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CONTENTS Featured Article 6

Amoolya Moses

Health IT NEWS.Direct! is a global Healthcare Information Technology (Health IT) portal providing research, news, and business intelligence services. We publish several market research and strategic industry reports with key information for top management and decision makers in the healthcare technology industry.

Preventing Medication Errors Using Information Technology

An insight into common medication errors, and how information technology solutions are being used across the world to help healthcare providers reduce the burden

Interview 15 Asian Healthcare Information Technology Industry Mr Sandeep Sinha

Health IT NEWS.Direct! is used by leading healthcare technology companies, hospitals, insurance companies, and media houses from around the globe.

The director of Frost & Sullivan speaks on Asiaâ&#x20AC;&#x2122;s HIT market

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Cerner to Enhance SurgiNet Solution with Standardized Documentation Framework

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FEATURED ARTICLE Preventing Medication Errors Using Information Technology The commonly used phrase “To err is human” has long been used to explain the mistakes committed by people in various walks of life. However, human slip-ups in the healthcare milieu pose a very serious implication when the safety of human lives is at hand. Medical errors, as per the Institute of Medicine (IOM), is defined as ‘the failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning)’.1 Medical discrepancies, resulting from factors or incidences like wrong medication, medical or administrative procedures, diagnosis, laboratory results, miscommunication, faulty equipment, etc., can occur at any phase of the treatment process, and may result in adverse drug events (ADE) or fatal consequences. According to IOM, an adverse event is ‘an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a preventable adverse event’.1

Amoolya Moses Assistant Editor Health IT NEWS.Direct!

Among the various types of medical errors, slips during the drug delivery process, i.e., medication prescription, dosage and mode of administration, are the most common.3

Medication Errors The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines medication errors as ‘any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.’4 The most prevalent among medication errors, as indicated through a five-year study, include wrong drug, inappropriate dose, and incorrect administration route.5 According to the U.S. Food and Drug Administration (FDA), medication errors in the United States take away at least one life per day and injure about 1.3 million patients every year.6 Australian statistics (2-part literature review across 2002 to 2008) on the degree and basis for ADEs and medication incidents in acute care were an estimated 190,000 annual medication-related hospitalizations.7 The 98,000 deaths due to medical errors in the US, indicated by the landmark IOM report in 1998,1 acted as a wakeup call that jolted policymakers, such as the Department of Defense (DoD) Military Health System (MHS), providers, and

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consumers in their efforts towards reducing or eliminating them for ensuring better patient safety.8 This need has infiltrated into the many operations of the caregivers, as well as technology solutions offered by various healthcare vendors. The intervention of information technology into the healthcare industry has been considered by many as the answer to the medical error crisis.

could also help in achieving improved workflow and safe prescribing practices. Integrating the system with decision support tools provides an added advantage of empowering physicians with the right information on drug dosage and generating alerts on probable drug interactions. Apart from benefiting physicians and patients, the deployment of ePrescribing solutions at public health can lower medical errors and related expenditures to the society, drug diversion (forgeries), and prescribing costs; and enhance prescribing efficiency, along with better patient care and outcomes. Pharmacists, payors and pharmacy benefit managers can avail formulary prescribing conformities, improved workflow efficiencies, and reduced drug costs and financial loss caused by preventable ADEs.

In the United States, ADEs annually affect 1.5 million people, at monetary effects of $3.5 billion.2

Preventing Medication Errors through Technology Patient safety, through the reduction of medication errors, are being addressed at many hospitals by automating the entire drug delivery system - right from prescribing through dispensing, until the administration of the medication to the patient - using solutions based on health IT. These preventive measures could be directed towards errors related to dosing and wrong prescribing stages, and dispensing.

The significance of employing an ePrescribing system has been recognized globally, and has been included into the strategies of many countries for encouraging its nationwide adoption.

Automating Prescription and Order Writing

• US: Electronic prescribing, which has been included in the Medicare Modernization Act (MMA) of 2003, forms a major element in the establishment of the country’s national electronic health information infrastructure. Under the Medicare Part D, a prescription drug benefit, drug plans are required to adopt electronic prescribing, while the same is optional for participating pharmacies and physicians.11 Apart from CMS, the technology has been endorsed by the Institute of Medicine (IOM), the Leapfrog Group, and the Institute for Safe Medical Practices (ISMP) as a key tool for averting errors.9

Prescribing errors constitute the most important source of medication errors,3 and occur primarily due to the misinterpretation of physicians’ illegible handwritten prescriptions by the pharmacist.9 Another form of this error occurs when medication is communicated by physicians verbally or over the telephone. Either the physician or the pharmacist confuses similar sounding drug names, and the corresponding parties prescribe and dispense the wrong drug. A 2002 study reported that 30% of nurses attributed the primary cause of medication errors to illegibility or poor legibility of the physicians’ order form.10 Illegibility of prescriptions accounts for 1-2% of medication errors. - National Hospital Ambulatory Medical Care Survey9

Driven by the American Recovery and Reinvestment Act (ARRA), the number of ePrescribers in the US will grow to more than 75% through the next five years; an increase of more than four times of the current usage rate.

Medication errors at drug prescribing and ordering stages of care delivery could be prevented through the use of information technology solutions like electronic prescribing (ePrescribing) and computerized physician order entry (CPOE) systems.

Over the next 10 years, the technology would help avoid around 3.5 million detrimental medication errors, and aid the federal government in saving $22 billion in medical and drug expenses. – Pharmaceutical Care Management Association (PCMA)12

»» Role of ePrescribing Systems With evidence indicating illegible prescriptions9 as one of the root causes for wrong dosage, drug-allergies, drug-drug interactions, etc., prescriptions written electronically (by physicians) and transferred (to pharmacists), are being greatly promoted. Designed to aid in the generation of precise, error-free, and comprehensible electronic medication prescriptions, the ePrescribing solutions

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• Canada: ePrescribing in Canada is supported by the Canada Health Infoway’s Drug Information Systems (DIS) investment program. The program maintains jurisdictional projects to enable the development of interoperable systems which aid authorized caregivers in accessing, sharing, protecting, and managing medication histories of patients for correct and

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error-free prescribing and dispensing of drugs. Drugto-drug interactions and allergy alerts are verified against a comprehensive medication profile for each prescription.13

Government initiatives play a major role in accelerating the adoption of such technologies. Federal bodies across the globe have gone a step ahead in their efforts to ensure the utilization of ePrescribing technologies for the prevention of medication errors by introducing certain incentives and penalties in their programs. In the US, physicians prescribing electronically are liable to receive financial awards of an extra 2% allowable Medicare charges under the Medicare Improvements for Patients and Providers Act (MIPPA), while those who do not participate in ePrescribing in 2012 will be subjected to penalties. A similar Practice Incentives Program (PIP) has been established in Australia.17

• Europe: A recent Frost & Sullivan research has found the increasing acceptance of ePrescribing systems across the continent, with the growing adoption of handheld and wireless devices expected to further promote its deployment. The analysts also attribute the increasing number of government initiatives to its proposed widespread implementation. 14 The major efforts to promote ePrescribing across the continent are listed below. • The European Union introduced the eHealth Action Plan, making the development and adoption of ePrescribing mandatory for all member nations. The plan has set out targets for the widespread implementation of eHealth technologies by 2010.15, 16 • In UK, ePrescribing takes the form of Electronic Prescriptions Service (EPS), and is a part of the NHS IT modernization program.15 • Electronic health cards were developed in Germany, on which prescription data could be uploaded and read at the pharmacy.15 • The mandatory use of ePrescribing imparted on primary care providers is thought to have greatly spurred the adoption of the system in Norway and Denmark. In Norway, ePrescribing is supported by the E-Resept program.17, 18 • Sweden’s state monopoly of pharmacies is considered to have driven the establishment of a national ePrescribing system.17 • Finland introduced the €20 million (US$26.59 million) KanTa project, to allow the transmission and archiving of electronic patient records (EPRs) and ePrescriptions.17

Additionally, the incorporation of capabilities like clinical decision support (CDS) tools and medication safety alerts will determine the success of ePrescribing technology in patient safety arenas.

ePrescribing adoption across six countries during 2006 • Netherlands: 85% • Australia: 81% • New Zealand: 78% • Germany: 59% • UK: 55% • US: 20% • Canada: 11% - 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians21

»» Role of CPOE Systems Computer-based provider order entry systems are clinical information system components that automate the medication ordering process by allowing caregivers to electronically enter and transmit medications and/ or clinical procedure-related orders to the concerned departments and/or professionals for implementation. Eliminating the need for handwritten transcriptions, which are prone to errors, the system helps accelerate the healthcare delivery process,9 aiding in better physician ordering patterns, clear communication among caregivers, compliance with guidelines, and clinical time optimization.22 Enriched with data collected from laboratory, radiology, patient monitoring, and pharmacy systems, CPOE alerts physicians on potential medication allergies, drug-drug and drug-allergy interactions, incorrect dosing, duplicate therapy, and suggests alternative medication before being transferred for medical action. Other advantages attributed to the CPOE system are as follows:

Rates of ePrescribing adoption among primary care physicians are almost 100% in Finland, Sweden, and Denmark.17 • Australia: Prescribing and dispensing drugs electronically forms a major part of the government’s quality patient care goals. The National Health (Pharmaceutical Benefits) Amendment Regulations 2006 was established to enable the process of electronically prescribing and dispensing medication.19, 20 • Middle East: Dubai’s Department of Health & Medical Services (DOHMS) rolled out an ePrescription system for its hospitals and primary health centers in 2007.

• Real-time patient data access and patient evaluation

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• Minimal practice variations and best practices • Integration of multiple departments (nursing, laboratory, imaging, and medication records) to enhance efficiency and resource utilization • Cost containment by -- lowering extra and unnecessary costs (clinical and litigation) arising from medication errors -- providing test and medication cost data (key to prescription costs reduction) -- reducing duplicate tests

achieved at the pharmacy only if dose scanning is conducted at the filling stage, or if the technology is used to aid the stocking and retrieval system.26 In 2004, FDA mandated the use of the National Drug Code (NDC) number in bar codes applied on all human drugs.27 In an attempt to improve safety, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) introduced the National Patient Safety Goals, adding bar coded wristbands to identify patients at the time of drug administration, surgery, patient transfer, taking blood samples, x-rays, etc.28

Automating Drug Dispensing and Administration Mistakes in drug dispensing form a considerable part of the medication errors occurring at hospitals. The overall rates of errors at this stage of care delivery have been found to be low; however, due to the large volumes of medications dispensed at a busy pharmacy, the extent of harm that could result from even a small percent of error could be significantly high.23 Only approximately one third of the dispensing and transcription errors are caught by nurses before administration, while the remaining reach the patients.24 The next stage of the drug delivery system, where the drug is administered to the patient, has also been found to be a common ground for medication errors.25

»» Role of RFID29 Radio frequency identification systems wirelessly communicate data encoded on small devices called tags, which can be embedded on hospital equipment, as well as drugs and patients. These tags can be read anywhere from within the range of the reader. With information like patient history, medication allergies, etc., stored on the tag, caregivers have enough information to provide informed care. A medication management solution using RFID allows clinicians to identify and review physician orders, and ensure the consistency and accuracy of the drug and dosage by scanning a patient’s wristband. Advancements have also enabled the technology to record the number of times a RFID-tagged prescription bottle is opened, thereby indicating the proper administration of medicines.30

Recognizing these as potential sources of mistakes, healthcare organizations have adopted medication administration systems, such as bar codes and radio frequency identification (RFID) tags for use across various settings.

»» Role of Bar Code Technology

Often mistaken for an advanced version of the bar code technology, RFIDs differ in their ability to contain more information, and automatically read without the assistance of any user.

Being user-friendly and highly reliable across various industries, bar codes have been integrated within the healthcare sector also to aid in many processes across an enterprise. The technology can be used to automate and increase the accuracy at both the dispensing and drug administration stages.26

A recent whitepaper by Zebra Technologies expects bar coding to complement RFID, in terms of cost, ease of use, and relative functionality.29

The bar coding system forms an interface with pharmacy systems and electronic medical records (EMRs). The pharmacy generates labels for patients with a unique bar code, once the orders are written by physicians and crosschecked with the patient EMRs. At the pharmacy, it can be used to ensure that the right drug, at its correct dose and formulation is dispensed. The bar codes are scanned by the nurses, along with the medication label to make sure that the right drug and its dose is given to the right patient.

Addressing Medication Errors at Various Areas of Care Delivery Being ubiquitous, medication errors occur across various care settings, regardless of treatment stage. The prevalence and means of overcoming the errors at selected hospital environments have been summarized below.

»» Automating Emergency Department Care Processes

A 2005 study found more than 60% reduction in potential ADEs during drug dispensing on using bar code technology. On analyzing three configurations of the system, the study also demonstrated that patient safety can be efficiently

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A hospital emergency department (ED) is often crowded, requiring caregivers to make quick treatment decisions under high stress levels. The hectic and fast-paced nature of an ED, added to the frequent ‘hand-over’ due to shifts

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and interruptions, are known to increase the risk for committing errors; very few of them being intercepted.31 Hospital EDs that are not properly equipped, and have under-trained or shortage of staff can also contribute to errors. Medical errors at the ED occur due to the combined influence of various factors, which cause workflow breakdown.

histories at the point-of-care. Apart from EMRs, several hospitals are seen deploying clinical information systems, such as emergency department information system (EDIS) and tools designed for the ED, in support of better care outcomes and fewer medication mishaps at the department.

