delivery of results, says Lynda Banig, senior vice president of global marketing for Beckman Coulter Diagnostics. Our products and Lean expertise remove unnecessary steps in laboratory processes saving time and helping the integrated delivery systems achieve the lowest total cost of ownership. As a leader in workow innovation, partnership with Beckman Coulter helps laboratories deliver value-based care by enabling the
62 SPONSORED CONTENT BY BECKMAN COULTER DIAGNOSTICS
lab to partner across the entire integrated health delivery system to achieve critical outcomes. Diagnostic testing in the laboratory plays a crucial role in the detection, diagnosis and treatment of disease in patients. Laboratory tests help determine the presence, extent or absence of disease and monitor the eectiveness of treatment. An estimated 60 to 70 percent of all decisions regarding a patients diagnosis and treatment, hospital admission and discharge are based on laboratory test results. However, decision makers sometimes overlook the impact that lab utilization can have on the entire integrated health delivery system. In todays changing landscape, its important to remember that the laboratory doesnt need to be a cost center, in fact, theres a lot that can be done to enhance its protability ultimately, with the right
Our products and lean expertize remove unnecessary steps in laboratory processes saving time and helping the integrated delivery systems achieve the lowest total cost of ownership.
structure and technologies, laboratories can become prot centers. Integrated health delivery systems can benefit from Beckman Coulters legacy of innovation around highly prevalent disease states, such as cardiac, cancer, anemia and reproductive health, says Banig. Focusing on science with a purpose, we monitor the ever-changing guidelines for disease-management and responds with novel, standardized solutions that ensure credible and consistent results are generated across laboratories in the entire healthcare network. With a legacy of innovation stemming from its founders, Arnold O. Beckman and Wallace and Joseph Coulter, who invented the very rst pH meter and the Coulter Principle, respectively, Beckman Coulter Diagnostics makes science and innovation in the laboratory its business. Learn why Beckman Coulter is your best partner at www.beckmancoulter.com/labforward.
62
LAB FORWARD
Your lab is the foundation of patient care and well never stop partnering with you to move it forward.
Beckman Coulter has always been uniquely committed to advancing and optimizing your lab. We share your commitment to providing uncompromising service to physicians and patients. Thats why we remain focused on innovative and reliable solutions to improve your lab performance. Move your lab forward with Beckman Coulter. www.beckmancoulter.com
SPEED FORWARD PERFORMANCE FORWARD
Copyright 2013 Beckman Coulter, Inc. Beckman Coulter and the stylized logo are trademarks of Beckman Coulter, Inc. and are registered with the USPTO.
63
The New Landscape of Healthcare

An Interview with John Bojanowski, president of Honeywell HomMed
Can you discuss Honeywells concept of telehealth, and how Honeywell is approaching telehealth in the future?
Like most of the businesses in our industry, we are seeing the concept of telehealth evolve alJOHN most daily, and the transitions were seeing encompass two main BOJANOWSKI themes. The first is we are seeing a shift in the application of telehealth as healthcare providers begin to utilize it with broader populations of people, particularly from an episodic care standpoint. As patients are being discharged from the hospital after an acute event, theres a 60- or 90-day window during which hospitals are now nancially motivated (through Centers for Medicare & Medicaid Services (CMS) reimbursement penalties) to closely monitor those patients, regardless of whether they are homebound or not, and try to proactively prevent readmissions. In order to cost eectively do that, we think the market needs to be able to improve clinical workows by making it easy for a single care provider to manage large groups of people. In other words, moving the needle from where we are today, with the ratio of care provider to patient at about 1 to 150, to something like 1 to 1,000 or 1 to 2,000. The second shift were seeing is related to time: Our customers are expressing the desire to use remote patient monitoring (RPM) to manage their conditional patient populations (i.e., patients with chronic conditions like heart failure or diabetes) for much longer periods of time. That 60- or 90-day window that was once the industry standard for telehealth utilization is now in the process of being rewritten as we see patients who are being monitored with high degrees of success for years. Taking those two shifts into consideration both the need to manage a broader population of people along with the combined desire to monitor patients for longer periods of time were focused on how to eectively deliver a telehealth solution that addresses those goals.
In todays terms, telehealth or RPM as we dene it enables delivery of patient biometrics back to the hospital or healthcare provider. In the future, our vision is synonymous with most members of the healthcare industry: that empowering individuals to be more involved in their own care is the best way to go. To that end, our industry must move the frontline of healthcare to the individual by giving patients the tools they need to interact with and manage their own health, while giving care providers a unied, easy-to-use platform through which they can deliver a variety of customized care plans back to the patient. And though moving the frontline of healthcare may seem like the far-o future, we have a number of clients who, as healthcare providers, are doing just that already, and have been for quite some time. In fact, we recently created a case study on Physicians Preferred Monitoring (PPM), an individual health and wellness organization that works principally with the Medicaid population of South Carolina. They have a number of patients who have been using our RPM devices for more than ve years, primarily because PPM recognized that when patients have chronic illnesses, its much more cost-eective to continuously monitor them on a daily basis than to treat their disease-related episodes in the hospital. Mark Fuleihan, vice president of PPM told us that, when people are dealing with chronic diseases such as diabetes or congestive heart failure (CHF), we nd that long-term monitoring is the key to steady improvement in overall health. The consistent communication provides regular access to healthcare that so many people in lower socio-economic brackets lack, which in turn empowers them to be proactive in the management of their health. And as healthcare providers, it gives us the ability to help achieve collective goals, such as the reduction of healthcare costs in our state. The case study Redefining the Patient Care Model: Using Telehealth to Address Chronic Disease Care in Medicaid Populations demonstrates that patients can be cost-effectively managed from home with a well-designed RPM program, and will likely also demonstrate improved levels of self-management, reduced length of stay when hospitalized, and reduced ER and medication costs.
What role does telehealth play in an integrated health delivery system?