»» Automating Bed-side Care Processes Medication errors at point-of-care can occur due to the acts of commission or omission.36 Mistakes in medication administration can occur due to incorrect timing and site of administration; wrong drug dose, route, patient and form; infusion rate; administration of a drug contra-indicated for a particular patient; or medication past the expiry date. Administration errors are found to be the second most common medication error, occurring at a rate of 14.9%.37

The nature of errors are seen to be multi-layered, complex, and a cause of intermingled network of activities, significantly governed by stress, large volume of patients, and the tendency to rely on shortcuts.32

Extent to which factors contribute to administration errors37

According to the findings of U.S. Pharmacopeia, an independent organization, medication errors at the ED commonly occur at the administration, drug prescribing, documenting, dispensing, and monitoring stages, in order of highest incidence.31 Very few mistakes are interrupted before they reach the patient in the emergency department compared to other hospital departments.33 To choose a proper and safe treatment procedure for an ED patient, the care team would require proper details about patient history, physical examination, and diagnostic workup. The patient’s information exchanges hands during the shift changes/hand-offs, teaching activities, consultation, documentation, and use of computer resources. It has been indicated that the limited access to comprehensive patient medical record increases the chance of discrepancies.34 The non-availability or loss of information during the care process may occur as a result of these interruptions that are characteristic to the ED setting. The complex care process at the ED could be streamlined by automating the workflow. The use of the right technology can aid in enhancing communication between clinicians within the ED and across other departments as well. The ability to share patient data across various facilities can enable better prescribing of medication. A 2003 study has suggested that ADEs in an ED could be averted by adopting a systems approach, i.e., incorporating IT systems, such as EMRs with CPOE and standardized bar codes, apart from ward-based clinical pharmacists.35 Technology-driven documentation using an EMR allows access to complete medical records, including medical

Error

Error Rates (%)

Dose

Wrong Time

Preparation

Administration

Technology plays a greater role in medication error prevention during drug administration when compared to the other phases of medication delivery, as the chances for interception before the patient takes the medication is less likely at this stage.

Technology Aids Five Rights Compliance Patient safety is governed by quality healthcare, and encompasses nursing care to a large extent. With many organizations depending on nurses to detect and notify potential medication errors, many believe that the occurrence of errors is a result of reduced nursing. Although nurses are involved in patient safety, 38% of errors have been reported during nurse administration of medication.38 To avoid mishaps during care delivery, nurses are expected to follow the five rights of medication administration: right patient, right route, right dose, right time, and right medication. The safety net that the five rights offers can be enhanced with the application of information technology, such as bar codes and RFIDs. These systems help bridge the communication gap between the various caregivers, by helping the staff at bedside to be aware of and apply all the vital instructions provided by the physician to the right patient. Integrated with other clinical information systems of the enterprise, the technology empowers the caregiver with on-hand, comprehensive and up-to-date information.

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Learning from Past Mistakes Improvements in the quality and safety of patient care have been made through the concept of incident reporting, whereby any incident and adverse event is reported in order to avoid the repeated occurrence of similar mishaps in care delivery. Reporting of adverse events or any problem encountered during the care delivery by providers and healthcare organizations, through a system-wide, regional, or national reporting system, helps outline basic similarities or patterns in the risk source.48 It is not the reporting itself that improves safety, but the resulting measures initiated to bring about change in the future outcomes. The National Reporting and Learning System (NRLS), a voluntary national system, was introduced in 2003 by the National Patient Safety Agency (NPSA) with intents to enhance patient safety through the practice of incident reporting largely sent electronically from the local risk management systems.49 Incident reporting has been well established as a vital ADE prevention tool across most hospitals in England and Wales through the RLS.48, 50 In Australia, the Australian Incident Monitoring System (AIMS) Incident and Risk Management Program was implemented by the Australia Patient Safety Foundation (APSF). The Advanced Incident Management System software, developed by APSF, is being utilized at above 1,000 facilities across Australia, South Africa, United States, and New Zealand.48, 51, 52 Hospital incident reporting, when connected to multi-center data collecting electronic systems can help gather ADE incident data across all connected hospitals. It also supports the creation of a national IT system for the collection and analysis of the incident data.53

The nurses’ role also includes calculation of dosage data, and data entry for intravenous infusions and medications. The most likely errors, including transcription data entry, dosage calculation, and medication titration, can be avoided by automating this process as well, thereby aiding in the practice of safe medication administration procedures at the bedside. CPOE has been found to be proficient in automating and reducing errors for such tasks.39 In order to avoid errors during IV administration, which could occur due to lack of inbuilt double checks and minimal chances of interception before the medication reaches the patient, intelligent or smart IV pumps have been adopted across many hospitals. The IV infusion pumps include drug library profiles software configured specifically for patient care units, integrated to provide decision support at pointof-care, and programs to aid in maintaining safety limits for drug/dose calculations.40 Another source for medication errors lies in the charting process, which could take up nearly 17% of a nurse’s time.41 The healthcare market offers charting systems aided with decision support tools to assist with real-time medication charting processes.

»» Automating Perioperative Care Processes The perioperative care department, a highly complex care arena in a hospital enterprise, poses great challenges to the

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clinicians. The uniqueness and complexities characteristic to this section of the hospital, i.e., the need for managing a large range of inventories and supplies, and harmonizing the operation of technologies, create challenges in addressing medication errors. Although uncommon, medication errors in clinical anesthesia are likely to cause serious morbidity.43 Many anesthesiologists experience at least one medication mistake or near miss; the most common among them being the exchange of syringes and misidentification of labels.44 Errors at a surgery care unit can include drug omission, administrating drugs which have previously indicated allergies, loss of patient information during transfer, incorrect patient identification, etc. Interruption in information flow is one of the main factors contributing to medication errors in the perioperative care process. Mistakes, such as miscommunication of the set procedure, misidentification of patients, omission of antibiotics or allergies, can be further amplified while the patient is being shifted from surgical clinics to inpatient care units like the preoperative preparation units, operation room, post-anesthesia care, ICU, etc., and follow up care in the primary care or surgical clinics.42 The use of health IT for perioperative care processes has

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the potential to reduce medication errors. Currently, the market offers a wide range of health IT solutions to help establish a safer environment across this hospital setting. However, the deployment of the different clinical information systems from multiple vendors could give rise to interoperability issues, thereby impairing consistent information exchange, and data collection.45 Proven clinical systems, which can automate perioperative workflow and interoperate with all relevant technologies across the department, enabling sharing and exchange of data across the unit and other departments, could help reduce medication errors by empowering caregivers with the right information at the right time.42 Monitoring the flow of patient data through the perioperative process can help avoid transcription errors and duplication of the effort.42 The various technology options available for the perioperative sector include anesthesia information systems, clinical information systems for ICUs, perioperative documentation systems, charge capture, charting tools, etc. Medication delivery safety during perioperative care could also be enhanced with the use of tracking technologies. Bar code scanning technology helps ensure administration of correct medication by confirming patient identity and medication information against data stored in patient’s EMR. Apart from enabling inventory management and asset tracking, RFID technology at the perioperative setting also helps ensure patient safety through the identification of the right blood type as indicated in the patient EMR. Using RFID technology, surgery patients are labeled to obtain complete medical histories and ensure that the right procedure is being carried out on the right patient, at the right site. Efforts at reducing medication errors at surgery departments can be seen in the development of the AORN SYNTEGRITY™ Standardized Perioperative Framework (SPF) by the national Association of periOperative Registered Nurses (AORN) for the establishment of standards for electronic documentation specific to perioperative care. The framework utilizes AORN’s Perioperative Nursing Data Set (PNDS) vocabulary provided within an XML format, which could be mapped into a vendor’s EHR.46

»» Preventing Medication Errors at Patient Discharge Medication errors have also been seen to occur due to gaps in the flow of information at transition points, like discharge, or while being referred to other departments or physicians. Such errors are represented by inapt and incomplete medication reconciliation, inadequate patient data (particularly in a multicultural population scenario), and poor interactions among care providers. Being the main form of communication between primary and secondary

care, discharge summaries provide information which is vital for maintaining the continuity of care. Hence, any medication discrepancy in the documentation could cause potential harm to patients. Occurrence of errors in medication details at the time of patient discharge has been established by several studies. One such observational study found that 10.8% of medication orders had errors during hospital discharge medication documentation, affecting 65.5% of patients. The researchers found drug omission to be the most common mistake (20.9%).47 Discharge errors occur generally due to manual medication transcription, which is opted for the documentation of medication charts to discharge summaries. Automating the process through electronic discharge summaries provides the potential to lower the chances of errors at this stage of medication delivery, thereby ensuring the safe transfer of the patient’s care to the primary care provider. The substitution of manual transcription with information technology involves the transmission of medication to the electronic discharge summary from an electronic medication management system. This also aids in more complete and legible discharge summaries.

Extent to Which Technology can be Relied Upon Inadequacies in clinical systems and other health information technologies could give rise to latent errors, which ultimately result in adverse events. These latent errors go unnoticed, as most often, the care-team member interacting with the system is thought to have gone wrong in the way the system has been used. Although IT systems may support faster and better documentation and information availability; there is always a possibility of data loss due to hardware meltdown or software glitches. Maintaining a balance between technology support and human interventions can help deliver error free care.

Closing the Loop: Key to Patient Safety As established by several studies, IT has the potential to prevent ADEs; however, the effectiveness of these systems will also depend on its proper usage. The installation of one of these systems alone doesn’t solve the medication error problem. Although many departments in a hospital have in place their respective IT systems, budget constraints, or complications involved with revamping systems and processes within an enterprise may delay the automation of the entire organization. A whitepaper by Microsoft states that medication errors may be kept under control in departments where the work flow is computerized, but may creep in during handover

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of tasks from one department to another. The whitepaper discusses the importance of an integrated solution for improving the safety of the care delivery process. A closedloop medication management system is one in which the various systems, such as ePrescription and CPOE, work in sync, allowing streamlined flow of information between departments and clinicians. The mechanism enables the reentry of the medication process outcomes into the system again, thereby facilitating future changes and enhancements in the course of care. The management of the drug delivery system starts from medication orders, through the prescribing and dispensing stages. Once the drug completes its cycle at administration, the “loop is closed” with the monitoring of the patient for vital signs, reactions, condition, and other data. Recorded in the patient’s medical record, this data helps the physician understand the patient’s response to the drug and modify the course of treatment, if required. By automating all the functions related to medication delivery, this system helps streamline the workflow and does away with many of steps involved in the complex process, in turn significantly lowering the chances for errors, improving quality of care, and promoting more informed care.54

competence, control, and culture. Qual Saf Health Care. 2003 Dec;12 Suppl 1:i29-32. 04. What is a Medication Error? National Coordinating Council for Medication Error Reporting and Prevention. Last Accessed April 20, 2010. 05. Phillips J, Beam S, Brinker A, et al. Retrospective analysis of mortalities associated with medication errors. Am J Health Syst Pharm. 2001 Oct 1;58(19):1835-41. 06. Medication error reports. U.S. Food and Drug Administration. Last Accessed April 20, 2010. 07. Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Aust New Zealand Health Policy. 2009 Aug 11;6:18. 08. Nosek RA, McMeekin J, Rake GW. Standardizing Medication Error Event Reporting in the U.S. Department of Defense. Advances in Patient Safety: From Research to Implementation. 2005 Feb.4. 09. Gerstle RS, Lehmann CU; American Academy of Pediatrics Council on Clinical Information Technology. Electronic prescribing systems in pediatrics: the rationale and functionality requirements. Pediatrics. 2007 Jun;119(6):e1413-22. 10. Karadeniz G, Cakmakçi A. Nurses’ perceptions of medication errors. Int J Clin Pharmacol Res. 2002;22(3-4):111-6. 11. E-Prescribing. Centers for Medicare & Medicaid Services. Last

The close-loop medication management has also been recommended by ARRA’s criteria for meaningful use.55

Accessed April 20, 2010. 12. PCMA Study: New Stimulus Law Will Dramatically Increase E-Prescribing Adoption Rate. Pharmaceutical Care Management

In addition, in order to maximize the benefits of any system, it is important to establish best practices and change the patterns in practice.56 Since no single approach, be it efficiency in workflow or the intervention of a particular technology, will be adequate in eliminating the problem of medication errors, a more comprehensive approach of amalgamating workflow efficiency initiatives along with the power of information technology for improving the safety of patient care is the need of the day.57

Association. Press Release. Last Accessed April 20, 2010. 13. Drug Information Systems. Canada Health Infoway. Last Accessed April 20, 2010. 14. European Markets for e-Prescription Systems. Frost & Sullivan. Last Accessed April 20, 2010. 15. E-Prescription in Europe: First Things Fast. Frost & Sullivan. Last Accessed April 20, 2010. 16. The right prescription for Europe’s eHealth. European Commission. Last accessed February 9, 2010. 17. Explaining International IT Application Leaderhip: Health IT. The

Furthermore, efforts are required from multiple fronts and all healthcare stakeholders to help enable patient safety through the adoption of technology-backed solutions.57 Advancements in new information technology, which can support evidence-based care and interventions before errors occur, can help in lowering the incidence of medication errors and ADEs.

Information Technology & Innovation Foundation. Last Accessed April 20, 2010. 18. Electronic Health Records: A Global Perspective. HIMSS Enterprise Systems Steering Committee and the Global Enterprise Task Force. Whitepaper. Last Accessed April 20, 2010. 19. Select Legislative Instrument 2006 No. 200. EXPLANATORY STATEMENT. Australia Department of Health and Ageing. Last Accessed April 20, 2010.

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26. Poon EG, Cina JL, Churchill W, et al. Medication Dispensing Errors and Potential Adverse Drug Events before and after Implementing

44. Fedorko L, Fisher J, Miller B, Kowalchuk B, Fung E. A point of care

Bar Code Technology in the Pharmacy. Ann Intern Med. 2006 Sep

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2003 Dec;25(6):264-8. 38. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse

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intravenous infusion pumps to improve medication administration

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INTERVIEW Asian Healthcare Information Technology Industry

Mr Sandeep Sinha, Director-Healthcare, South Asia and Middle East, Frost & Sullivan, in Conversation with Amoolya Moses, Assistant Editor, Health IT NEWS.Direct! Frost & Sullivan, in collaboration with Alexandria Real Estate Equities, Inc. will be hosting the 2010 India Excellence in Healthcare Awards to be held on 23rd September, 2010, in Mumbai, India. We are pleased to have Mr Sandeep Sinha to tell us about the awards show as well as share his views on the healthcare information technology industry in the region. Q: What is the motivation and vision behind the forthcoming 2010 India Excellence in Healthcare Awards? By recognizing and honoring leaders, how do you think it will shape or influence the healthcare industry in the country?

Mr Sandeep Sinha, Director-Healthcare, South Asia and Middle East, Frost & Sullivan

A: For Indian healthcare there is a clear need for recognizing the best of the best across healthcare delivery, medical technologies, and life-sciences sectors under one umbrella. We at Frost, as per our global best practices, would like to recognize the innovative growth strategies and solutions adopted by the best companies, along with addressing the local need in the healthcare industry through these awards. Globally we have been doing these awards in other regions as well. The success of our first year (2009) awards has given us a lot more confidence and motivation to execute this at a much larger scale and with lot more participation from many players across the Healthcare Industry. Q: Can you give us an insight into the present scenario of the health IT industry in Asia, particularly India and China? What are the related markets that are currently flourishing in the region? A: The Indian Healthcare IT market is growing at 25 percent CAGR, and has seen many models evolving to cater to the need of the local market. China has also seen great development, and their public sector IT initiatives are far ahead than India. The Indian private healthcare providers are far more prompt than public healthcare providers. Apart from standard Hospital Information Systems (HIS) the need is growing towards PACS, RIS, EMR and clinical systems. India is also seeing new trends like IT Outsourcing (ITO) in healthcare. Q: What is the role of the government in driving the use of IT in healthcare? What is the current focus in Asia and how would you rate the IT policy of the Indian government? A: The role of the government should be to work on policy guidelines like standards, interoperability, etc. IT policies in some of the developed regions of Asia are pretty clear, where as in India, we are still looking for some basic guidelines for the customer. There are few committees being formed and are looking in this area.

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Q: Standards and interoperability are the key aspects that help optimize the benefits of information technology. What is the importance given to these in the Indian healthcare industry? What are the standards adopted, and the steps being taken to ensure interoperability among systems? A: Private healthcare providers are definitely looking at all these aspects as interoperability of various systems are key for growth. However, the Government has not yet taken concrete steps to develop any Healthcare IT-specific standards/regulations; though, even government initiatives/programs have clear requirement on this. So now, majority of Healthcare IT application/solution providers (not all) have adopted the international standards like DICOM, HL7, etc., and made their existing products compliant to these standards. This way the interoperability issues are being addressed in the current scenario. Q: There has been great focus on implementing telehealth practices in the country. Do you think that this effort will actually help us reach out to the 70% of rural Indians having limited access to care services? Will the current efforts be able to bridge the urban-rural health divide? A: Yes, telemedicine will definitely help to reach out to the rural populations. However, this is being promoted more by government agencies. Private players have been using telemedicine more for referral management. If telemedicine has to be penetrated to all levels, mainly to the rural market, and to be a successful delivery model, a solid incentive-based sustainable business model has to be in place.

In India, there are few hundreds of telemedicine implementations across Government and private players; however, the country is still missing out on the sustainable model which can last forever. We feel that the telemedicine model should be looked at on a much bigger platform. It should be part of a nationwide health network or integrated healthcare network where telemedicine becomes an integral part of the same. Q: Will nation-wide connectivity be included in Indiaâ&#x20AC;&#x2122;s future agenda? What are the barriers that the country would need to overcome to achieve this goal? A: Yes, India should look at a nationwide integrated network. This is the only way we can address healthcare delivery to the larger population. The Government is already working on this model, and there are a few pilots being initiated. The challenges for implementation of such a model are the large population to cover, integration, implementation, etc. Q: With the global countries rapidly advancing towards complete automation of clinical and administrative processes, what do you foresee for the Indian provider market in terms of IT acceptance? A: The Indian healthcare providers, specially the private players, are very open for automation of their processes. Administrative areas are already covered by most of the healthcare providers. Now, they are looking forward for other applications like RIS, PACS, EMR, clinical information systems, etc.

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April - June 2010

eHEALTH Eclipsys to Create Enterprise-wide EHR at Private Healthcare System Aiming towards building an integrated electronic health record (EHR) that could connect all multiple care sites, New Rochelle, NY-based Sound Shore Health System (SSHS) has roped in Eclipsys Corporation® in order to support its IT initiative. With interests directed towards enhancing the safety, quality and continuity of care delivered, the Health System will undertake an accelerated activation of Eclipsys’ Sunrise Enterprise™ integrated solution suite at 196-bed Mount Vernon Hospital and 252-bed Sound Shore Medical Center of Westchester. Considered as one among the large independent healthcare systems within Albany and New York City, SSHS was formed out of the affiliation of Sound Shore Medical Center, Schaffer Extended Care Center, Dorothea Hopfer School of Nursing, and Mount Vernon Hospital. Keeping the procurement of the American Recovery and Reinvestment Act (ARRA) incentives as its target, the Care Facility selected Eclipsys based on its ability to support clients in accomplishing deep technology adoption, which is an important criterion for meaningfully using technology. Apart from this, the vendor’s industry-recognized open technology platform, designed to aid clients in utilizing the fast emerging technology innovations in the dynamically evolving healthcare arena, was what drew the Health System to involve Eclipsys in its IT initiative. Additionally, John R Spicer, CEO and President, Sound Shore Health System, states that Eclipsys has aligned with SSHS’ requirements for a long-term clinical solution and technology partner. He feels that the company’s advanced technology vision for interoperability with distinct enterprise-wide systems, provided SSHS with the conviction that the vendor could help them achieve clinical effectiveness and efficiency. Using Eclipsys’ “speed to value” implementation methodology, SSHS will bring in place the following integrated revenue cycle, clinical, and access management solutions, in order to accelerate the activation of the enterprise EHR for increasing the ARRA payment opportunities. • Computerized physician order entry (CPOE) solution • Integrated pharmacy information system • Orders reconciliation application • ePrescribing solutions

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• Sunrise Emergency Care™ • Sunrise Patient Financials™ Through its Patient Financials solution, Eclipsys will help manage SSHS’ business. Furthermore, the vendor’s access management solution is expected to broaden its enterprise EHR capabilities to front-end scheduling and registration operations, providing the administrative department with improved efficiency in collecting payment verification and demographic data of a patient. Apart from these, SSHS plans to adopt Eclipsys’ Sunrise Clinical Analytics™ solution to facilitate tracking and evaluation of clinical performance for enhanced medication safety and care quality. The solution is also expected to empower the organization with the ability to comply by the Joint Commission standards and quality measures set by the Centers for Medicare & Medicaid Services (CMS). Eclipsys’ offering will be hosted from its Technology Solutions Center in Mountain Lakes, NJ. By automating the vital healthcare processes, the Health System intends on reinvesting on more upgrades for its facilities, and supporting better physician connectivity across the community. In the past two months, Eclipsys has inked various deals for its Sunrise Enterprise solution suite with organizations having the primary strategic objective of creating a single EHR across multiple sites, and meeting the meaningful use criteria of technology. Apart from the current Health System there have been two others, Bronx Lebanon Hospital Center and New York Downtown Hospital, from the city of New York. In its support of the ARRA program, Eclipsys focuses on three aspects, adoption, agility, and analytics to aid in the transformation of health data and technology utilization. Serving the industry with advanced healthcare IT solutions for the past 40 years, the Atlanta, GA-headquartered Outcomes Company® delivers clinical, performance and revenue cycle management solutions, professional and clinical content services to physician practices and hospitals. The company recently reported its fourth quarter revenue, ending December 31, 2009, to be $133.7 million, when compared to $126.8 million of the same quarter the previous year. The total revenue for the year 2009 was $519.2 million, compared to the $515.8 million for the year 2008.

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Phoenix Health and Medsphere to Deliver IT Outsourcing Services and Open Source EHR Solution to Critical Access Hospital Columbia Basin Hospital (CBH) has roped in Phoenix Health Systems for its Total IT Solution service line under a five-year contract, to meet the healthcare IT requirements of CBH’s nursing home, rural health clinic, assisted living center, and the hospital. The agreement also includes the deployment of Medsphere Systems Corporation’s OpenVista electronic health record (EHR) solution. Ephrata, WA-based Columbia Basin Hospital, a critical access hospital (CAH), offers services through its rehabilitation center, family medicine clinic, as well as telehealth services. CBH’s CEO, Robert F Reeder explains that with the year’s focus directed towards capitalizing on emerging information technology for streamlined medical recordkeeping, the hospital expects the current alliance with Phoenix to cover both the operational as well as the financial aspects of bringing into place a quality EHR solution to realize this strategic goal. CBH will outsource services, such as infrastructure management, application management, and IT leadership, apart from implementing and availing support services for OpenVista EHR. Leveraging this, the hospital hopes to automate recordkeeping and clinical operations, connect various facilities and facilitate the accessibility of vital clinical data, integrate EHR across various CBH facilities, and qualify in time for the American Recovery and Reinvestment Act (ARRA) of 2009 investments. Being an open source derivative of the US Veterans Health Administration’s (VA) VistA EHR, the OpenVista implementation is thought to draw more clinicians to the CBH community owing to its recognition and acceptance expressed by many physicians who have used the technology during their VA training. The size of hospitals has been seen to play a role in the implementation of health IT adoption. The current implementation, including combined offering, has been considered as an innovative, distinct and cost-effective solution to address the various critical issues, such as inefficient resources to manage IT needs, faced by especially small, budget-restrained facilities like Columbia Basin. This setback could further influence the implementation of EHR technology in time to meet the deadlines of the ARRA stimulus funds.

About Phoenix Health Systems: Based in Richardson, TX, the vendor delivers integrated IT outsourcing, revenue cycle management (RCM), and strategic consulting services. Under its outsourcing services, the company caters to

performance, desktop, help desk, server, network, people and technology transition, as well as procedures, methods, and standard policies to operate an IT department.

About Medsphere Systems Corporation: Established in 2002, the Carlsbad, CA-headquartered provider of open source healthcare enterprise products, focuses its delivery towards enabling the accessibility of health IT to facilities of all scales. The company’s OpenVista, the VistA EHR’s commercial version, is a comprehensive solution that has integrated into it, bar code medication administration, computerized patient record system, and computerized physician order system, apart from others. The current deployment at CBH is the first joint venture since the two IT companies recently entered into a partnership to deliver affordable and effective technology to the rural CAH-niche.

Efforts to Uplift Care at Critical Access Hospitals Initiated by the Balance Budget Act of 1997, under the Medicare Rural Hospital Flexibility Program, the critical access hospital program was introduced to reduce hospital closures and enhance access to rural healthcare. Under the ARRA investments, the more than 1,300 rural critical healthcare facilities across the US will receive Medicare costbased reimbursement at 101% of Medicare allotted costs. The initial ARRA house bill had not allotted any incentives for CAHs, with the rationale that these facilities do not require HIT incentives as they can avail Medicare cost reimbursement. Later, the Congressional Budget Office proposed only half of the CAHs to become meaningful users of technology by 2019. ARRA 2009 then created a special incentive structure for CAHs, which builds off the present Medicare-permitted cost-based system. Through the stimulus plan, meaningful technology CAH users are eligible for complete deprecated costs of EHR expenses, which include undepricated costs of past years, as well as increased Medicare incentives provided over four years. Penalties will be incurred on CAHs not deploying EHRs by 2015, in the form of reduction in payment. Now, a recent survey by Healthland, which caters to the health IT needs of CAH and small community facilities, shows that with the new legislations, more than 80% of the small community healthcare organizations surveyed have decided to implement an EMR solution.

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April - June 2010

PRODUCTS AND SOLUTIONS Launch of First End-to-End Continua Standards-based Connected Health Solution Continua Health Alliance has released the first Continua architecture-based end-to-end connected health application. This achievement of the more than 220-organization alliance, is said to be a noteworthy milestone in its goal to create an environment of interoperable connected personal health systems. The Continua End-to-End (E2E) Reference Architecture provides a high-level architectural overview of the Continua ecosystem, includes four network interfaces and five reference device classes, and indicates constraints in topology. The network interfaces, PAN, LAN, WAN, and Electronic/Personal Health Records Network Interface (xHRN), are primary to Continua’s interoperability objectives, and governs its product testing and certification efforts. Using the new end-to-end connected solution, Continua members will demonstrate the transfer of data from consumer health devices to medical offices, hospitals, patient information systems, etc., using the following: • Nonin’s Nonin Onyx® II Model 9560 Bluetooth® fingertip pulse oximeter, a Continua Certified™ wireless device, as a source of the data • Vignet’s Connected Health Services platform employing Continua’s device interface standard, to receive the data transferred from the oximeter into a PC manager • IBM server, employing the Continua WAN interface standard, to allow uploading of data from the PC manager. The IBM server, leveraging the Continua interface, will then be able to transfer the data to various other sources.

Guidelines Spur Continua Standards-based Solutions Development The impetus for the development of compliant health solutions and services was provided by the publication of the Continua Health Alliance Version One Design Guidelines, which is based on a comprehensive set of existing industry standards. The guidelines were established to act as a basis for the integration of a product into the interoperable personal healthcare environment. Focusing on the PAN-IF and xHRN-IF interfaces (Disease Management Services [DMS], WAN devices [xHR Senders], and electronic health record devices [xHR Receivers]), the guidelines were framed specifically for • manufacturers interested in certifying their devices by Continua criteria

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• vendors integrating Continua devices into systems and subsystems • test labs certifying for Continua-specification compliance The alliance plans on rolling out the next set of guidelines in the first half of the year, along with more use cases, two standards for wireless technology, extended capabilities, and new devices into the Continua ecosystem.