We see that role as changing. Up to this point, telehealth has been widely viewed as a cost to the system. But as the market continues to shift from fee-for-service to fee-for-value (where integrated health delivery systems (or IDNs) and Accountable Care Organizations (ACOs) are receiving a single payment for a patient based on their diagnosis), it is incumbent on them to manage care within the boundaries of a single payment per patient across the spectrum of care they receive.
How is telehealth changing the industry landscape?

There has been a recent explosion of new technologies in the marketplace that are referred to as telehealth, a phenomenon that has created what we often refer to as teleconfusion.
64 SPONSORED CONTENT BY HONEYWELL HomMed
64
Telehealth
In the future, our vision is synonymous with most members of the healthcare industry: that empowering individuals to be more involved in their own care is the best way to go.
To that end, telehealth is being tapped more and more by providers as the solution to maximize reimbursement funds by providing a unifying tool for care transitions and a more streamlined approach to the continuum of care. In a whitepaper we recently presented at the Healthcare Unbound conference in Denver, Colo., we looked at how the utilization of an extensive telehealth program has impacted the reduction of readmission rates of a major IDN the Lee Memorial Health System in Florida. Recognizing the ability of their telehealth program to positively impact the system-wide goal of reducing hospital readmissions to avoid CMS penalties, the Lee Memorial Home Health team obtained system-wide support for RPM following patient hospital discharge thus facilitating the collabora tion between the hospitals, physicians and other care practitioners. Reducing readmissions at Lee Memorial Health System centered on improving patient care transitions with telehealth because patient biometrics could be regularly monitored with a remote device after hospital discharge. With that infrastructure in place, any changes in the patients condition could be detected early on and medical interventions could be initiated to prevent potential complications and a hospital readmission. In addition, Lee Memorial Health System care providers could use telehealth to provide patients and their families with education related to discharge instructions or their diagnosis. For patients, this experience provided them with a basis for owner ship in the management of their diagnosis, the result of which was increased compliance and patient engagement. This impacted the quality of care, resulting in improved clinical outcomes. And in the more than 32 months since its inception, the Lee Memorial Health System telehealth program has allowed the system to avoid more than 950 readmissions to the hospital, resulting in an estimated savings of more than $5.3 million, based on average Lee Memorial Health System hospital costs of $5,600 per hospital admission or readmission (a gure much lower than the national average of $9,600, according to CMS). The whitepaper, The Role of Telehealth in an Integrated Health Delivery System, articulates the idea of leveraging telehealth to achieve a more connected approach to the continuum of care
with signicant positive nancial results.
And what are the implications for the healthcare provider and patient care?
As weve discussed, if healthcare providers continue to embrace the use of technology, they will be able to address some of the biggest challenges facing the healthcare industry today. RPM provides the opportunity to better manage patients who are coming out of the hospital after an acute event, while also providing the ability to cost-eectively manage patients with chronic conditions long-term. From a patient-care standpoint, the same technology will allow telehealth to go from being the solution for fragile, homebound patients to a healthcare management tool for not only patients but also their families. We believe the implications of creating a platform that enables and encourages patient interaction are: better, more consistent long-term care; fewer visits to the hospital; and patients who are happier, healthier and more engaged in their own health.
How are Honeywell and the division, HomMed, positioning itself as a leader in the eld?
We are focused on addressing the pain points of both patient and care providers. That is, providing a solution that empowers patients to take a more significant role in managing their own health, while simultaneously expanding our existing technologies to allow care providers to better manage larger populations of patients for longer periods of time, at a lower cost. Our overarching vision is simple: telehealth will become a seamless part of patients lives, a solution thats integral to the maintenance of their health while also improving the way healthcare providers can manage myriad patient conditions and populations. Ultimately, we are building on our foundation of clinical expertise and the ability to impact ROI that weve built over the last two decades with our current telehealth solution.
Honeywell HomMed
3400 Intertech Drive, Suite 200 Brookeld, WI 53045 888-353-5440 www.hommed.com
SPONSORED CONTENT BY HONEYWELL HomMed 65
65
Enterprise Imaging
iConnect Enterprise Clinical Platform: Making an Image Management Strategy Easy