Harmony of Standards The challenges of plug-and-play interoperability and transparent integration of medical devices with computer systems have been universally addressed by using standards. In their efforts towards promoting interoperability of healthcare devices and services, the global, non-profit, open industry coalition has developed design guidelines based on industry connectivity standards, like • USB for wired devices and Bluetooth for wireless devices • ISO/IEEE 11073 at point-of-care and EN13606 connecting to the electronic healthcare record server • Integrating the Healthcare Enterprise (IHE) • HL7

Continua’s Journey So Far Identifying the need to create a connected personal healthcare environment, and extend care delivery from the traditional hospital setting to homes in response to the increasing chronic conditions and aging population, the industry’s leading healthcare, fitness and technology facilities converged to form the Continua Health Alliance. The efforts of the alliance are directed towards monitoring healthcare requirements of the aging population, proactive health and fitness, and management of chronic diseases. Since its establishment in 2006, Continua has translated its mission of connecting the healthcare industry through various achievements.

»» September 2007: First set of guidelines for personal fitness and health services, and solution interoperability

»» October 2008: First public interoperability demonstration of Continua pre-certified products and solutions

»» January 2009: Nonin Medical’s Nonin 2500 PalmSAT® handheld pulse oximeter with USB, recognized as the

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first Continua™ Certified solution

acceptance of electronic medical records (EMRs), patient health records (PHRs) and connected health devices.

»» June 2009: Release of Version One Design Guidelines »» August 2009: Join forces with IHE to create a single set of content, vocabulary, and transport standards for devices employed at home and hospital. The harmonized standard was also supported by the Healthcare Information Technology Standards Panel (HITSP) Abiding by their mission of enabling complete interpoperability among connected health systems, the alliance’s President and Chairman of the Board, Rick Cnossen states that their current endeavor of facilitating standards-based interfaces will help stimulate innovation and eliminate barriers for global adoption and implementation. Vignet’s CEO, Praduman Jain says that the empowerment of data sharing capabilities between patients and providers by solutions, can promote the

Connected care, an approach of delivering healthcare remotely through technology, includes telehealth and home care, all aimed towards managing disease and lifestyle, elderly patient care, and improving chronic care. The industry is currently witnessing the transition of care delivery from hospitals to homes, owing to convenience and cost issues. A recent report by Parks Associates anticipates the US wireless homecare services and solutions market to experience more than 80% annual growth rate in a collective five years, and by 2013, develop into a $4.4 billion industry. Industry experts attribute the growth of connected health to the rapidly advancing technology, which could support the emergence of more healthcare delivery models, enabling enhanced access and care outcomes, while managing costs.

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April - June 2010

PRODUCTS AND SOLUTIONS

Cerner to Enhance SurgiNet Solution with Standardized Documentation Framework In a move to enable care providers with streamlined documentation capabilities in the perioperative care setting, Cerner Corporation has partnered with the Association of periOperative Registered Nurses (AORN) and Computer Sciences Corporation (CSC), to incorporate AORN’s Standardized Perioperative Framework (SPF), AORN SYNTEGRITY™, with Cerner Millennium SurgiNet® solution.

investigation, financial justification, operational analysis, and establish regulatory compliance. The vocabulary aids in aligning nursing documentation with national standards, and regulatory and accreditation criteria. Further, using PNDS in an XML overlay allows the mapping of SYNTEGRITY into an EHR, thereby equipping hospitals with a standardized language for perioperative care documentation.

SurgiNet perioperative and anesthesia information system provides tools for nursing documentation across pre-surgery, intra-surgery, post-surgery areas, and post anesthesia care unit (PACU). The information system also supports material management and surgical scheduling, apart from automating surgery case tracking.

»» Data fields: This allows reporting of appropriate regulatory, quality, and operational data.

»» Companion guide: A Web-based manual, which aids nurses with easy access to clinical information and documentation requirements in relation to specific documentation fields. This allows nurses to quickly clarify queries while documenting vital information at the bedside.

Leveraging the SYNTEGRITY guidelines through the current contract, SurgiNet is expected to aid care facilities in decreasing the time required for the establishment and management of electronic documentation-related guidelines, and workflow procedures, while ensuring the aligning of the perioperative care documentation with AORN recommendations. It is expected that with SYNTEGRITY, hospitals will require up to 80% less time to support and configure electronic health record (EHR) perioperative documentation. As a combined creation of CSC and AORN, SYNTEGRITY, an electronic reference dataset, has been designed to automate critical patient data collection across hospital perioperative care areas, ambulatory surgery centers and outpatient facilities. The framework is touted to enable caregivers with the capability to quickly identify and record patient care elements starting from the preadmission phase to preoperative, intraoperative, and postoperative phases of the perioperative care continuum. Complying by regulatory requirements, clinical standards, and accreditation terms, the SPF framework has been created to promote consistent patient care and continued compliance. Other features of the SPF are enumerated below.

»» Data recording method: Through the data recording method enabled by the framework, organizations will be in a position to benchmark and evaluate the outcomes, quality, and effectiveness of care delivered. It also enables organizations to compare their surgical aspects like surgical outcomes, turnover time, etc., with other facilities across the nation. Backing the integration of the SPF framework into SurgiNet, CSC Healthcare Group’s president, Deward Watts states that, while the combined offering can enhance the efficiency and safety of hospital operating rooms, providing AORN SYNTEGRITY to its clients could roll out reliable documentation tools. The SYNTEGRITY project, started off as the Standardized Perioperative Record and Direct Repository System initiative in 2008, with the combined efforts of AORN’s team of informatics specialists and nurses, CSC, and other collaborators. SYNTEGRITY now forms a key part of CSC’s health information technology portfolio.

»» Perioperative Nursing Data Set (PNDS): Acting With care quality and patient safety arising as the prime as the foundational basis for the development and functionality of SYNTEGRITY, PNDS, the standardized nursing vocabulary, aids perioperative nurses to deliver evidence-based care. Additionally, it allows capturing and mining of data for performing research

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issues of interest across the perioperative care areas, Cerner, which has a worldwide client base of 8,000, hopes that the current partnership will help further enhance its SurgiNet solution as a valuable perioperative documentation tool for hospitals.

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April - June 2010

MERGERS AND ACQUISITIONS Unisys to Divest Health Information Management Business to Molina Healthcare »» Louisiana: The HMI unit supports Louisiana

Unisys Corporation has sold its health information management (HIM) business to Molina Healthcare, Inc., a managed care organization, in an all-cash deal valued at $135 million. Subject to a standard working capital adjustment, the transaction amount was paid using Molina’s credit facility at closing. Following closing conditions and customary regulatory approvals, as well as receipt of customer consents, the acquisition completed in May 2010. Following the acquisition, HIM’s 900-odd employees will join Molina Healthcare. Under the terms of the contract, for one year, Unisys will provide some technology and transitional support services to Molina. The acquisition will expand Molina’s product portfolio with a range of tools varying from full-risk managed care health plans to feebased information technology solutions.

Unisys’ HIM Business Unit: The approximately $110 million HIM business, supports several state government clients with services and solutions required for the management of Medicaid and other healthcare programs. HIM offers BPO solutions, as well as design, development, and implementation services for Medicaid management information systems (MMIS). At present, the division holds contracts with the following states:

Department of Health and Hospitals (DHH) with several technological efforts to help mange its Medicaid program and improve spend management.

»» Idaho: As a part of two seven-year, potential $167.5 million dollar contract signed with the Idaho Department of Health (DHH) in December 2007, HIM is tasked to design, develop, implement, and operate the Idaho MMIS, Health PAS.

»» Florida: HIM supports the state with drug rebate administration services under its Medicaid program. Now, following the strategic acquisition of the Unisys-HIM business, Molina Healthcare’s president and CEO, J Mario Molina states that the acquired asset, which complements Molina’s Medicaid health plan business, will extend the company’s offerings beyond managed care expertise. He further asserts that state governments are increasingly focusing on cost containment in their health programs to enable Medicaid members to improve their health; now with the current acquisition, Molina as a single company will be able to meet the Medicaid program requirements of the state clients.

About Molina Healthcare: Headquartered at California, »» New Jersey: A Medicaid fiscal agent since 1989, the vendor is currently associated with the state through a $212 million contract extension signed in 2009 for the delivery of MMIS and Medicaid fiscal agent services for the next 5 years (base 3 years and optional 2 years).

»» Maine: HIM holds a $179 million, firm-fixed-price, seven-year agreement, signed with Maine Department of Health and Human Services (DHHS) in May 2008, to design, develop, implement and operate a new MMIS, and mange the state’s Medicaid program, MaineCare.

»» West Virginia: The West Virginia Department of Health and Human Resources (WV DHH) has roped in HIM as a fiscal service agent to offer Medicaid services, which include electronic media claims (EMC) helpdesk, provider relations, consumer services, provider enrollment and pharmacy helpdesk.

Molina Healthcare currently caters to about 1.4 million clients across Washington, Florida, California, Ohio, Missouri, Mexico, New Utah, Texas, and Michigan. With a track record of above 25 years in managed care services, the vendor currently has six National Committee for Quality Assurance (NCQA)-accredited health plans. By contracting with the state governments, the vendor offers an array of healthcare services to individuals and families, qualifying for government-approved programs like Medicaid.

About Unisys: Based at Blue Bell, PA, the vendor specializes in the transformation and outsourcing of data centers, end user support services and outsourcing, security, and application outsourcing and modernization. For above 50 years, Unisys has been catering to the public sector market through the Unisys Center for Innovation in Government, which leverages best practices and research in technology innovation.

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April - June 2010

MERGERS AND ACQUISITIONS

IBM to Strengthen Analytics Capabilities through Initiate Systems Acquisition Entering into the 30th acquisition under its information and analytics strategy, IBM Corporation has signed an agreement with Initiate Systems, to acquire the data integrity software provider for an undisclosed amount. Subject to customary closing conditions and regulatory clearance, the transaction completed in March 2010. Initiate Systems will now operate with IBM’s Information Management business. Initiate’s technology assets are anticipated to fortify IBM’s offerings for the healthcare and government clients. Chicago, IL-based Initiate Systems, a privately held company with above 15 years of experience in health IT, supports data sharing among government and healthcare enterprises. The company caters to above 1,700 healthcare sites through its Initiate® software. Initiate’s portfolio includes solutions and services for payer information management, health information exchanges, provider data management, and electronic medical record (EMR) management. Also included in the company’s healthcare offerings is the integration platform, Accenx Exchange™, acquired from Accenx Technologies Inc. in 2009. The platform helps enterprises share health information across a wide area. The vendor earned the Healthcare Information Technology Standards Panel (HITSP) Implementer title, by qualifying in the HITSP test at the 2009 Integrating the Healthcare Enterprise (IHE) Connectathon™ event, considered the industry’s largest interoperability testing event. In an attempt to strengthen its health information exchange capabilities, during the same year, the company partnered with Axolotl Corporation to integrate its patient identification solution with Axolotl’s award-winning Elysium® Exchange solution. General Manager of IBM’s Information Management business, Arvind Krishna says that by adding Initiate’s software and its industry expertise, IBM will be able to deliver an end-to-end solution for information exchange required for effectively enhancing patient care at lower costs. He further states that in the same way, for the government clients, the acquisition will help IBM deliver solutions with enhanced capabilities for collecting

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information and using them to efficiently serve citizens in a timely manner. The quest for improving healthcare and services for citizens, has long since been a priority of healthcare organizations and governments across the world. In the healthcare arena, providers are continuously looking for means to enhance care outcomes and efficiency. Government sector consumers are expressing the need for ways to support a cost effective model that can deliver better services for citizens, by integrating data from many agencies like veterans’ programs and child welfare. The current buyout by IBM is aimed at cashing-in on such demands from the healthcare and government clients. By leveraging Initiate’s technology expertise, IBM intends to expand its Cognos and InfoSphere software for integrating and assessing data, and its business analytics and optimization consulting organization’s offerings. ‘Big Blue’, on an acquisition spree, has made several similar investments to enhance its analytical capabilities. With a strategic intent to make use of the emerging scope in analytics and optimization, IBM launched its global Business Analytics and Optimization Consulting centers in 2009. The venture, which is included in a total investment of above $10 billion in acquisitions and organic growth, is supported by a team of 4,000 consultants and comprises of a network of analytics solution centers, operating from New York City, Washington D.C., London, Tokyo, and Beijing. Further building on its analytics strategy, IBM launched the Global Healthcare Centre of Excellence at La Gaude, France, in the same year, to enable its healthcare clients to design and develop life sciences and healthcare solutions for improving the delivery of care, preventing and predicting diseases, and enabling better health and wellness. The Center, with focus on healthcare analytics, EMR and EHRs, business intelligence, complex solutions design, unified communications and identity management, will provide proof of concept and prototype demonstrations, architecture consultancy, integration of partner solutions, and experiential demonstrations.