By Steven Tolle, chief product ofcer of Merge Healthcare
For many C-level healthcare leaders, image management is synonymous with picture archiving and communications systems (PACS). As essential as PACS are, however, its important to understand that they are only one component of a robust image management strategy. In order to STEVEN TOLLE thrive in todays value-based healthcare environment, organizations must develop an enterprise-wide imaging strategy. Medical imaging is one of healthcares most vital tools, especially with Meaningful Use, patient-centered care models and other factors fueling demand for technologies that promote comprehensive patient records across the continuum of care. Fortunately, emerging technologies can help healthcare organizations quickly and easily implement imaging strategies that make image storage, accessibility and sharing more readily available to clinicians and sta. Successful development and implementation of an enterprise-wide image management strategy requires successful execution of these ve phases:
Phase 3: Implement universal viewing access

Combining a VNA with a universal, zero-download image viewer like the one thats included in Merges iConnect platform enables clinicians to have access to images for every patient within the facility. A universal viewer is a crucial component of an enterprise-wide image management strategy; it has immediate impact on patient care and the bottom line by helping reduce redundant images. In fact, statistics show that a third of all medical image scans are unnecessary.
Phase 4: Take advantage of the cloud

Storing images in the cloud and instituting an image-sharing gateway prevents the need to provide patients with image CDs. This will eliminate all of the risks associated with lost or incompatible CDs and will ultimately save costs. Furthermore, clinicians dont have to disrupt normal workows. Sharing images is simply a matter of securely dragging and dropping image files onto the gateways web address.
Medical imaging is one of healthcares most vital tools.

Phase 5: Link care delivery networks together
Finally, an enterprise imaging strategy must efficiently connect patient data across care delivery networks. As reimbursement and care delivery models shift, all providers must look beyond a singular patient record to provide an improved overall patient experience. For example, leveraging technology like Merges new iConnect Network to aggregate and link vital medical images to a variety of referral networks can assist with more global, population-based healthcare management. Medical images are an essential part of todays collaborative healthcare delivery models. Merge is helping keep organizations at the forefront of the evolving healthcare landscape by making enterprise-wide image management easy. A comprehensive strategy contributes to improved patient care, as well as the protability of the organization as a whole. Visit www.merge.com/Solutions/Interoperability.
Phase 1: Assess current imaging workows

You must understand the current operational workflow within imaging before you can implement a strategy that gives clinicians access to any image, anywhere, anytime, across your enterprise. Start by looking carefully at the existing data sharing environment within the organization.
Phase 2: Shut down storage silos

The concept of care collaboration should include developing a centralized image storage bin. A vendor-neutral archive (VNA) allows organizations to save and manage images across multiple specialties. By placing all images in one location, providers gain faster access to the images they need to enhance patient care.
66 SPONSORED CONTENT BY MERGE HEALTHCARE
66
Image-enable your EHR for MU2
Improve operational efficiencies
Increase revenue potential
67
Healthcare Analytics
The Next Generation

An interview with AG Breitenstein, chief product ofcer of Humedica, an Optum company
Can you discuss your companys product/solution?
Our product is the next generation intelligent health management platform that powers providers beyond the electronic medical record (EMR) to leverage health insights and then pivot this knowledge into targeted action at the point of care. Healthcare is changing rapidly. The fee-for-service model is dying. Healthcare providers need a system they can use to manage risk in the new fee-for-value world. EMRs were built to bill for services rendered, not manage longitudinal population health or an organizations risk-based nancial health. Healthcare organizations need a system that augments their EMR. The Optum platform is powered by the most established longitudinal and largest integrated data set an unmatched 30 million longitudinal patient lives from clinical data and more than 109 million lives of claims data. But its not just big data, its good data. Both clinical and claims data have huge error rates. Big data means nothing if it hasnt been cleaned, normalized and validated. Additionally, our data is fortied by decades of experience - working with data, identifying patterns, predicting and managing risk - the type of acumen that takes years to aggregate and inform.
playbook is not fully written. However, it is clear if healthcare organizations cant identify their most costly patients and intervene early in their health, they wont succeed in a fee-for-value world.
How is your company positioning itself as a leader in the eld?