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April - June 2010

Oracle to Takeover Phase Forward Redwood City, CA-based Oracle Corporation has announced its intent to acquire Waltham, MA-based Phase Forward Incorporated, a publicly held company providing integrated data management solutions, for approximately $685 million ($17.00 per share). Expected to make the acquiree the foundation for the Health Sciences SaaSbased offerings, the current move is anticipated to provide Oracle with significant domain expertise, and facilitate accelerated SaaS solutions of Health Sciences. For Phase Forward, its R&D investments are to increase, as it would be able to benefit from Oracle’s anticipated R&D budget of $2.8 billion, after the closure of the agreement. Phase Forward will be joining Oracle Health Sciences, a global business unit catering to the healthcare, biotechnology, medical device, and pharmaceutical companies. In order to facilitate the acquisition, Pine Acquisition Corporation, a wholly-owned subsidiary of Oracle, was established. Once the agreement is fulfilled, the subsidiary will merge into Phase Forward. Subjected to stockholder and regulatory approval and other customary closing conditions, the deal is likely to complete in mid 2010. Until the close of transactions, both the companies will operate independently. Founded in 1997, Phase Forward offers a SaaS-based integrated clinical research suite (ICRS), including enterprise software products, hosted solutions, and services for clinical trial programs and drug safety monitoring activities. The software is said to be deployed in more than 10,000 clinical trials and employed by more than 300 life sciences companies, regulatory agencies, medical device companies, and public health organizations to speed up the advancements in the field of drug development and patient care delivery. The company reported GAAP revenues of $57.2 million for the first quarter of 2010. Phase Forward’s acquisition is thought to be consistent with Oracle’s stratagem to offer mission-critical applications to the key sectors. The current strategic move is said to demonstrate Oracle’s commitment to its delivery of open and integrated systems. Oracle Health Sciences, through its product portfolio, offers an end-to-end suite of software solutions for clinical development, clinical trial and data management, adverse event reporting, electronic data capture, risk management, and collection of clinical and non-clinical data for assessment, reporting, and submission. Some of the key products include Oracle Healthcare Transaction Base, Oracle Enterprise Healthcare Analytics, Oracle Clinical, Oracle Clinical Development Analytics, and Oracle Remote Data Capture.

The current acquisition is expected to result in a comprehensive applications portfolio of complementary resources, by integrating clinical development with clinical management, research discovery, manufacturing, sales, financials, and marketing applications. The agreement will enable Phase Forward clients to benefit from improved access and reach enabled via Oracle’s worldwide services and support organizations. Phase Forward’s offerings, combined with Oracle’s resources is expected to help Health Sciences clients, as well as researchers, physicians, clinical development professionals, patients, and regulators to • efficiently and securely capture, manage, aggregate, analyze, access, and share data • accelerate time to market drugs and innovative therapies • gain better insight into patient care outcomes • offer more options on SaaS-based or on-premise offerings • manage healthcare expenses Healthcare cost is a key aspect addressed by the life sciences and healthcare industries, while focusing on enhancing patient care and medical outcomes. Owing to the pressures from the economy and constant regulatory scrutiny pressing the need for increased investments in safety monitoring during and following market approval, health sciences organizations are looking out for various means through which they could contain costs. Paper-based processes and unstructured data captured are thought to impede quality care delivery at both the health science as well as healthcare organizations. Another challenge faced by the life science industry is the need to accelerate the introduction of an increasing number of viable devices and therapies to the market, while making sure of a targeted application. The need of the hour is a solution, based on standards, which will help the life science and healthcare industries attend to data access, cost, and quality issues, in order to deliver safe care to patients. Now with the current move converging life science and healthcare through a standards-based solution, which will integrate clinical information with care delivery data, the acquisition is expected to promote patient-centered innovation, support personalized medicine, and empower patients with active involvement in their care. Apart from this, with the synergy expected to enable organizations to efficiently use and reuse these two forms of data, it is anticipated that the acquisition will encourage value-based healthcare, thereby providing quality care delivery.

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MERGERS AND ACQUISITIONS

Oracle offers a range of integrated and open business software and hardware solutions to various sectors, including healthcare and life sciences, with over 370,000 customers in above 145 global countries. Another recent addition to the Health Sciences industry includes the acquisition of Relsys, focusing on risk management, drug safety, and analytics applications. The company’s healthcare offerings were further widened through the 2009 acquisition of California-based Sun Microsystems, a

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chief provider of service-oriented architecture (SOA) and network computing infrastructure for $7.4 billion. Sun’s resources have helped Oracle to help payers and providers form a unified network to interact and collaborate in a secure, seamless, and personalized environment. The company’s total GAAP revenue for the fiscal year 2010 was reported to be increased by 15% from the previous year to $26.8 billion.

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April - June 2010

PARTNERS AND ALLIANCES iSOFT to offer Global Support for Picis Solutions With intents to strengthen its position in the global acute care arena, Picis has signed a strategic partnership with iSOFT, through which the latter will offer implementation, distribution and global support for selected solutions of Picis CareSuite® family of high-acuity solutions across several international markets. Delivering information solutions to support the financial, clinical, and operational workflows, Wakefield, Massachusetts-based Picis directs its offerings to hospitals’ acute care sectors, such as the operating and recovery rooms, intensive care units, and the emergency departments. Through its CareSuite® family of solutions, the vendor has helped automate life-critical sections of the hospital; licensing systems for above 1,700 hospitals, across 19 countries. Basing the contract on the complementary product portfolios of both the vendors, the collaboration of the product suites is expected to create a comprehensive solution. The benefits of the integrated healthcare IT offering is said to be already experienced at two of England’s National Healthcare Service (NHS) trusts, Torbay Hospital and Frimley Park Hospital. The endeavor, which will facilitate hospitals with a common source of end-to-end health IT software, is slated to initially concentrate on delivering anesthesia and ICU solutions across United Kingdom, Australia, New Zealand, Scandinavia, and Ireland. Responding to the company’s expansion plans, Picis Co-founder and Executive Vice President of International Operations, Liz Popovich says that the partnership with iSOFT, one of the largest healthcare IT vendors with market presence across several countries, would provide Picis with new opportunities in the healthcare industry. She also believes that with iSOFT’s market strength complementing Picis’ core capabilities, the acute care IT provider will be able to realize significant growth in these markets.

iSOFT has a clientele of more than 13,000 healthcare providers distributed across more than 40 countries. iSOFT’s presence in UK, where it has its headquarters, has been significantly established through procurement reforms and contracts inked with about 60% of all NHS trusts. The company holds above 40% combined market share in UK and Ireland, with joint revenue amounting to $305.3 million for the entire year 2009. The vendor’s health IT products support more than 40 hospitals in New Zealand, its applications being employed in 18 of the country’s 21 district boards. In Australia, iSOFT products have been employed at over 550 hospitals, including state health departments, and area health services, such as Sydney West Area Health Service (SWAHS) and Hunter New England (consisting of 17 hospitals). Across the German market, the vendor has installed more than 1,000 hospital and medical information systems, and reported a double digit growth in 2009 full year revenues through new contracts. With intents to leverage iSOFT’s market presence in Germany, Massachusetts-based iMDsoft®, a clinical information systems (CIS) vendor, entered into a distribution agreement with iSOFT Health, a subsidiary of iSOFT Group, to distribute iMDsoft’s MetaVision® Suite, initially across the country. With the current Picis contract and the iMDsoft deal focusing on the critical care market, iSOFT’s strategic move in a span of one month will offer the opportunity for hospitals across these six countries to leverage acute care solutions from two of the industry’s leading vendors. The company’s geographic reach also extends to Europe, South East Asia, Africa, China, Middle East, and India. iSOFT, a subsidiary of IBA Health Group Limited, the largest health IT vendor listed on the Australian Securities Exchange, which is now known by the name iSOFT Group Limited, designs, creates and distributes health IT applications and platforms for clinical, connectivity, and administrative needs of healthcare facilities. For the fiscal year 2009, the company reported a 50% increase in revenues to $540.1 million.

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PARTNERS AND ALLIANCES

Cerner and CareFusion Collaborate for Better Medical Device and HIS Interoperability CareFusion Corporation and Cerner Corporation have extended their know-how and experience in delivering solutions for better interoperability through a contract aimed at integrating CareFusion’s hospital information system with the latter’s device connectivity architecture. This move is expected to help healthcare providers deliver better care through greater system interoperability.

reside in disparate systems, and are not interlinked to the patient’s EHR, requiring manual entry. This increases the chances of medical errors and inefficiencies in workflow. Connecting medical devices to the EHR is important for enabling interoperability across the enterprise. Empowered with ready-to-use data at hand, care givers can make better clinical decisions, further improving patient outcomes.

San Diego-based CareFusion Corporation, a medical device company, focuses on solutions related to hospital-acquired infections and medication errors in order to help improve care outcomes. Employing more than 15,000 staff in over 20 countries, the company makes available its two product portfolios, Medical Technologies and Critical Care Technologies and Services, across more than 120 countries. Some of the solutions offered by the company include Pulmonetic Systems™ and AVEA® for ventilation, MedMined™ for surveillance of infection, Alaris® for infusion, PleurX® and AVAmax® for interventional processes, and Pyxis® for supply and medication management.

The current alliance is expected to close the communication interface gap between devices and healthcare information systems, and in turn reduce the requirement of manual intervention, workflow duplication, risk of noncompliance with guidelines, and medical errors.

Under the current agreement, CareFusion will integrate its Pyxis medication supply, dispensing, and anesthesiology systems, with Cerner’s CareAware®, to facilitate data communication. According to the terms of the contract, the management of supply and medication, through this integration, will be extended to current and new clients of both the solutions. As an extension to the vendor’s strategy of closing the loop of medication management for reduced errors, Cerner will provide value added reseller services for the CareFusion Pyxis dispensing solutions; clients being selected from Cerner’s main electronic health record (EHR) installed base. The current alliance also plans on developing a Pyxis health IT adaptor, designed to help pharmacy, medication management, and perioperative clinical information to integrate with EHRs. Medical devices form the primary source of patient information at point-of-care, but this information often

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CareFusion’s CEO, David Schlotterbeck states that the convergence of healthcare information technology and devices will allow hospitals to bridge the gap between logistical and clinical processes in supply and medication management. Considering this approach critical to ensuring patient safety, Neal Patterson, Cerner’s co-founder, chairman and CEO, states that the ability to offer CareFusion’s market-leading technology could increase Cerner’s options for its clients. Cerner introduced the CareAware MDBus™ device connectivity architecture, an interoperable platform, to establish a standard for device interoperability, connectivity, and workflow transformation. The medical device connectivity solution was recently okayed by the U.S. Food and Drug Administration (FDA). Founded in 1979, Kansas City, MO-based Cerner Corporation helps optimize financial and clinical outcomes through its healthcare solutions. Situated across 14 countries, the vendor has licensed its solutions in 8,500 physician practices, ambulatory facilities, hospitals, retail pharmacies, and home health facilities. The vendor recently announced $404.9 million as its 1Q10 revenue, ending April 3, 2010; a 22% increase from the revenues reported during the same time of the previous year.

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April - June 2010

TELEHEALTH Bosch Healthcare Enters into Telehealth Initiative with CMO Palo Alto, CA-based Robert Bosch Healthcare, Inc. has joined forces with the Care Management Company (CMO) LLC, to introduce the Bosch Health Buddy® System at Montefiore Medical Center as a part of a telehealth project that will help monitor nearly 6,600 elderly and chronic care Medicare beneficiaries of Bronx. The initiative is supported by grants from the Centers for Medicare & Medicaid Services (CMS) under its Care Management for High-Cost Beneficiaries Demonstration (CMHCB), which is aimed at assessing various methods for enhancing care for patients who depend on extensive social and medical services.

development tools.

CMO, a part of the integrated delivery system, Montefiore Medical Center, provides various care management, and managed care services and programs to more than 100,000 patients. The Medical Center in turn caters to 2 million residents within the borough, as well as close by Westchester Counties, other parts of the nation, and across the globe. It delivers care through four acute care hospitals, above 20 ambulatory care settings, home health agency, and rehabilitation center.

Professing that the telehealth device has repeatedly demonstrated decreased hospitalization requirement unless absolutely necessary, and better connectivity between the patients and their caregivers, Derek Newell anticipates continued results with the Health Buddy System through the January 2009-announced 3-year expansion of CMS’s CMHCB demonstration to 2012. Also, advocating lowered costs in healthcare spending through the telehealth program was CMO’s Chief Operating Officer, Stephen Rosenthal, who believes that with the Health Buddy program supporting the CMO’s care management skills, Montefiore hospitals will be able to deliver enhanced quality of life and health for their elderly and chronic care patients.

The current roll-out of the program at the Medical Center has been undertaken following the success of the initial installations at Bend, OR and Wenatchee, WA. Following the deployment of the program at rural settings, Derek Newell, the vice president of Bosch Healthcare’s North American office, explains that the initial Health Buddy System rollouts have demonstrated the success of telehealth models in rural environments, and that with its implementation in Montefiore, the concept will now be tested in one of the nation’s most diverse urban settings. Forming an interface between the home-based patient and their healthcare provider, Bosch’s Health Buddy system will enable participants of the telehealth program to communicate historical patient information to their nurses and care managers on a daily basis, and reinforce positive behavior. Data collected about the patient’s health from the Health Buddy Appliance will be transferred to a Bosch data center for processing via Ethernet or a telephone line, which is then made available to the Medical Center’s care managers through the Health Buddy Desktop. The care managers risk-stratify the information to identify the beneficiaries requiring treatment intervention before their condition becomes critical. The system features health management programs for above 30 medical conditions, and supports secure clinical information databases, Internet-enabled decision support and customized content

By facilitating remote monitoring of the elderly and chronic patients, telemonitoring devices like this have the potential to lower the need for hospitalization, which further offers the prospective reduction in healthcare resource utilization and related costs. A 2005 randomized controlled study carried out by the Tufts-New England Medical Center, found that the Health Buddy System was capable of lowering re-hospitalization for heart failure by 72% and all cardiac-related hospital visits by 63%.