No one else is doing what we do with data. The information found in EMRs is awed; information in the billing and claims systems is awed. By starting with a complete, longitudinal and normalized analytics repository, you can have reliable and accurate data. We also are the leader in risk prediction the only company that has brought nancial and clinical risk modeling together to drive focused and high-value population management. With limited resources, you have to identify the following: high-value conditions; opportunities to intervene; and effective clinical pathways. This requires a conuence of clinical and claims-based risk prediction, and the combination of Optum and Humedica is the first time these analytics are coming together in a single platform.
Can you discuss the future of healthcare analytics?

The power of good data is that it provides the tools to manage risk and patient populations, and it creates a transparency between providers, payers and patients and cures the misalignment with how organizations function.
What role does healthcare analytics play in an integrated health delivery system?
The Optum integrated platform was designed with the integrated health delivery system in mind. Our platform is EMR agnostic meaning no matter how many EMRs are being used by one system, we can aggregate and clean the data in our platform. There are few large integrated delivery systems that use just one EMR, so the ability to share data and collaborate is crucial. Population and risk analytics and care coordination are tied to reporting so that organizations can reduce costs and improve health and patient satisfaction.
And what are its implications for healthcare providers as well as for overall patient care?
Being able to drive intelligent, predictive and data driven activities (i.e., care plans) around data and insights rather than mechanistic response is transformative. By identifying patients earlier and keeping an organization focused on those opportunities, we can improve healthcare delivered by providers and the overall health of their patients. As we improve upon this, we will be able to leverage evidence-based medicine earlier, so we can further reduce costs, preserve health sooner and prevent complications. Visit www.optum.com/journey or call 800-765-6619.
How are your products/solutions changing the industry landscape?

We understand our solution is disruptive. It is disrupting the siloed paradigm and unburdening healthcare organizations so they can effectively understand and manage their patients and avoid unnecessary costs. By using intelligent analytics, organizations will change their current workow. While fee-for-service is a thing of the past, the fee-for-value
68 SPONSORED CONTENT BY OPTUM
68
When moving toward a value-based care model, youre sure to encounter a few sharp turns and forks in the road.
Plan your path forward with Optum, one step at a time.

The choices you make in response to such challenges can affect your systems short-term functionality and long-term success. Optum stands ready to help you methodically plan your shift to a new business model by helping identify opportunities for enhancement and growth across your care continuum. Starting with a comprehensive opportunity assessment, well help you create a road map and provide technology solutions and services to enable organization-wide alignment so that you can achieve better health outcomes and financial stability. To get your free value-based care map and access additional information to help guide your journey, visit optum.com/journey.
Helping 14 million people use information to save lives, improve care and transform health care systems
4 out of 5 Hospitals 149 million + Covered lives 300 Health plans More than 50% Fortune 500 employers
2013 Optum, Inc. All rights reserved.
69
Modern Communication
Learn more about this pioneering company that is providing healthcare organizations with cost-effective phone messaging software and services.
PhoneTree provides custom patient communication for physicians using the HealthWave product line. PhoneTree oers its customers various ways to customize their solution, including the ability to congure based on an individual practice, location or provider and market-leading custom message scripting. HealthWave Connect also offers two-way communication, which means all the patients can respond back to the practice. For instance, a patient can conrm an appointment or call back to the physicians oce to reschedule. Our customization is not limited; we oer clients the ability to seamlessly integrate our solution into their infrastructure and personalize messaging specic for each patient. Plus we support our clients with in-house technicians to further meet their specic requirements. All our technicians are located at our headquarters in Winston-Salem, N.C. This gives an added value to our clients since our in-house technicians work one-on-one with clients, so there is a personal connection.
With national healthcare focused on proactively affecting patient outcomes and managing patient populations, there are more reasons than ever to make PhoneTree an integral part of your practice.
What role does patient engagement play in an integrated health delivery system?
We pride ourselves on helping practices engage with their patients so they not only meet certain Aordable Care Act (ACA) obligations, but they also improve patient outcomes by reaching out to the patients with relevant medical information. HealthWave can integrate with certied electronic health record (EHR) technologies to improve practice eciency in communicating eectively with patients. With national healthcare focused on proactively aecting patient outcomes and managing patient populations, there are more reasons than ever to make PhoneTree an integral part of your practice, says A.J. DiBianca, president and CEO of PhoneTree. DiBianca, along with his partners, founded the company in 1989. Their expertise in automated messaging technologies created a strong following among faith-based organizations as well as with the healthcare and general business sector. PhoneTree specializes in the development and manufacturing of automated telecommu70 SPONSORED CONTENT BY PhoneTree
70
MOODBOARD PHOTOGRAPHY
ISTOCKPHOTO/VETTA COLLECTION
Patient Management
nication tools, and the company designs, assembles and markets its own proprietary telecommunication hardware and software.
How are your products/solutions changing the industry landscape?