Health Buddy was included into the Bosch Group’s (parent company of Robert Bosch GmbH) healthcare product portfolio following the 2007 acquisition of Californiabased Health Hero Network, which focuses on the remote healthcare industry. CMO, the current Health Buddy client had previously contracted with Health Hero Network, in 2008, for its disease and care management programs, including the Montefiore Care Guidance Demonstration Project for New York. Protected by 57 US patents, the home health monitoring technology has been approved by the U.S. Food and Drug Administration (FDA). As an open system, Health Buddy is designed to be interoperable with many current systems, applications, devices, etc., deployed at healthcare organizations. Collaborating with various software Solution Partners, like application developers, content developers, and medical device manufacturers, Bosch aims to create new applications or transform the existing hardware and content solutions to be used along with its Health Buddy system. In

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TELEHEALTH

September 2009, the company was honored with the 2009 Frost & Sullivan Market Strategy Leadership Award for the remote monitoring system, based on significant market presence achieved in the North American market. Bosch has strong brand recognition in the market by associating with corporate partners and large public groups, as part of the companyâ&#x20AC;&#x2122;s marketing strategy. In order to compliment its emerging position in the North American telehealth market, and fortify its presence

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in other dynamic areas, globally, Bosch entered into an agreement to acquire the Virginia-based remote healthcare management technology vendor, Visual Telecommunication Network Inc. (ViTel Net), in 2009. With both CMO and Bosch encouraging the remote care delivery model, it is left to see how the current CMO-Bosch alliance will augment care of the elderly and chronically ill patients, and also influence the management of medical spending and care outcome.

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April - June 2010

VENDOR WATCH Wolters Kluwer Health Supports Evidence-based Care with Multiple ProVation® Order Set Deals The year has started off with a good note for Wolters Kluwer Health, with the information services company bagging several deals for deploying its products, especially its ProVation® Order Sets, at various healthcare organizations. The most recent implementation of its order set management solution is at High Point Regional Health System; selected to enable automation of the development, maintenance and deployment of order sets across its High Point Regional Medical Center. The North Carolina-based not-for-profit community health system offers its services through its 400-bed High Point Regional Medical Center, The Cancer Center, The Emergency Center, the Piedmont Joint Replacement Center, the Carolina Regional Heart Center, The Women’s Center, and The Neuroscience Center. The system also includes centers for rehab, curative wound care, diabetes self care, vascular care, sleep lab, behavioral health, as well as a regional health education center. With interests to uphold its mission of delivering quality care to its region of service, the Health System has selected Wolters order set solution for installation at its largest facility. ProVation Order Sets combines the award-winning technology platform designed for clinicians from ProVation® Medical, and evidence-based clinical content from UpToDate® Decision Support. UpToDate Decision covers 7,700 topics across 15 medical specialties, and includes a drug database, above 80,000 pages of text and graphics, 260,000 references, and links to Medline abstracts. The customizable solution equips caregivers with evidencebased and standardized clinical content by enabling creation and management of order sets, which can be integrated into everyday clinical operations. In addition, through its export capabilities and vendor-neutral mapping, the order sets solution is designed to seamlessly integrate with existing electronic medical records (EMR) or computerized physician order entry (CPOE) systems, regardless of the system’s vendor. Its order catalog, mapped to various standard terminologies and structured content, allows the integration of CPOE and EMR. The solution is expected to facilitate delivery of better care outcomes, patient safety, improved performance, while complying by regulatory specifications. A large part of planning treatment for a patient happens during the writing of orders. Order sets, treatment

templates used to create orders for patients, have been employed by hospitals to address the challenges faced in terms of medical errors, quality of care, and variations in healthcare processes across facilities. With a set of care processes predefined for the caregivers, order sets help incorporate various established guidelines into the regular workflow. Coordinating the operations of the entire care team, the order sets interact with the hospital’s various processes and supporting systems such as the approved abbreviations, medication policy manual, drug formulary, and means of following diagnostic procedures. Order sets can be further enriched by integrating best practices, evidence-based and electronic clinical knowledge support into them. The results of a recent study on an order set project (20082009), by Grey Bruce Health Network (GBHN), indicated improved ordering of more than 100 best practices in relation to investigations, medications, consults and treatments; the length of hospitalization reduced from 5.84 to 4.88 days with the use of order sets at 11 hospitals under GBHN; and readmissions reduced by nearly 50%. Additionally, the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, has attributed to order sets the advantage of reducing the time taken by clinicians to process ordering of the regular and guideline-governed medications and tests. AHRQ also found that order sets play a positive role in influencing the overall implementation of the CPOE. Wolters Health acquired ProVation Medical, Inc., a vendor providing solutions to streamline procedural documentation, and coding accuracy, in 2006; and UpToDate, in October 2008. ProVation Medical software has been termed #1 by KLAS in the Clinical Procedure Documentation Market Segment under 2009 Software & Professional Services. The UpToDate electronic clinical knowledge support system has been shown to enhance care outcomes and reduce length of stay (an average of 0.167 days per discharge) in US acute care hospitals, in a 2008 study. However, the study suggests the need for further clarification on its use as an indicator of enhanced performance, either as an independent cause, or in combination with other quality improvement factors. Leveraging the expertise of both offerings, Wolters introduced the ProVation® Order Sets,

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VENDOR WATCH

powered by UpToDate® Decision Support, at the 2009 Health Information and Management Systems Society (HIMSS) Annual Conference and Exhibition. The current deployment of ProVation® Order Sets, powered by UpToDate® Decision Support adds High Point Regional Health System to a list of more than 70 hospitals licensing Wolters’ order set solution. Other recent deployments of ProVation Order Sets solution in 2010 include Kendall Regional Medical Center in Miami, South Carolina’s Oconee Medical Center, West Georgia Health System (WGHS) of

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Georgia, Southeast Alabama Medical Center (SAMC), and Southwest Washington Medical Center. Wolters Kluwer Health, headquartered in Philadelphia, PA, forms a part of the global publishing and information services company, Wolters Kluwer. The company reported annual revenue for the Health division in the year 2008 to be €687 million (US $933 million), which accounted to 20% of the total revenue recorded by Wolters Kluwer. For the 2009 half year, ended June 30th, Wolters Kluwer Health posted revenues worth €365 million (US $496 million).

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April - June 2010

Intel Health Guide Enters UK Market with GE-Intel Alliance Expansion With intents to aid care providers in addressing the increase in chronic diseases and conditions associated with the aging population, GE Healthcare and Intel Corporation have entered into an agreement to expand the sales and marketing of the Intel® Health Guide to the United Kingdom. As a comprehensive remote patient monitoring (RPM) solution, the Intel Health Guide aids in the management of care for chronic conditions. The care management tool unifies the power of Intel Health Guide PHS6000, an in-home patient equipment, and Intel® Health Care Management Suite, a Web-based interface that facilitates monitoring and remote care management. The solution is equipped with patient reminders, vital signs collection capabilities, communication tools like alerts and video conferencing, and also allows self-monitoring of the health condition by patients. The U.S. Food and Drug Administration (FDA)approved solution was recognized by Frost & Sullivan with the 2009 North American Home Health Devices Product of the Year Award. Backing the home care service model, which enables care delivery for the elderly population in independent living and the management of chronic diseases by patients from home, Mariah Scott, Director of Sales and Marketing of the Intel Digital Health Group, states that the concept of technology-backed home care, is fundamental to the establishment of a cost-effective and personalized healthcare system. With GE Healthcare already involved in the marketing of the product in the United States, Intel hopes to leverage the vendor’s disease management expertise and distribution footprint across UK’s healthcare sector, to enhance the

understanding of the technology across the UK telehealth market. For GE, the agreement is expected to further extend its Home Health business, adding to its other ventures in patient monitoring and disease diagnosis, which are already established in the UK. The company has been involved in providing services to the National Health Service (NHS) and the nation’s private health sector for over 30 years. Additionally, the company hopes that the move will contribute to various pilot programs and policy development initiatives of NHS and the Department of Health, in the field of home care management. The announcement of the product’s release in UK has been preceded by many ongoing pilot programs to test the competence of the Health Guide in enhancing home healthcare management. The current alliance follows a $250 million investment across five years, made by both the companies in April 2009 for the research, development and distribution of home health technologies. The marketing of Intel’s Health Guide across the US, was included in the deal. Intel’s recognized expertise in technology development and ethnographic research, along with GE’s potency in global distribution of electronic medical records, critical care, healthcare IT, and passive monitoring, was viewed as a robust strategic fit for the alliance. The common vision of using technology for bringing about efficient home-based healthcare services for the elderly and patients suffering from chronic conditions has been depicted by the various efforts of both companies in delivering various products, initiatives and strategic moves

Strategic Moves in the Field of Home Care GE Healthcare • Acquired QuietCare®, a remote behavioral and passive activity monitoring system, from Living Independently Group, Inc. in December 2009 • Acquired VersaMed Corporation and Vital Signs Inc., both catering to the home care arena • Signed a $5.3 million, three-year contract for collaborative research program on home care, funded by the Hungarian Government

Intel Corporation • Established a $30 million Technology Research for Independent Living Centre through a contract with the Irish Development Agency • Developed the Telehealth Value Model, which acts as a framework to help detect and assess value generated by telecare and telehealth programs

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VENDOR WATCH

to support connected health in a broad perspective. According to the UK Department of Health, nearly 17.5 million adults and almost three-quarters of the population aged above 75 years in Great Britain could be inflicted with a chronic disease. Further, the department estimates that by 2030, the incidence will be two-fold in people above 65 years of age. The growing care requirements among

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the elderly population could be managed by extending the delivery of care from the healthcare facilities to the home, which could in turn open up potential opportunities in the home health monitoring and telehealth market. Based on the combined US and Europe estimates, Data Monitor anticipates the home health monitoring and telehealth market to soar from $3 billion in 2009 to approximately $7.7 billion by 2012.

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April - June 2010

LAN2LAN Bags Multi-year deal from Aneurin Bevan Health Board in Wales Surrey-based LAN2LAN, systems integrator providing networks for enterprises, has been chosen by the Aneurin Bevan Health Board to develop, deploy and maintain a wireless infrastructure for subsequent 3-5 years. The vendor, a Gold Partner of Trapeze Networks, holding Master Reseller status, will support the wireless infrastructure with its Trapeze 802.11n WiFi platform for Aneurin Bevan’s Clinical Futures program. Established in 2006 to reconfigure and remodel clinical services for the delivery of better healthcare across Gwent, Wales, the Clinical Futures Project is a part of the 2005 Designed for Life initiative, a 10-year strategy aimed at transforming healthcare in Wales through the intervention of the NHS. Clinical Futures was introduced with the objective to change the traditional approach of centering the healthcare delivery from District General Hospitals into a system capable of leveraging more comprehensive community and primary services out of hospitals, while creating a network of the local general hospitals, and supporting a critical care centre and a single specialist. With its wide range of routine services offering, such as consultations, inpatient care, tests, and rehabilitation operations, Clinical Futures augments Health, Social Care and Wellbeing Strategies made by local health boards and the Clinical Futures Strategy. The program is supported by the Torfaen, Wales-based Aneurin Bevan Health Board, which has replaced Gwent Healthcare NHS Trust, and local health boards of Torfaen, Monmouthshire, Caerphilly, Newport, and Blaenau Gwent. Established in October 2009, the Board caters to above 600,000 citizens of the Gwent area through 18 community hospitals and three acute hospitals, apart from various primary care facilities, local clinics, and specialist health centers. Their search for a wireless technology vendor, which could enable efficient coverage across the multi-location, multi-tenant setting, free from the restrictions of a conventional voice technology, ended with Health Board choosing LAN2LAN. After evaluating more than 20 other vendors, LAN2LAN was selected for its commitment in understanding the program’s business needs and offering an always-on, robust wireless solution that could meet NHS’ cost-saving and security particulars. Trapeze WiFi empowers applications with high bandwidth and services including accessing corporate resources, asset tracking, and delivery of content. Claiming 99% uptime, the wireless platform supports self-healing

on failure, and enables speeds and abilities that could challenge conventional cabled technology. The platform facilitates anytime-anywhere access and transmission of data-intensive services, such as picture archiving and communications (PACs) and wireless Voice-over-IP (VoIP). The official ratification of the 802.11n wireless standard by IEEE Standards Association (IEEE-SA), an international standards body, is expected to produce tenfold performance improvement for wireless networks. The Director of LAN2LAN, Gary Duke claims that another major advantage of employing wireless technology is cost, which is also a primary consideration of all NHS trusts. He continues to say that with an established wireless infrastructure, the Health Board will not require to invest in various mobile and fixed devices, and will also be able to lower the total number of mobile billing minutes by routing all calls from a landline. Established in 1994, LAN2LAN employs 50 staff and offers its networking expertise in the areas of infrastructure, security, collaboration and mobility to clients in healthcare, manufacturing, travel, law, consultancy, recruitment, financial services, and publishing sectors across UK. The vendor partners with IBM/Lotus, HP, RIM®, Cisco, Microsoft, TippingPoint, and Fortinet. For the current project, LAN2LAN agreed to comply by the N3 program as part of the competitive bidding process for the service level agreement. As stated by Head of Telecommunications for Aneurin Bevan Health Board, Andrew Evans, the compliance to N3 was essential as the national code of connection does not accept ad hoc connections. The N3 program, a component of the National Programme for IT (NPfIT) for enabling fast and secure broadband services to England and Wales’ NHS, will now enable LAN2LAN to leverage the Welsh public sector broadband access (PSBA) in order to remotely offer its support services to Gwent sites.