PhoneTree launched HealthWave Connect in 2013. The cloudbased communication system is a solution for practices that want an online service with a low initial investment and can be customized to t the needs of the individual practice. As a HIPAA certied and secured system, HealthWave Connect has a positive overall impact on the practice. It frees staff time, reduces no-shows, and improves patient outcomes. HealthWave Connect provides two-way patient communication; patients can respond to physician messages or confirm appointment times. Among other features, HealthWave Connect integrates into EHRs and can assist with Stage 2 Meaningful Use requirements. Ultimately, it allows physicians and practices the freedom to work in the cloud while increasing the level of exibility and customization with communicating and engaging patients.
The future of patient engagement is strong. New legislation encourages patients and their families to be engaged and actively participate in healthcare decisions.
tient wellness. HealthWave Connect provides healthcare organizations of all sizes, from a one-doctor practice to large enterprise healthcare systems, the tools necessary to meet some requirements but to also involve more patients with their individual wellness plans. Whether it is reporting recent health changes or adding and conrming appointments, this solution helps to build a more engaged patient base to help build a healthier population.
And what are its implications for healthcare providers as well as for overall patient care?
Traditionally, a practices sta makes reminder calls or mails annual postcards. However, these options are outdated, expensive and time consuming. Most importantly, these methods dont provide the comprehensive reporting and audit trail that HealthWaves automated solution has to oer. A practice can view their customizable reports based on provider, location, or specialty. HealthWave empowers patients to actively participate in their health. With more information available to the patient and an open dialog with their doctor, preventative actions can occur earlier with more positive patient outcomes.

PhoneTree oers a robust two-way patient communication solution which allows a practice to share information with patients in a timely manner. The benet of this shared information is that physicians can better manage a patients wellness plan, including everything from follow-up visits to a medication plan. A more informed patient can make better decisions with their doctor on their individual care needs. This includes taking preventative measures and being proactive with their healthcare decisions. The PhoneTree communication solution also serves the chronic patient, who is managing an existing illness like diabetes or heart disease where physicians can use customized communication to encourage patients to adhere to the established wellness plan. Fundamentally, the solution also supports the physician by making it is easier to meet Meaningful Use Stage 2 requirements and ensuring an interactive way for patients to respond while giving the practice robust reporting and an audit trail.
For more information on PhoneTrees solutions, visit www.phonetree.com.
Can you discuss the future of patient engagement?

The future of patient engagement is strong. New legislation encourages patients and their families to be engaged and actively participate in healthcare decisions. Specically, Meaningful Use requires institutions to utilize secure electronic messaging to communicate with patients on relevant healthcare information. And with the ACA physicians are required to use technology to gather information and process it to improve population health and pa-
PhoneTree
301 N. Main Street, Suite 1800 Winston-Salem, NC 27101 800-951-8733
SPONSORED CONTENT BY PhoneTree 71
71
Excellence in Clinical Engineering Services

An interview with Dale Hockel, senior vice president of operations at TriMedx
Created by and for healthcare in 1998, TriMedx started as a small clinical engineering department at St. Vincent Hospital in Indianapolis, Ind. ToDALE HOCKEL manages more than 600 skilled biomedical, laboraday, TriMedx tory and imaging technicians and serves more than 1,100 facilities nationwide, from large health systems to small clinics, surgery centers and labs. TriMedx Clinical Engineering Services offering provides a cost-eective, low-risk model that allows hospitals to move toward clinical engineering excellence. The TriMedx program is designed to simplify and streamline clinical engineering processes while tracking, documenting and measuring service performance all in an eort to provide an enhanced level of accountability and focus while helping hospitals realize a signicant cost savings.
boost your bottom line by planning for all lifecycle costs and options related to capital equipment such as selection and procurement, implementation, management and monitoring, and end of life management.
What role does your service play in an integrated health delivery system?
Over the years, weve worked with a growing cadre of healthcare providers who are hard pressed to serve more patients (and comply with more federal mandates) with fewer resources. And, despite those challenges, weve led them to considerable savings and newfound eciencies, without compromising care through our unique service delivery strategy. The TriMedx philosophy for
TriMedx utilizes the best technology available in the Clinical Engineering service industry. Our state-of-theart, web-based capital asset management system, is the most innovative, comprehensive and reliable platform in the industry.
superior service is decreasing medical equipment costs while increasing equipment uptime and response time without compromising care. We do so by increasing the availability and expertise of in-house sta, closely monitoring equipment preventive maintenance schedules and reducing reliance on OEM and vendor service contracts. This process begins with developing a capital equipment plan using historical data, matching every device located in the hospitals inventory individually to a service strategy to support clinical requirements. In addition, TriMedx collaborates with key stakeholders within the system to choose the best combination of services and resources. The plan will provide a detailed roadmap of service for each piece of equipment based upon clinical need. We believe the most responsive, sustainable and cost-eective clinical engineering model is a well-trained in-house team, continually building on their own capabilities and self-suciency. We have refined the tools and methods that have built high-performance clinical engineering teams at hundreds of healthcare facilities. Because well build on the team already in place, the transition to a fully in-house program is seamless and low risk and allows for improved quality of service and patient safety. TriMedx also invests heavily in the professional growth, engage-
How is your solution unique in the industry?