Healthcare Infrastructure Initiatives of Wales Created in 2004, to serve the overall requirements of public sector bodies on a national platform, the PSBA, leveraging the present information and communication technology (ICT) infrastructure, offers a platform for the convergence of high-speed connectivity demands across various sectors. NHS Digital All-Wales Network (DAWN), NHS Wales’ technology foundation for about 20 years, was replaced by the PSBA. As a single communication network, PSBA will provide services in data, voice, video conferencing, and other traffic. PSBA is one of the many projects undertaken

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April - June 2010

VENDOR WATCH »» Network Cabling and Building Infrastructure:

by the Welsh Assembly Government program, Informing Healthcare (IHC) to transform the care delivery process. The primary objective of IHC is to initiate new means of accessing, employing and storing data by using a single electronic health record (EHR) system. IHC’s National Architecture for NHS Wales forms a framework for the designing and creation of information systems in NHS Wales, and dictates how technology can be leveraged to support enhanced care and services. The recently published National Infrastructure Strategy for networking services in Wales specifies the requirement for a secure data network enabling access to information, augmented by an appropriate service quality in terms of speed, and availability, based on function and not just physical location. Some of the proposed steps for individual networking services include:

»» Wide Area Networking: migrate trusts to PSBA network, develop minimum standards for WAN connections to the NHS Wales Core network, upgrade WAN or implement optimization technologies

»» Local Area Networks and Wireless Local Area Networking: create standards and frameworks, assess gaps in standards, upgrade technology to comply by minimum standards, and contract for national licensing, support and maintenance of equipment

»» Mobile Network Connectivity: establish best practice guidelines and standards for the use of mobile technologies, and join forces with Welsh public sectors and Welsh Assembly Government while offering workers mobile connectivity

»» Internet Protocol (IP) Addressing: migrate to new IP addresses, consider consequences of migration to IP Version 6 and establish an installation plan

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prepare approved infrastructure standards such as national cabling standards for new buildings

»» Internet Domain Name Services and Internet Connectivity: enable high speed access to internet, and updated number of internet circuits and DMZ infrastructures

»» Network Time Services: research, procure and deploy options to provide a nationally hosted, highly available time synchronization service for NHS Wales facilities Apart from networking services, the strategy also focuses on other areas including storage, servers and hosting environments; monitoring, management and reporting; user access and application delivery devices; collaboration and messaging services; identity management and directory services. Initiated in 2003, Informing Healthcare is one of the primary enablers of Designed for Life, Wale’s national strategy for quality health social care delivery.

Roping Vendors to Reinforce Healthcare Initiatives In their attempt to support the various initiatives, apart from LAN2LAN, NHS Wales has recently contracted Capgemini, Millar Hutchison and PA Consulting Group, to provide architecture framework, software architectures, specifications, and HTML for the Informing Healthcare’s My Health Online patient portal. On a smaller scale, Cisco Systems Inc. was selected by The Princess of Wales Hospital, which comes under the Bro Morgannwg NHS Trust, for Cisco Wireless Local Area Network, in 2008. The deal further includes a larger technology improvement and information management strategy by the NHS Trust, whereby it would leverage Cisco’s wireless and fixed networking technology for 80 hospitals, general practitioner and community clinic settings, and serve as a platform for the deployment of additional services including voice over IP, and radio frequency identification (RFID).

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April - June 2010

ACS Inks $1.6 Billion Deal to Manage California MMIS The California Department of Health Care Services (DHCS) has roped in Affiliated Computer Services, Inc. (ACS), A Xerox Company, as a new claims processor, through a $1.6 billion Medicaid contract for ten years, under which ACS will manage the Medicaid Management Information System (MMIS) of California. By leveraging advancements in technology, proposed savings in administrative costs, and better public health program, the state hopes to allow more of its resources to be directed towards health coverage for the citizens of the state. Considered as one of the biggest and most complex Medicaid processing systems across the nation, the more than 30-year old California MMIS processes both Medicaid as well as non-Medicaid claims to providers under the Medi-Cal fee-for-service Medicaid program. Administered by DHCS, it is overseen by the Centers for Medicare & Medicaid Services (CMS). Keeping in pace with the increasing complexities of the Medi-Cal Program, a 2008 fiscal intermediary procurement request for proposal states that the main objective for CA-MMIS replacement is the increased costs and restrictions in time associated with continued maintenance and changes of the systems, and when they no longer meet the requirements of the Medi-Cal policy makers. The DHCS expressed its intent to leverage opportunity of procurement in order to deploy new MMIS technology with functionalities, enabling better management of the program as well as improved ROI for 15 years or more. The requirements specified by the proposal for a replacement system included: • Creation of an environment to allow business and IT integration for better management of the Medicaid program • Enable a scalable architecture to allow future growth with the changing program • Support health information exchange/health IT • Detection and prevention of fraud • Enable the alignment of the MMIS with service oriented architecture (SOA) and Medicaid Information Technology Architecture (MITA) guidelines, and compliance with the Health Information Portability and Accountability Act (HIPAA) • Facilitate quick and cost-effective implementation changes of policies and systems for the State and better electronic access for providers to submit and correct claims information, and collect billing and status data Following a bidding and evaluation process lasting for two years, ACS was chosen over the other bidding companies, including Electronic Data Systems (now HP

Enterprise Services following the acquisition) and Noridian Administrative Solutions, as the new contractor. According to the terms of the transaction, ACS will take over the operations from February 2011. Until this time, DHCS and HP, the current contractor, will continue to support the beneficiaries and providers. As the state’s fiscal intermediary, ACS will operate the current MMIS, while introducing enhancements to operate more efficiently and enable better control across California’s Medicaid program. The program will be later switched to the ACS Health Enterprise, a Web-based set of data analytics and applications, to support the Medicaid enterprise administration. The features inherent in the solution include • Aligns with the MITA, Medicare and other federal programs standards and SOA • Patient-centered view • Interoperable across programs • Aptly utilizes Commercial Off The Shelf (COTS) products • Allows quick and easy policy and program changes through interfaces, while not having to change the software • Technology aligns with current and future business requirements • Protects against fraud and abuse With the above mentioned features, the transition is expected to provide DHCS added flexibility for better serving and supporting beneficiaries and providers in the precise and quick claims payments. Apart from these, the contract also includes complete fiscal intermediary services from ACS, which would include provider and stakeholder training and relations, telephone service centers, security and privacy protections, beneficiary relationship services, and provider claims payment, to name a few. The current deal includes ACS as the prime contractor, with technology partners including CGI Group Inc and IBM. CGI, a business process service and IT vendor, is tasked with staffing the Enterprise Project Management Office and managing the Quality Management organization. Responsibilities also include managing the business change management services and automated business rules extraction that are relative to the transition of DHCS to the new MMIS. Organization testing will be controlled via CGI’s Sacramento-situated testing center. In addition, the vendor will implement and customize its Computer Assisted Collection System® for Government (CACS-G) solution so as to enhance third party collections. For these responsibilities, CGI’s share of the MMIS deal amounts to

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April - June 2010

VENDOR WATCH

$168 million for the 10-year time-frame. This collaboration is expected to allow more than seven million beneficiaries across more than 80,000 health care providers of California to avail health care services. Both companies, ACS and CGI, claim to have offered their solutions and services to Californian government agencies for over 25 years. Recently, ACS struck a deal with the Department of Health Care Finance (DHCF) for the implementation of a new MMIS at the District of Columbia.

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Under the companyâ&#x20AC;&#x2122;s state healthcare program administration offerings, ACS provides systems and corresponding services via integrated solutions ranging from child health programs and care management solutions to traditional Medicaid fiscal agent and pharmacy benefits management services. Considered the countryâ&#x20AC;&#x2122;s largest government program pharmacy benefits administrator, the vendor holds fiscal agent contracts in more than 12 states, processing about 571 million Medicaid healthcare claims every month.

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April - June 2010

GOVERNMENT HHS Announces Regional Extension Center for Utah and Nevada As a part of the American Recovery and Reinvestment Act of 2009 (ARRA) Health Information Technology (HIT) Extension Center program, the Department of Health and Human Services (HHS) and the Office of the National Coordinator (ONC) have selected HealthInsight™ as the REC for Utah and Nevada. Privately-held HealthInsight has been associated with Nevada and Utah, through the federal Medicare program for above 20 and 35 years, respectively. Being a Medicare Quality Improvement Organization (QIO), HealthInsight offers HIT consultation, quality assessment, and improvement services. The organization helps Medicare beneficiaries realize their healthcare rights and responsibilities, responds to their concerns on care quality, and encourages the enhancement and positive delivery of healthcare systems and payment redesign. The not-for-profit organization also assesses medical record cases to decide if the care services comply by professionally recognized care standards, and were medically essential and apt. As Nevada and Utah’s REC, HealthInsight, will aid the ONCdefined priority primary care providers in selecting and using EHRs through hands-on and one-on-one customized assistance. HealthInsight will primarily focus on primary care providers like family practices, federally qualified health centers, internal medicine, rural health clinics, OB/Gyn, pediatrics, and facilities providing services to underserved populations. HealthInsight will also provide support for providers and healthcare specialists not mentioned in the priority list. Commencing with the REC operations in the current month, HealthInsight has plans to work with 1,500 providers during the first year, and an additional 1,500 providers through the coming three years and later. More than 1,000 healthcare providers across the two states have already agreed to work with HealthInsight to meet the eligibility criteria for obtaining Medicaid/Medicare bonus payments from the federal government. According to the Nevada State Medical Association Executive Director, Larry Matheis, HealthInsight is well positioned to help physicians take decisions on novel technologies. Utah Medical Association’s CEO and Executive Vice President, Michelle McOmber strongly believes that the company’s establishment as a REC will bring more physicians online, and help the state to maintain and

enhance its leadership in healthcare quality.

Regional Extension Centers Authorized by the Public Health Service Act (PHSA) under the ARRA, the Extension Program aims at establishing approximately 70 (or more) Regional Extension Centers. The RECs will render direct, technical support, and information related to best practices, which can help care providers adopt and meaningfully use certified electronic health records (EHRs) for improved patient care outcome, while complying with patient data protection standards. The RECs will have to be affiliated with a US-based, not-forprofit organization or institution to receive allotted funds totaling $643 million, to be awarded on a rolling basis. The chosen RECs across specific regional areas will focus on delivering intensive technical assistance for • Clinicians, including physicians, nurse practitioners, and physician assistants, practicing particularly in solo and small group practices and employing less than 10 physicians with prescriptive privileges • Physicians providing primary care in critical access hospitals, public, and community health centers, mainly catering to the uninsured, underinsured, and medically underserved populations The RECs are anticipated to provide support and outreach services to at least 100,000 primary care providers over the first two years of the program. The extension program recently got a boost through grants of $375 million, announced by the HHS secretary, Kathleen Sebelius, and United States Secretary of Labor, Hilda Solis. The fund, a part of about $1 billion in Recovery Act awards, allotted to improve health IT adoption and its meaningful use, and train thousand of workers for jobs in healthcare and IT, will initially be distributed among 32 not-for-profit organizations for the development of RECs. Under this, HealthInsight, Utah-Nevada REC will get $6 million. The decisive factor for the federal financial support of a Regional Center will depend on its efficacy in helping providers to meaningfully use certified EHRs. Under the ARRA extension program, a panel of private professionals, not associated with the center under evaluation, will be selected by HHS to assess the performance of each REC once in two years. Future financial support for the RECs will be based on overall results of these assessments, and HHS’ decision that the federal support works in the best interest of the program.

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April - June 2010

GOVERNMENT

Proposed Rule for Defining Meaningful Use of EHR Technology The Office of the National Coordinator for Health Information Technology (ONC) and the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) have proposed two regulations that would help guide the government in awarding incentives for the meaningful use of certified EHRs under the American Recovery and Reinvestment Act of 2009. Open for public response, the regulations will be issued as a final rule in 2010 following refinement, after a comment period of 60 days. Following the enactment of the Act in February 2009, various bodies and work groups have been established to support the incentive program that is set to begin as early as October 2010 (for some eligible hospitals), and for some others in 2011. Initially created in 2004, ONC’s role was further expanded, following the Recovery Act, with the responsibility of allowing the adoption and meaningful use of health IT among care providers in agreement with CMS; encouraging the creation of regional extension centers for state-level technical support; and reinforcement of health IT workforce, through grant allotment, and others. CMS, on the other hand, was tasked with the implementation of the incentive programs and defining the meaningful use of EHRs; implementing specifications, establishing standards, and certifying EHR technology criteria; and ensuring privacy and security issues. Building on the HIT Policy Committee’s work on the matrices for defining ‘meaningful use’, and the input from various other stakeholders, CMS and ONC worked together in releasing the proposed rule so as to provide greater depth to the incentive program, and specifying the decisive factor for the allotment of the incentives.

CMS’ proposed rule: This outlines the projected provisions central to the Medicare and Medicaid incentive program, including payment procedures, as well as criteria required for meaningfully using EHR technology. Acting as a minimum standard for participation, the rule includes

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specific definitions for eligible hospitals and critical access facilities; and healthcare professionals participating in the Medicare Advantage and Medicare fee-for-service incentive plans. Taking into account many of the public and stakeholder inputs, following the release of the matrices, the incentive plan will be carried out through a 3-stage phased approach for meaningful use implementation. This would begin with criteria covering the present practice experience of providers and existing technological competence, which would expand into more stringent and extensive requirements. With Stage 1 beginning from 2011, Stage 2 and 3 are expected to be proposed by the end of 2011 and 2013, respectively.

ONC interim final regulation (IFR): This sets various standards for EHR certification and implementation, apart from preliminary standards for health information exchange, which are anticipated to improve the functionality, utility interoperability, and security of the technology. The IFR specifications are based on established standards, such as Integrating the Healthcare Enterprise (IHE), National Institute of Standards and Technology (NIST), and HL7; as well as nomenclature and classifications: ICD-9 and 10, RxNorm, X12, NCPDP, SNOMED CT, and LOINC. As a beacon to standardizing the exchange of health information through certified technology, the IFR includes standard terms to specify laboratory tests, clinical procedures, medications, allergies, and problems; and standard formats for prescriptions and clinical summaries. A separate Notice of Proposed Rulemaking (NPRM) will be rolled out for testing, and certifying modules and complete EHRs in 2010. The provisions of the Recovery Act are not only centered around information technology and its supporting systems, but also aims on enabling secure health information exchange to attain enhanced quality in care delivery by using the power of various resources and stakeholders inputs.