Unlike many service providers in this area, TriMedx collaborates with the hospitals existing sta to identify service solutions to eliminate disparate processes and ineciencies. With this type of solution, the hospitals clinical engineering employees remain their employees while TriMedx works to enhance and maximize their skill sets through ongoing career training. Hospitals gain evidenced-based data to assist with capital acquisition processes, training, regulatory support and relevant Industry Best Practices to achieve performance excellence, all with their existing sta. In this environment, we work together to centralize all clinical engineering components, including equipment performance data, vendor service contract management, automated parts procurement, alerts and recall management as well as trouble call reporting through our call center. Ourcall center allows hospital sta to speak with a live person, who answers the phone quickly with the data to triage their issue immediately helping to improve uptime. We refer to this method as an in-sourced solution one which uses your staff in a total cost of ownership approach to capital equipment planning. This approach enables you to effectively
72 SPONSORED CONTENT BY TriMedx
72
Lifecycle Management
ment and satisfaction of the in-house clinical engineering team to move them to biomedical independence.

TriMedx utilizes the best technology available in the Clinical Engineering service industry. Our state-of-the-art, web-based capital asset management system, is the most innovative, comprehensive and reliable platform in the industry. This system provides real-time data to our initial responders to healthcare equipment maintenance and repair requests. Because they have all of the inventory information available to them at the touch of their ngertips, our call-response times are some of the fastest in the industry. Our proprietary computerized maintenance management system (CMMS) oers various service and nancial reporting tools which will allow hospitals to monitor equipment performance, program eectiveness, and meet regulatory standards. These reports include device information such as age and value, maintenance service cost histories, preventative maintenance schedules, work order views, device reports and inventories. When it comes to parts procurement, TriMedx is a leader. Our seasoned sourcing specialists manage the parts purchases and invoices for more than 8,000 purchase orders on a monthly basis giving us bulk purchasing power to obtain the best part for each repair based on quality, service cost and uptime requirements. Through TriMedxs dedicated Regulatory Compliance team, customers receive expert regulatory guidance for all devices in the hospital inventory. Our regulatory expertise equips TriMedx customers with information necessary to adhere to ever-changing regulatory environment. This dedicated team also facilitates the instant communication of all electronic, safety recalls and alert notices that impact the hospitals equipment.
Can you discuss the future of Clinical Engineering Excellence?

Comprehensive lifecycle management is critical to the clinical engineering success of hospitals in the future. TriMedx has developed a comprehensive Medical Equipment Lifecycle program that leverages our rich medical equipment data, expertise and resources in a way that supports and empowers clinical delivery strategies. By fully utilizing these resources, we bring maximum value to the planning, acquisition, usage and disposition of medical equipment assets. In doing so, we ensure hospitals have the right technology at the right time at the right cost in the right place with the right relationship to deliver superior care to patients. TriMedx customers benet from in-depth, evidence-based and vendor-neutral equipment lifecycle data collected from healthcare providers for more than 12 years including: lifetime service cost,
uptime statistics, utilization, failure history and equipment life expectancy. This data provides total cost of ownership and helps to evaluate whether a technology will improve patient safety, clinical outcomes and operational eciencies.Through this analysis, TriMedx actively assists in the management of aggregated capital planning and provides real-time commitment and spending monitoring to keep costs low. Once capital equipment is selected and purchased, it is important to successfully integrate that equipment into the system. As part of the TriMedx Capital Asset Management Process, we ensure that the facility site has been appropriately prepared and that installation has minimal impact on day-to-day workow, patient care and operations. We then assist with both clinical and technical training, and ensure equipment service capabilities are available. Accurate equipment inventories, access to total cost of ownership data and strong clinical engineering involvement in the capital acquisition process are all requirements on the road to better asset utilization. These are the hallmarks and differentiators of the TriMedx program. Whether a hospital is looking to redeploy assets or more eectively triage the capital acquisition planning process and the rigor to that process, it cannot be replaced by the latest wave of asset management software. Nor does one solution t all. TriMedx works to understand the specic objectives around asset utilization and design a process with the appropriate technology to reach those goals. One of the valuable outcomes of Comprehensive Lifecycle Management is the extension of the capital equipment lifecycle by redeploying equipment within the system. By incorporating a technology replacement plan for each facility, purchases can be planned and implemented to maximize equipment usefulness. However, at the end of the lifecycle, a determination must be made as to the best method of liquidation. TriMedx utilizes our established, retired medical equipment management program, which assists in the sale of retired equipment separate from the purchase of a new item, maximizing prot. On average, this program oers more than 20% premium over existing hospital-managed solutions.
TriMedx
5451 Lakeview Parkway S Drive Indianapolis, IN 46268 Toll-free: 877-TriMedx/ 877-874-6339 www.trimedx.com
SPONSORED CONTENT BY TriMedx 73
73
5
Things Learned From This Issue Mobile App Security
If you allow mobile devices on your organizations network and perhaps have a BYOD policy, there are some basic tips for securing mobile devices that help meet HIPAA compliance. Use of le sharing in software should be carefully examined. These types of software often allow you to copy information from applications like email directly to the software cloud provider. This could mean that ePHI is moved off the mobile device and out of the control of your organization. To prevent these data leaks, disable this type of software or utilize MDM software that can containerize the ePHI and prevent data copy.
CLOSING COMMENTS
Competence in m-Health
The early recommendations for stage 3 MU focus on accommodating patient-generated data. The idea is for healthcare providers to support patients between encounters. Accepting patient-generated data validates the patients role in their health. Much of health reform is meant to reorient the industry around this patient-centric perspective. This may not be a challenge for some EHR vendors that have supported mobile for years. Some vendors, however, may be behind the curve and will struggle to catch up. A mobile version of the patient portal may be on the way, but patient-centric healthcare changes the game.
PAGE 18
5 Strategies for Reshaping the Revenue Cycle
Enterprise Informatics
When it comes to managing big data, getting it right from the beginning is critical. According to research from Oracle, 43 percent of healthcare decision makers are concerned they are not capturing enough data or the right data. Data is inherently valuable, and when its capture, storage, and overall management are strategically thought out, its worth both inside and outside your organization will increase exponentially. What you collect and how you manage and share it should demand as much attention as the development of new treatments.
RAC Data Analysis

Recovery Audit Contractors escort revenue dollars out your hospital doors every day. Auditors use complex data mining tools to identify hospital vulnerabilities and improper payments. Hospitals should do the same. Historical RAC data in combination with AHAs RACTrac reports offer important insights into new revenue retention tactics and strategies. The goal of RAC data analytics is to answer the following questions: How much money is at risk? What are your reasons for denial? How many audits are held in appeals? How are audits impacting cash ow? How much is the program costing us?
Patient outcomes, effective population health management and renement of revenue cycle functions will change in profound ways as reimbursements decline and there is a corresponding shift to value based care. In light of the Affordable Care Act, providers will need to have aggressive programs that pursue the patients eligibility for a funding source and determine categories of patients who may qualify for the providers economic programs. These programs will offer potential increased sustainability for the provider. Fast growing patient segments include Dual Eligibles and Hierarchical Condition Categories.
PAGE 21
PAGE 30
PAGE 49
PAGE 51
74
Nuance.com/chain
Reinventing Clinical Documentation
For successful EHR adoption, start with a stronger clinical documentation chain.
From capturing the complete patient story to optimizing physician productivity and financial integrity, Nuance is redefining the clinical documentation process.
A clinical documentation chain embraced by everyone is critical for healthcare organizations facing monumental challenges such as ICD-10 compliance, EHR mandates and entirely new payment models. Nuances intelligent systems revolutionize the entire clinical documentation process with a more efficient end-to-end solution. It allows clinicians to rapidly create more complete and compliant clinical documentation within their EHR while simultaneously providing computer-assisted solutions that improve downstream coding, CDI and quality reporting processes. See how a stronger clinical documentation chain can increase EHR adoption, reduce cost and optimize reimbursement. For a no cost, no obligation clinical documentation assessment, visit Nuance.com/chain or call 877-805-5902.
75
PROVIDING OVER 5,000 HOSPITALS WITH GREATER SAFETY, SECURITY AND EFFICIENCY
From infant protection to fall management and asset management, STANLEY Healthcare is proud to provide an extensive portfolio of safety, security and operational efciency solutions to hospitals worldwide:
Leader in RTLS for healthcare, with solutions for asset management, temperature monitoring, clinical workow and more Leader in patient security, protecting over 1.5 million infants annually, along with at-risk patients across the hospital Pioneer in patient safety solutions for fall management, now joined by innovative new solutions such as hand hygiene compliance monitoring Space and process efciency experts, helping hundreds of hospitals re-engineer their physical space and workows
For more information visit stanleyhealthcare.com
2013 STANLEY Healthcare
76
IS
YOUR SUCCESS begins with our dedication. Its a bold statement, but its born from decades of doing whats
right for our clientsno matter how challengingto ensure that they receive the knowledge, guidance, insights, and alignment they cant nd anywhere else. And whether its late nights, early mornings or simply the extra effort to deliver unique combinations of services that boost performance, were passionate about what we do every day.
FIND GREATER SOLUTIONS. GET MORE INTEGRATED.