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New Bill to Improve Veterans’ Medical Data Accessibility Recognizing the cumbersomeness of healthcare information transfer process from military to civilian life, Congresswoman Niki Tsongas has introduced a new legislation, which would help veterans access their military records, service, and benefits data securely and electronically. Through the Improving Veterans’ Electronic Transition Services Act (iVETS Act), the Department of Defense (DoD) and the Department of Veterans Affairs (VA) would develop a Web-based portal to facilitate this capability. The portal will be based on the Defense Knowledge Online, a system that allows access to Official Military Personnel Files by all members in active duty until they become veterans. Almost 8 million veterans avail services and benefits offered by the VA. The transition from service member to veteran is considered to take a burdensome turn when they are unable to gain access to the Official Military Personnel Files, thereby limiting the care continuum. Apart from enabling access to healthcare data, the current bill will also allow veterans to interact with other veterans as well as caregivers, and form a platform through which they get updates from VA about new benefits or programs via email. The legislation also requires the Secretary of Defense and Secretary of Veterans Affairs to carry out a study and submit a report within 90 days of the enactment of the bill. Some of the factors to be assessed through the study include • Use of online portal knowledge as a basis to create a single sign-on portal for personal profiles, email, file sharing, etc. • Ability of veterans to access military files, including the Department of Defense’s form 214 • Ability of veterans to request for medical care and file for compensation; and track the status of these requests and filings

The iVETS Act follows other efforts made attempting to enhance the accessibility of veterans’ military records and also improve the interoperability between VA and DoD. The coming together of the two departments under the VA and DoD Health Resources Sharing and Emergency Operations Act, in 1982, is considered to be the first move made to improve the efficiency of the healthcare system. More recently, President Barack Obama introduced the Joint Virtual Lifetime Electronic Record, focusing on enhancing the delivery of care and services to transitioning veterans. This was a first step taken by both DoD and VA to define and create a system that would ensure the streamlined transfer of medical records between the departments. As a result, the Lifetime Record will aim towards including both administrative and clinical data from the time an individual enrolls into the military, throughout service, and even after the service member leaves. Following a hearing to assess the medical record interoperability between the two departments, the DoD/VA Interagency Program Office (IPO) was created later in 2009 as a mandate of the 2008 National Defense Authorization Act (NDAA). The IPO was established to form a single point of accountability for the rapid development and deployment of electronic health records, which enable complete interoperability of healthcare data between both the departments. Sharing the President’s commitment towards delivering quality care to veterans, both the organizations have invested heavily in including healthcare into their budget, with the DoD set to spend more than $47 billion in FY10, and the VA to invest for enhanced technology to provide benefits and services.

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April - June 2010

NEWS Axolotl Secures Public Sector HIE Deal

National Hospice Provider Selects MedAsset’s RCM Solution

Axolotl Corporation and Memorial Healthcare System of Florida have entered into an agreement, as a part of which, the former will deliver its Elysium® Exchange suite of solutions to help streamline the exchange of information among Memorial’s physicians.

MedAssets has been roped in through a multi-year contract by one of USA’s largest hospice care providers, Odyssey HealthCare, Inc., for its Web-enabled revenue cycle management (RCM) solutions. The deal was inked in the intent of enhancing the facility’s business office efficiency, cash flow, and ensuring reimbursement integrity.

Memorial Healthcare System, one of the largest public hospitals in the US, serves across Broward County through its network of facilities including Memorial Hospital West, Joe DiMaggio Children’s Hospital, Memorial Hospital Pembroke, Memorial Hospital Miramar, Memorial Manor, Memorial Regional Hospital, and Memorial Regional Hospital South. With the Elysium® solutions in place, Memorial Healthcare hopes to establish clinical interoperability with physician practices by allowing the hospital to network health data with electronic medical records (EMR) deployed at the disparate physician practices. This will empower physicians and medical staff with the ability to securely access and exchange clinical data among themselves. Axolotl’s President Glenn Keet hopes that with this implementation, the hospital will be able to also meet the ‘meaningful use’ criteria. Used by more than 25,000 physicians and 80,000 healthcare professionals, Elysium Exchange provides tools to electronically communicate and transfer radiology reports, laboratory results, sharing referrals, and other patient information between disparate EMRs. Through the Elysium Exchange solutions, Axolotl also supports over 200 hospitals, and 18 regional and 3 statewide HIEs. Bronx Regional Health Information Organization (BronxRHIO) is one of the recent clients to select the Elysium Exchange solution. Enhancing its HIE solution portfolio, the vendor recently announced the addition of Elysium Image Exchange, a medical image sharing technology from its partner, eHealth Global Technologies. Integrated with the Elysium® Exchange suite, the new solution is expected to help streamline image sharing between care facilities within a HIE organization.

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Dallas, TX-based Odyssey HealthCare has been delivering its services in hospice care since 1996, and operates under it 89 facilities in 30 states. MedAssets was selected in view of its flexibility to meet the efficiency needs of non-acute providers. Under the current deal, MedAssets will deploy solutions from its RCM product suite for the following functions: »» Claims management: MedAssets’ Xclaim will help improve patient accounting systems, automate payer claim reconciliation, manage payer communication, change all payer report into a standardized format, and electronically route payer rejects to biller. It will integrate operations scheduling abilities in order to transfer pending claims to respective departments for accountability and resolution.

»» Receivables management: Receivables Manager tool will enable the overall viewing of receivables, provide a graphical representation of key performance indicators (KPI) and data trends, indicate areas of progress for patient representatives, etc.

»» Denial management: MedAssets solution will help identify and address payer denials and challenging issues that influence the bottom line, so as to ensure that all due receivables are obtained from payers. According to Odyssey’s Senior Vice President and CFO, R Dirk Allison, with the MedAssets’ solutions provided to address the requirements of the organization’s unique business model needs, the hospice care provider anticipates better visibility of its revenue cycle functions. To address the revenue cycle management needs of care providers, like Odyssey, MedAssets also offers technology solutions in the areas of patient access management, revenue capture, revenue recovery, decision support and performance analytics, and charge integrity. The company claims that with its revenue cycle offerings, enabling on time and fair reimbursement of services, it could improve

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patient revenue by 1-3%. Recent contracts signed for MedAssets’ RCM solutions include BJC HealthCare, Hays Medical Center, and Wellmont Health System.

identifying alternative medication therapies that are equally effective.

»» Point-of-care intervention: Using mobile MedAssets supports more than 3,300 hospitals, 40,000 non-acute care providers, and 125 health systems in realizing improved financial strength by enhancing cash flow and operating margins, and meeting their supply chain management needs. The company recently announced fourth quarter 2009 total net revenue of $95.7 million, a 14.3% increase from $83.7 million reported in the same quarter of the previous year. The revenue earned from its RCM offerings was $56.49 million. This 14.1% growth from the previous year was primarily attributed to the increase in the implementation of transformational or comprehensive RCM solutions and services, and increased reimbursement technology demand.

Thomson Reuters Includes Pharmacy Intervention Solution to Clinical Decision Support Portfolio Thomson Reuters has unveiled Pharmacy Intervention solution designed to enhance workflow at hospital pharmacies. By leveraging the power of the Micromedex reference information, along with real-time clinical surveillance, and mobile accessibility to patient information, the new solution is expected to aid hospital pharmacists in averting adverse drug events, facilitate bed-side detection, execution and documentation of interventions, and lower medication expenses. The Pharmacy Intervention will be offered within Thomson’s clinical decision support offering, Clinical Xpert Suite™ of workflow solution. The solutions in the suite help enhance clinical workflow through clinical data collection from across an enterprise’s clinical information systems, to empower care providers with real-time patient information at the point-ofcare through smartphones, Web and mobile devices. The latest addition to the Clinical Xpert product portfolio allows »» Identification of patients at risk: Pharmacy Intervention equates clinical profiles with information collected from the various clinical systems to recognize patients on potentially lethal medication combination or dosage, which could pose the risk for an adverse drug event.

»» Pharmacy cost containment: The solution is believed to support hospitals in lowering expenses by

devices, pharmacists can avail benefits of point-ofcare interventions, which can be linked with the patient’s health record, and accessed any time by all authorized care providers.

»» Clinical decision support: Utilizing the Micromedex reference information, pre-built profiles of the solution enable caregivers to address narrow therapeutic indexing, antimicrobial, anticoagulation and glycemic monitoring, patient safety, and intravenous-to-oral conversion. Columbus Regional Hospital’s clinical pharmacy coordinator, Christine Soedel believes that Pharmacy Intervention, apart from enhancing the hospital’s pharmacist workflow, will help efficiently monitor patients’ medication requirements and improve patient safety. Built on the technology know-how from major vendors like Micromedex, PDR, Medstat, MercuryMD, and Solucient, Thomson’s Healthcare unit offers a host of decision support solutions designed for hospitals, health plans, clinicians, healthcare providers, pharmaceutical companies, government agency employers, and researchers. In the US itself, the company touches more than 150 million lives. To empower caregivers with direct mobile and Web access to Micromedex content, in 2009, the company introduced the clinical information system, Micromedex® 2.0. Employed at above 3,500 hospitals across 83 countries, Micromedex solutions support care providers with evidence-based reference data related to patient education, disease management, alternate medications, neonatal dosages, drugs, and toxicology. Thomson Reuter’s clinical decision offerings also include Order Set Solution, the Micromedex® Corporate Solutions suite, and the Micromedex Integrated Content.

ClinicTools Releases Integrated Electronic Management Record System Philadelphia-based ClinicTools, Inc. has announced the release of ClinicTools®, a Web-based integrated healthcare management system, for healthcare facilities and other providers. The application helps collect and develop patient health information (PHI) and process the data for treatment and payment purposes, at any place in real-time.

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NEWS

The system is designed to cater to the three major sectors of healthcare: medical centers/physician offices, mental health/behavioral health, and home health services. Initially developed as an electronic medical record platform, the HIPAA compliant ClinicTools comprises of a built-in appointment scheduling and reminder system, treatment platform, employee management system, billing system, and a communication medium for providers. Additionally, the tool helps the providers to • generate PHI for treatment initiation • track PHI modifications • allow generation and transfer of electronic prescriptions, doctor’s orders, and diagnostic test requests to pharmacies, diagnostic centers, laboratories and home health agencies • view patient’s x-ray images on laptop, PCs, or iPad • monitor employees’ productivity by generating files and supervising their activities, such as number of hours worked, from any place • provide documentation and ongoing training assistance to employees • keep the records at hand always • allow interactions and collaborations among healthcare providers • track and correct documentation errors at an early stage • bill for services offered wherever there is access to the Internet Despite extensive consensus on the promising benefits of digital health records and other health IT systems, many

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reports show slow adoption rates. Estimates of 67% of medical offices, comprising of four or more physicians not using EMR software, was reported by a 2009 research survey by SK&A Information Services, Inc. The low acceptance rate has been attributed to common barriers such as insufficient capital for purchase, maintenance costs, uncertainty about return on investment, physician resistance, and the unavailability of staff with enough experience in IT by a study published in a 2009 issue of The New England Journal of Medicine. However, as per a Congressional Budget Office’s (CBO) 2009 report, many believe that the current ARRA requirements are expected to drive the adoption of EMR solutions by physician practices and hospitals, across the hospital settings, enabling an increase from 12% to 90% by 2019, and 11% to 70%, respectively. Taking into consideration the budget restraints of the healthcare organizations, the vendors would have to face the demands of the providers expecting easy-to-use and cost-effective solutions, while also ensuring compliance with the meaningful use criteria mentioned by ARRA. Estimating the 2009 EMR market to be $13.8 billion, a 2010 report by research publisher, Kalorama Information states that, despite many IT giants ruling the healthcare IT market, no one vendor holds at least one fifth of the overall physician EMR market. Bruce Carlson, Publisher, Kalorama Information states that with no company having closed the deal with regard to physician mindshare, the market still holds opportunities for vendors thinking of entering the system with an enhanced product.

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EVENT LISTING Alexandria-Frost & Sullivan 2010 India Excellence in Healthcare Awards Organizer: Frost & Sullivan and Alexandria Real Estate Equities, Inc. Date: September 23, 2010 Location: Mumbai, India Link: http://www.frost.com/prod/servlet/summits-details.pag?eventid=201921815

82nd AHIMA Convention & Exhibit Organizer: American Health Information Management Association Date: September 25-30, 2010 Location: Orlando Link: http://www.ahima.org/events/convention/

HIMSS Europe Health IT Leadership Summit Organizer: Healthcare Information and Management Systems Society (HIMSS) Date: September 29 - October 1, 2010 Location: Rome, Italy Link: http://hitleadershipsummit.eu

2010 Connected Health Symposium Organizer: Center for Connected Health Date: October 21-22, 2010 Location: Boston, MA Link: http://www.connected-health.org/events/symposium-2010.aspx

HIMSS Asia’10 Health IT Congress & Leadership Summit Organizer: Healthcare Information and Management Systems Society (HIMSS) Date: October 26-29, 2010 Location: Daegu, Korea Link: http://himssasiapac.org/asia10korea/

2nd Annual Electronic Health Records Forum Organizer: The Center for Business Intelligence Date: November 2-3, 2010 Location: Kansas City, MO Link: http://www.cbinet.com/show_conference.cfm?confCode=FC10067

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EVENT LISTING

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Fall Health IT Summit Organizer: Institute for Health Technology Transformation Date: November 3-4, 2010 Location: Beverly Hills, CA Link: http://www.ihealthtran.com/fallccs.html

Global Healthcare IT News, Research and Intelligence

HIMSS Middle East Health IT Leadership Summit Organizer: Healthcare Information and Management Systems Society (HIMSS) Date: November 7-10, 2010 Location: Dubai, UAE Link: http://www.himssme.org/10/education/summit.aspx

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