PHYSICIAN SERVICES + TOTAL COMPENSATION AND REWARDS + HUMAN RESOURCE CONSULTING GOVERNANCE & LEADERSHIP + ENGAGEMENT SURVEYS + COMPENSATION SURVEYS + MSA EXECUTIVE SEARCH
866.569.1251
A
www.INTEGRATEDHealthcareStrategies.com

Executive Insight

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Executive Insight

Încărcat de

Drepturi de autor:

Formate disponibile

ADVANCE for Executive Insight

ADVANCE for Executive Insight

The interoperability to succeed with accountable care

ADVANCE for Executive Insight

30 5 Strategies for Reshaping the Revenue Cycle

33 Tools, Technology Improvements for Your Radiology Department

40 The Business Case for Improved Sepsis Diagnosis

46 Use Your Pharmacy to Grow Revenue

Clinical, Peer-reviewed Article

44 Role of Mobile Health in ACOs

Are you leveraging technologically smart strategies to maximize benets?

18 CEO: Competence in m-Health

21 COO: Mobile App Security

24 CFO: A Patient-Centered Strategy for Bottom-Line Payoff

28 CIO: Movement on Imaging Mobility

ADVANCE for Executive Insight

ADVANCE for Executive Insight

53 Enhanced ED Operations To Boost Bottom Line

55 Capital Equipment Management

Stuck in the Stone Ages

Meeting Patient Needs in the Affordable Care Act Era

57 Executive Insight Presents Whos Who in

Managing Escalating Employee Benets Costs

ADVANCE for Executive Insight

ADVANCE for Executive Insight

is published by Merion Matters Publishers of leading healthcare magazines since 1985

Are Paper-Based Strategies Still Critical to Successful HIE?

Lynn Nace Kerri Hatt Jennifer Montone

Susan Basile Walt Saylor Scott Frymoyer Todd Gerber

Maria Senior Laura Smith Mike Connor

Christine Hudak Brock Bamber

Lynn Nace Publisher lnace@advanceweb.com

EDITORS E-MAIL TO ORDER REPRINTS

Visit our ACO Resource Center at www.advanceweb.com/executiveinsightaco

FOR PRODUCT INFORMATION TO PLACE AN AD, OR TO CONTACT THE E DITORIAL DEPARTMENT

ADVANCE for Executive Insight

EDITORIAL ADVISORY BOARD

WHOS WHO INDEX - Executive Insight Presents Whos Who in

INDUSTRY ADVISORY BOARD MEMBERS

ADVANCE for Executive Insight

Move Over, BYOD; BYOA on its Way

Steve Huffman is vice president and CIO, Memorial Health System.

ADVANCE for Executive Insight

ADVANCE for Executive Insight

talk about it with your team and your executives is important.

Hospitals spend billions annually purchasing single-use medical devices.

To reclaim your loss visit sustainability.stryker.com/hpn or call 888.888.3433

ADVANCE for Executive Insight

Enabling better care in hospitals across the US The Paragon HIS

ADVANCE for Executive Insight

ADVANCE for Executive Insight

and maximize the benets.

and more time with the patient

remote monitoring /email communication

fective and timely care

ADVANCE for Executive Insight

from member portal/social media platforms

KEY CONSIDERATIONS FOR DEVELOPING MOBILE STRATEGY

appointments, re-lls, accessing lab results, etc.

ADVANCE for Executive Insight

ADVANCE for Executive Insight

onsider the following:

Matt Mattox is vice president of products at Axial Exchange.

Dr. Ben Alexander is CMIO, WakeMed.